Heart Failure Flashcards
What is the definition of HF? What is the body unable to do?
- inadequate pumping and/or filling of the heart
- It is unable to provide O2 to meet the O2 needs of the body
Which population is HF mostly seen in?
older adults
HF is the most common reason for admission of individuals in people aged _____ or older.
65 or older
HF can be ___ or ___. Caused by MI or progressive changes over time.
acute or chronic.
Heart failure results in decreased ___ ____.
cardiac output
What are the four parts of the compensatory mechanism of HF?
`-sympathetic nervous system activation
- neurohormonal response
- dilation
- hypertrophy
Sympathetic nervous system activation (when is it triggered, is it effective? What is increased? s/s of what is increased?)
- first triggered, least effective
- SNS increased –>increased HR, increased myocardial contractility, and peripheral vasoconstriction.
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)
- 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
dilation of _____ causing _____ ____ to stretch. Eventually _____ will ____ and will not be effective.
- of the heart chambers, muscle fibers stretch
- eventually fibers will overstretch and will not be effective
hypertrophy –> increase muscle mass of the heart making it ____. Initially its good, but overtime becomes ___.
- increase muscle mass of the heart - thicker
- Initially good but overtime becomes poor
Heart failure exacerbation causes the release of (5)
- 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
Risk factors of HF (9)
- 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
Primary causes of HF (4)
- CAD
- HTN
- underlying heart disease
- hyperthyroidism
Precipitating causes (8) (cause increased workload on the ventricles)
- anemia
- Infection
- thryotoxicosis
- hypothyroidism
- dysrhythmias
- pulmonary embolism
- hypervolemia
- bacterial endocarditis
What is the normal percentage for ejection fraction?
55-65%
What is the low function percentage of ejection fraction?
40-55%
What is the percentage for possible HF for ejection fraction?
<40%
Systolic failure mean the heart muscle is ____.
weak
Diastolic failure mean the heart muscle is ___.
stiff
How does systolic failure develop? What happens in the heart? What happens over time?
- 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
What is the hallmark sign of systolic failure?
decreased EF
What are the causes of systolic failure? (4)
- impaired contractile function- MI
- Increased after load- HTN
- cardiomyopathy
- mechanical. issues- valves
What happens during diastolic failure?
- ventricles unable to relax and fill during diastole
- decrease filling- leads to decrease SV and CO
What is diastolic failure characterized by? (2)
- EF remains normal
- charcterized by high filling pressures due to stiff ventricles- results in venous engorgement in the pulmonary and systemic vascular systems
What happens to result in LV hypertrophy? (disease processes [4])
- HTN (most common)
- MI
- Valve disease
- cardiomyopathy
What is mixed heart failure defined as?
-poor systolic function complicated by dilated LV walls that are unable to relax
What is the s/s of mixed HF? (6)
- extremely low EF
- high pulmonary pressures
- biventricular failure
- low CO and BP
- poor renal perfusion
- poor exercise tolerance dysrhythmias
S/S left sided HF (8)
- 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
what is pulmonary congestion (LV dysfunction prevents ____ from moving ____)? What does it do (increased ____ pressure causing fluid leakage into ____)?
- LV dysfunction prevents blood from moving forward
- Increases pulmonary pressure-fluid leakage in alveoli
s/s right sided HF (9)
- 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
What causes peripheral tissue edema and viscera congestion (right sided HF)
- RV not contracting efficiently
- blood backs up into the RA and venous circulation
stage 1 HF
- no limitation of physical activity
- ordinary activity does not cause undue fatigue
s/s stage 2 HF
- slight limitation of physical activity
- comfortable at rest, but physical activity causes fatigue
s/s stage 3 HF
- marked limitation of physical activity
- comfortable at rest, but less than ordinary activity causes fatigue
s/s stage 4 HF
- unable to carry out any physical activity without discomfort
- symptoms of cardiac insufficiency at rest
- If any physical activity is undertaken, discomfort is decreased
clinical manifestations of HF (congestion) (12)
- 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
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
- 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
FACES
- Fatigue
- Activities limited
- Chest Congestion
- Edema or ankle swelling
- Shortness of breath.
