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Nurs G140 Exam 2 (MS) > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is the definition of HF? What is the body unable to do?

A
  • inadequate pumping and/or filling of the heart

- It is unable to provide O2 to meet the O2 needs of the body

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2
Q

Which population is HF mostly seen in?

A

older adults

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3
Q

HF is the most common reason for admission of individuals in people aged _____ or older.

A

65 or older

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4
Q

HF can be ___ or ___. Caused by MI or progressive changes over time.

A

acute or chronic.

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5
Q

Heart failure results in decreased ___ ____.

A

cardiac output

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6
Q

What are the four parts of the compensatory mechanism of HF?

A

`-sympathetic nervous system activation

  • neurohormonal response
  • dilation
  • hypertrophy
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7
Q

Sympathetic nervous system activation (when is it triggered, is it effective? What is increased? s/s of what is increased?)

A
  • first triggered, least effective

- SNS increased –>increased HR, increased myocardial contractility, and peripheral vasoconstriction.

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8
Q

Neurohormonal response (With decreased ____, ___ released ____, resulting in ____ and _____. low ____, decreased _____ _____, ____ is released increased _____ ____ in _____. Blood volume _____ in a pt who is already in volume overload)

A
  • With decreased CO, kidneys release renin resulting in Na/H2O retention, peripheral vasoconstriction
  • low CO, decreased brain perfusion, ADH is released increasing H2O absorption in kidneys. blood volume increases. in pt who is already in volume overload
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9
Q

dilation of _____ causing _____ ____ to stretch. Eventually _____ will ____ and will not be effective.

A
  • of the heart chambers, muscle fibers stretch

- eventually fibers will overstretch and will not be effective

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10
Q

hypertrophy –> increase muscle mass of the heart making it ____. Initially its good, but overtime becomes ___.

A
  • increase muscle mass of the heart - thicker

- Initially good but overtime becomes poor

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11
Q

Heart failure exacerbation causes the release of (5)

A
  • ANP (atrial natriuretic peptide)
  • BNP (B-type natriuretic peptide)
  • Pro-B-type natriuretic peptide (NT-peroBNP: precursor BNP)
  • promote vasodilation and diuresis
  • not strong enough to overcome HF pathophysiology effects
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12
Q

Risk factors of HF (9)

A
  • age > 70 years old
  • HTN
  • atrial fibrilation
  • atherosclerosis of coronary arteries (CAD)
  • cardiac valve disorder
  • diabetes (tissue damage)
  • renal disease (volume overload)
  • Hx of cardiomyopathy
  • MI: Hx of cardiac muscle necrosis, loss of contractility
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13
Q

Primary causes of HF (4)

A
  • CAD
  • HTN
  • underlying heart disease
  • hyperthyroidism
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14
Q

Precipitating causes (8) (cause increased workload on the ventricles)

A
  • anemia
  • Infection
  • thryotoxicosis
  • hypothyroidism
  • dysrhythmias
  • pulmonary embolism
  • hypervolemia
  • bacterial endocarditis
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15
Q

What is the normal percentage for ejection fraction?

A

55-65%

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16
Q

What is the low function percentage of ejection fraction?

A

40-55%

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17
Q

What is the percentage for possible HF for ejection fraction?

A

<40%

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18
Q

Systolic failure mean the heart muscle is ____.

A

weak

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19
Q

Diastolic failure mean the heart muscle is ___.

A

stiff

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20
Q

How does systolic failure develop? What happens in the heart? What happens over time?

A
  • it develops when the heart is unable to pump blood effectively
  • In the heart the LV cannot generate enough pressure to eject blood into the aorta
  • overtime there is LV hypertrophy
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21
Q

What is the hallmark sign of systolic failure?

A

decreased EF

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22
Q

What are the causes of systolic failure? (4)

A
  • impaired contractile function- MI
  • Increased after load- HTN
  • cardiomyopathy
  • mechanical. issues- valves
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23
Q

What happens during diastolic failure?

A
  • ventricles unable to relax and fill during diastole

- decrease filling- leads to decrease SV and CO

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24
Q

What is diastolic failure characterized by? (2)

A
  • EF remains normal
  • charcterized by high filling pressures due to stiff ventricles- results in venous engorgement in the pulmonary and systemic vascular systems
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25
Q

What happens to result in LV hypertrophy? (disease processes [4])

A
  • HTN (most common)
  • MI
  • Valve disease
  • cardiomyopathy
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26
Q

What is mixed heart failure defined as?

