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Nursing 202 - Midterm > Heart Failure > Flashcards

Heart Failure Flashcards

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1
Q

Drugs that improve contractility (positive inotropes)

A

Epi, NorEpi, isoproterenol, dopamine, dobutamine, digitalis-like drugs, calcium, milrinone

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2
Q

Drugs that decrease contractility (negative inotropes)

A

CCBs, B-blockers

Acidosis acts like a negative inotrope

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3
Q

Preload

A

Amount of stretch @ the end of diastole

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4
Q

Afterload

A

The amount of resistance the heart must overcome to open the aortic valve & push the blood volume out into systemic circulation

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5
Q

Ejection fraction

A

The amount of blood pumped by the L ventricle w/each heart beat

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6
Q

How is EF calculated?

A

Subtracting the amount of blood present in L ventricle @ the end of systole from the amount present @ the end of diastole & calculating % of blood that is ejected

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7
Q

Difference b/t systolic and diastolic dysfunction

A
  • Systolic dysfunction = L ventricle becomes weak/flabby, not able to contract forcefully/loses ability to eject blood; HF w/reduced EF
  • Diastolic dysfunction = L ventricle stiffens/bulks up, can contract, but no relax afterwards —> decreased filling; HF w/preserved EF
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8
Q

L-sided HF S/S

A
  • Pulmonary congestion, crackles
  • S3 (“ventricular gallop”)
  • Dyspnea on exertion
  • Low O2 sat
  • Dry, nonproductive cough initially
  • Oliguria
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9
Q

R-sided HF S/S

A
  • Viscera & peripheral congestion
  • JVD
  • Dependent edema
  • Hepatomegaly
  • Ascites
  • Weight gain
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10
Q

S/S of pulmonary edema

A

Restlessness, anxiety, dyspnea, cool/clammy skin, cyanosis, weak/rapid pulse, cough, lung congestion (moist, noisy respirations), increased sputum (frothy, blood tinged), decreased LOC

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11
Q

What can manifest as pulmonary edema?

A

Acute decompensated HF (ADHF)

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12
Q

Pulmonary edema

Management

A
  • Early recognition: monitor lung sounds & for S/S of decreased activity tolerance, increased fluid retention
  • Minimize exertion
  • Oxygen via nonrebreather
  • Meds: furosemide, nitroglycerin
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13
Q

Pulmonary edema

Nursing interventions

A
  • Position pt upright w/legs dangling (best position for circulation)
  • Monitor response to RX and I&O
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14
Q

What is the hallmark sign of systolic failure?

A

Decreased EF

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15
Q

How is diastolic dysfunction confirmed?

A

Echocardiogram, cardiac cath

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16
Q

Causes of R-sided HF

A
  • Primary = L sided HF
  • R ventricular infarction
  • PE
  • Cor pulmonale (RV dilation & hypertrophy S/T pulmonary disease)
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17
Q

What kind of dysrhythmias are HF patients @ risk for?

A

Ventricular dysrhythmias, atrial fib

18
Q

What are the main compensatory mechanisms to maintain adequate CO?

A
  • Neurohormonal: RAAS & SNS
  • Ventricular dilation
  • Ventricular hypertrophy
19
Q

What affect to catecholamines have on cardiac fxn?

A
  • Increased HR
  • Increased myocardial contractility
  • Enhanced peripheral vasoconstriction
20
Q

What does ventricular remodeling occur in response to?

A

Continuous activation of neuro-hormonal responses (RAAS, SNS)

21
Q

What happens in ventricular remodeling?

A

Ventricles get large, but less effective in pumping

22
Q

Consequences of ventricular remodeling

A

Life-threatening dysrhythmias, sudden cardiac death

23
Q

Drugs to prevent/reverse remodeling

A

ACEs, b-blockers, aldosterone antagonists

24
Q

When are ANP and BNP released?

A

Released from overdistended cardiac chambers in response to increased blood vol in heart

25
Q

What are the effects of ANP and BNP?

A
  • Causes diuresis, vasodilation, and lowered BP

- Counteracts effects of SNS and RAAS in pts w/HF

26
Q

Diagnostic tests for HF

A

Echocardiogram, ECG, CXR, 6-min walk test, cardiopulmonary exercise stress test, heart cath, endomyocardial biopsy

27
Q

Labs for HF in initial assessment

A

Lytes, BUN, creatinine, LFTs, TSH, CBC, BNP, routine UA

28
Q

Which lab study is used to determine degree of HF?

A

BNP

29
Q

Other causes of increased BNP

A

PE, renal failure, ACS

30
Q

HF medications

ACEs

A

Vasodilation, diuresis, decreased afterload

Monitor for hypotension, hyperkalemia, altered renal function, cough

31
Q

HF medications

ARBs

A

Alternative to ACE’s (if pt unable to tolerate)

32
Q

HF medications

Hydralazine and isosorbide

A

Alternatives to ACEs

33
Q

HF medications

B-blockers

A

RX’d in addition to ACEs

May take several weeks for effects to be seen; use w/caution in pts w/asthma

34
Q

HF meds

Diuretics

A

Decrease fluid vol

Monitor lytes

35
Q

HF medications

Digitalis

A

Improves contractility

Monitor for toxicity

36
Q

HF medications

ADHF - IV meds

A

Milrinone (decreases preload & afterload —> hypotension, increased risk of dysrhythmias)

Dobutamine (L ventricular dysfunction, increases contractility & renal perfusion)

37
Q

Gerontological considerations

A
  • May present w/atypical S/S - fatigue, weakness, somnolence
  • Admin of diuretics to older men —> bladder distention S/T urethral obstruction from enlarged prostate (close monitoring)
38
Q

What are possible complications of HF?

A

Hypotension, poor perfusion, cardiogenic shock
Dysrhythmias
Thromboembolism
Pericardial effusion and cardiac tamponade

39
Q

Cardinal signs of cardiac tamponade

A

Falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds

40
Q

Pericardiotomy

A

Under general anesthesia, a portion of the pericardium is excised to permit the exudative pericardial fluid to drain into the lymphatic system

Nursing 202 - Midterm (12 decks)

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