A

-poor systolic function complicated by dilated LV walls that are unable to relax

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27
Q

What is the s/s of mixed HF? (6)

A
  • extremely low EF
  • high pulmonary pressures
  • biventricular failure
  • low CO and BP
  • poor renal perfusion
  • poor exercise tolerance dysrhythmias
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28
Q

S/S left sided HF (8)

A
  • paroxysmal nocturnal dyspnea (resp. distress that awakens people from sleep)
  • pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnea)
  • restlessness
  • confusion
  • tachycardia
  • exertional dyspnea
  • fatigue
  • cyanosis
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29
Q

what is pulmonary congestion (LV dysfunction prevents ____ from moving ____)? What does it do (increased ____ pressure causing fluid leakage into ____)?

A
  • LV dysfunction prevents blood from moving forward

- Increases pulmonary pressure-fluid leakage in alveoli

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30
Q

s/s right sided HF (9)

A
  • fatigue
  • peripheral venous pressure
  • ascites
  • enlarged liver and spleen
  • may be secondary to chronic pulmonary problems
  • distended jugular veins
  • anorexia - complaints of GI distress
  • weight gain
  • dependent edema
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31
Q

What causes peripheral tissue edema and viscera congestion (right sided HF)

A
  • RV not contracting efficiently

- blood backs up into the RA and venous circulation

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32
Q

stage 1 HF

A
  • no limitation of physical activity

- ordinary activity does not cause undue fatigue

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33
Q

s/s stage 2 HF

A
  • slight limitation of physical activity

- comfortable at rest, but physical activity causes fatigue

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34
Q

s/s stage 3 HF

A
  • marked limitation of physical activity

- comfortable at rest, but less than ordinary activity causes fatigue

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35
Q

s/s stage 4 HF

A
  • unable to carry out any physical activity without discomfort
  • symptoms of cardiac insufficiency at rest
  • If any physical activity is undertaken, discomfort is decreased
36
Q

clinical manifestations of HF (congestion) (12)

A
  • dyspnea
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • cough
  • pulmonary. crackles that do not clear with cough
  • weight gain
  • dependent edema
  • abdominal bloating/discomfort
  • ascites
  • jugular vein distention
  • sleep disturbance
  • fatigue
37
Q

Clinical manifestations of HF (poor perfusion/low CO) (9)

  • decreased ____tolerance
  • muscle ____ or _____
  • anorexia or ____
  • unexplained ____ ____
  • lightheadedness or ___
  • unexplained _____ or ____
  • resting ____
  • daytime _____
  • cool or vasoconstricted extremities
A
  • decreased exercise tolerance
  • muscle wasting or weakness
  • anorexia or nausea
  • unexplained weight loss
  • lightheadedness or dizziness
  • unexplained confusion or ALOC
  • resting tachycardia
  • daytime oliguria
  • cool or vasoconstricted extremities
38
Q

FACES

A
  • Fatigue
  • Activities limited
  • Chest Congestion
  • Edema or ankle swelling
  • Shortness of breath.
39
Q

HF assessment and diagnosis (s/s of, diagnostic tests, labs, lab values)

A
  • S/S of pulmonary and peripheral edema
  • ECG and CXR
  • echocardiogram with EF; structural abnormalities, valve malfunction
  • BNP (usually <99) and troponin (protein released after MI)
40
Q

What does BNP show?

A
  • differentiates cardiac from pulmonary cause of dyspnea
  • > 500pg/mL. likely due to HF
  • not diagnostic –> be prepared for CXR, ECG, and echo.
41
Q

HF diagnostic labs

A
  • HgB (for possible anemia)
  • thyroid function labs: factor in worsening HF
  • troponin
  • renal function
  • electrolytes if fluid imbalance
42
Q

Collaborative management for HF goal

A

-relive symptoms and improve functional status, quality of life

43
Q

Collaborative management for HF (3)

A
  • reduce preload (volume) and after load (pressure)
  • delay progression and extend survival and life expectancy
  • promotion of lifestyle that promotes cardiac health: patient education
44
Q

For HF exacerbation start with: (6)

A
  • maintain O2 sats
  • cardiac monitor, IV access, VS
  • seated posture
  • diuretic and vasodilator
  • monitor UO, electrolytes, renal fxn
  • sodium and fluid restriction PRN
45
Q

HF Medications

A
  • diuretics
  • vasodilators
  • beta blockers
  • ACE inhibitors
46
Q

What do diuretics do in the case of HF? (5)

A
  • reduce preload
  • decrease Na absorption- Na and fluid loss
  • decrease intravascular volume and preload on the heart
  • allows LV to contract more efficiently
  • loop diuretics can be administered IVP
47
Q

What do vasodilators do in the case of HF? Examples too

A
  • hydralazine, nitrates
  • reduces circulating blood volume, improves coronary artery circulation
  • reduces preload, increases myocardial O2 supply
48
Q

What do beta blockers do in the case of HF?

A
  • affects ventricular rate and afterload
  • decreases afterload
  • Inhibits SNS
49
Q

What do ACE inhibitors do in the case of HF? (2)

A
  • block the RAAS system allowing for vasodilation (increasing CO improving tissue perfusion)
  • decrease ventricular remodeling by inhibiting ventricular hypertrophy
50
Q

Side effects of ACE inhibitors (5)

A
  • hypotension
  • hacking cough
  • hyperkalemia
  • angioedema
  • renal insufficiency
51
Q

Systolic HF treatment

A
  • diuretics (loop)
  • ACEI/ARB
  • Beta blockers
  • MRA (spironolactone)
52
Q

Diastolic. HF Treatment

empirical treatment based on ____ and ____

  • relieve ____ with ____
  • control ventricular rate: ____, ____, ivabradine, amiodarone (not ____ ____ med)
A
  • empirical treatment based on symptoms and comorbidities
  • relieve congestion with diuretics
  • control ventricular rate: BB, digitalis, ivabradine, amiodarone (not first line med)
53
Q

Digitalis toxicity s/s (4)

A
  • anorexia, N/V
  • visual distrurbances
  • confusion
  • bradycardia
54
Q

What to monitor when someone is on digitalis

A
  • serum digitalis and serum K (hypokalemia)
  • muscle weakness
  • bradycardia
55
Q

other meds (4) and treatment (1) for HF

A
  • antiocoagulants
  • antiarrhythmics
  • evaluation for implantable cardioverter defibrillator or pacemaker
  • statins
  • K-binders for hyperkalemia
56
Q

Why are anticoagulants used in HF?

A

there is a risk for intracardiac and peripheral clots

57
Q

Why are antiarrhythmics used in HF? and ex?

A

ventricular control (amiodarone)

58
Q

Why are statins used in HF?

A

decrease serum lipids

59
Q

Example of K-binder

A

kayexelate

60
Q

Which drug do people w/ HF need to avoid?

A

NSAIDs

61
Q

Why do people w/ HF need to avoid NSAIDs? (5)

A
  • Na Retention: decrease efficacy of diuretics and ACEIs
  • decrease in K excretion through kidneys
  • peripheral vasoconstriction
  • cause decreased renal perfusion in adults
  • FDA warning: increase in MI and stroke for HF patients
62
Q

Treatment for HF (6)

  • avoid ____ fluid intake
  • O2 , cardiac revascularization, cardiac resynchronization
  • ultrafiltration (process to remove excess salt), cardiac transplantation
  • low ____diet: decreased blood volume; culture and preferences
  • teach patients about time it takes to get used to a lower salt diet (up to ____months)
  • ____ for patients with HF and obstructive sleep apnea
A
  • avoid excess fluid intake
  • O2 , cardiac revascularization, cardiac resynchronization
  • ultrafiltration (process to remove excess salt), cardiac transplantation
  • low sodium diet: decreased blood volume; culture and preferences
  • teach patients about time it takes to get used to a lower salt diet (up to 3 months)
  • CPAP for patients with HF and obstructive sleep apnea
63
Q

HF Gero Considerations (3)

A
  • atypical symptoms: fatigue,. weakness, somnolence
  • decreased renal function: resistance to diuretics
  • monitor for bladder distention (enlarged prostate), frequency, urgency
64
Q

HF nursing process: Assessments

A
  • symptoms, Hx (S3, JVD, pulmonary/peripheral congestion, pulses, edema, HR, I/O, oliguria, anuria, weight
  • significant weight change (2 lb/day or 5lb/week) NOTIFY PROVIDER
65
Q

HF nursing process: Goals

A
  • related to diagnosis, relief of symptoms, take meds as prescribed, improved function, extended survival
  • report sudden weight gain, increased fatigue
  • verbalize knowledge, decisions
  • patient and family education (HUGE)
66
Q

HF nursing process: interventions (3)

  • promoting ____ tolerance, supplemental ____ ____, manage ____ volume
  • promote effective management of therapeutic regimen
  • monitoring/managing potential complications
A
  • promoting activity tolerance, supplemental O2 PRN, manage fluid volume
  • promote effective management of therapeutic regimen
  • monitoring/managing potential complications
67
Q

HF: patient and family education (9)

A
  • balance exercise and energy conservation: cardiac rehab
  • monitor and prevent FVO: reduced salt diet, fluid restriction
  • Flu and PNA vaccines: PNA can worsen signs of HF, want to decrease respiratory symptoms
  • control anxiety
  • promote social integration
  • medication education: how to take meds, signs of toxicity
  • how to take BP and pulse
  • when to hold med, when to call provider (ex:sudden weight gain)
  • s/s of ADHF (Acute decompensated heart failure): call provider/911 –> dyspnea, leg or feet swelling, fatigue
68
Q

Joint commission core measures: HF (admission)

A
  • smoking cessation counseling to patient with hx of smoking anytime during the last year
  • evaluation of EF
69
Q

Joint commission core measure: discharge

A
  • ACEI or ARB for EF <40%

- discharge instructions: activity level, diet, daily weight monitoring, what to do if symptoms worsen

70
Q

HF Eval (5)

A
  • demonstrates tolerance for desired activity
  • maintains fluid balance
  • decreased anxiety
  • makes sound decisions regarding care and treatment
  • patients and family members adhere to therapeutic regimens
71
Q

Complications of HF

A
  • pleural effusion
  • dysrhythmias
  • LV thrombus
  • hepatomegaly
  • renal failure
72
Q

What is pleural effusion?

A

increase pressure in pleural capillaries caused by excess fluid in the pleural cavity

73
Q

Dysrthymias in HF (_____of heart chambers cause changes in ____ _____ _____. _____ fire spontaneously and rapid risk for thrombus formation which causes a risk for ____.)

A
  • enlargment of heart chambers cause changes in normal electrical pathways
  • afib-fire spontaneously and rapid-risk for thrombus formation-risk. for CVA
74
Q

LV Thrombus in HF (due to, risk for)

A
  • due to enlarged LV and decrease CO

- risk for CVA

75
Q

Hepatomegaly in HF (liver congested with ____ ____. Eventually liver cells die, ___ occurs and ____ develops)

A
  • liver congested with venous blood

- eventually liver cells die, fibrosis occurs, and cirrhosis develops

76
Q

Renal failure in HF

A

due to decreased perfusion

77
Q

thromboembolism in HF –> HF pts at risk for (arterial) and (venous)

A
  • HF patients at risk for arterial thromboembolism: Stroke, MI, PE, AFIB
  • Venous thromboembolism: decreased mobility, venous stasis, (DVT may lead to PE)
78
Q

Pulmonary embolism s/s

A

-dyspnea, chest pain, tachypnea, cough, hemoptysis, tachycardia, hypotension

79
Q

Diagnosis for pulmonary embolism

A
  • CXR
  • V/G lung scan
  • CT scan
  • angiogram

-D-dimer: Rule out PE or DVT, diagnosis of DIC (disseminated intravascular coagulation)

80
Q

pulmonary embolism treatment

A
  • thrombolytic therapy for emboli with hypoxia, hypotension and shock
  • heparin, Lovenox, fondaparinux
  • long term warfarin (6 months)
81
Q

Prevention of pulmonary embolism

A

-pharmacological preferred, mechanical acceptable for patients who cannot tolerate anticoagulants

82
Q

What is HF?

A

the inability of ventricles to fill with blood or eject blood

83
Q

Two main signs of HF

A
  • fluid overload

- Inadequate tissue perfusion

84
Q

What is the main complication of HF? S/S?

A

Acute decompensated heart failure –> severe respiratory distress and poor systemic perfusion - cold extremities and low O2 sat

85
Q

Abbreviation for diastolic HF

A

HfpEf (heart failure with preserved ef)

86
Q

Abbreviation for systolic HF

A

HfrEf (heart failure with reduced ef)

87
Q

Beta Blocker pt ed

A
  • early phase –> may worsen
  • Improvement may take 2-4 weeks
  • may need dosage adjustment in 2-4 weeks

Nurs G140 Exam 2 (MS) (6 decks)

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