HF assessment and diagnosis (s/s of, diagnostic tests, labs, lab values)
- 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)
What does BNP show?
- differentiates cardiac from pulmonary cause of dyspnea
- > 500pg/mL. likely due to HF
- not diagnostic –> be prepared for CXR, ECG, and echo.
HF diagnostic labs
- HgB (for possible anemia)
- thyroid function labs: factor in worsening HF
- troponin
- renal function
- electrolytes if fluid imbalance
Collaborative management for HF goal
-relive symptoms and improve functional status, quality of life
Collaborative management for HF (3)
- reduce preload (volume) and after load (pressure)
- delay progression and extend survival and life expectancy
- promotion of lifestyle that promotes cardiac health: patient education
For HF exacerbation start with: (6)
- maintain O2 sats
- cardiac monitor, IV access, VS
- seated posture
- diuretic and vasodilator
- monitor UO, electrolytes, renal fxn
- sodium and fluid restriction PRN
HF Medications
- diuretics
- vasodilators
- beta blockers
- ACE inhibitors
What do diuretics do in the case of HF? (5)
- 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
What do vasodilators do in the case of HF? Examples too
- hydralazine, nitrates
- reduces circulating blood volume, improves coronary artery circulation
- reduces preload, increases myocardial O2 supply
What do beta blockers do in the case of HF?
- affects ventricular rate and afterload
- decreases afterload
- Inhibits SNS
What do ACE inhibitors do in the case of HF? (2)
- block the RAAS system allowing for vasodilation (increasing CO improving tissue perfusion)
- decrease ventricular remodeling by inhibiting ventricular hypertrophy
Side effects of ACE inhibitors (5)
- hypotension
- hacking cough
- hyperkalemia
- angioedema
- renal insufficiency
Systolic HF treatment
- diuretics (loop)
- ACEI/ARB
- Beta blockers
- MRA (spironolactone)
Diastolic. HF Treatment
empirical treatment based on ____ and ____
- relieve ____ with ____
- control ventricular rate: ____, ____, ivabradine, amiodarone (not ____ ____ med)
- empirical treatment based on symptoms and comorbidities
- relieve congestion with diuretics
- control ventricular rate: BB, digitalis, ivabradine, amiodarone (not first line med)
Digitalis toxicity s/s (4)
- anorexia, N/V
- visual distrurbances
- confusion
- bradycardia
What to monitor when someone is on digitalis
- serum digitalis and serum K (hypokalemia)
- muscle weakness
- bradycardia
other meds (4) and treatment (1) for HF
- antiocoagulants
- antiarrhythmics
- evaluation for implantable cardioverter defibrillator or pacemaker
- statins
- K-binders for hyperkalemia
Why are anticoagulants used in HF?
there is a risk for intracardiac and peripheral clots
Why are antiarrhythmics used in HF? and ex?
ventricular control (amiodarone)
Why are statins used in HF?
decrease serum lipids
Example of K-binder
kayexelate
Which drug do people w/ HF need to avoid?
NSAIDs
Why do people w/ HF need to avoid NSAIDs? (5)
- 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
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
- 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
HF Gero Considerations (3)
- atypical symptoms: fatigue,. weakness, somnolence
- decreased renal function: resistance to diuretics
- monitor for bladder distention (enlarged prostate), frequency, urgency
HF nursing process: Assessments
- 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
HF nursing process: Goals
- 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)
HF nursing process: interventions (3)
- promoting ____ tolerance, supplemental ____ ____, manage ____ volume
- promote effective management of therapeutic regimen
- monitoring/managing potential complications
- promoting activity tolerance, supplemental O2 PRN, manage fluid volume
- promote effective management of therapeutic regimen
- monitoring/managing potential complications
HF: patient and family education (9)
- 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
Joint commission core measures: HF (admission)
- smoking cessation counseling to patient with hx of smoking anytime during the last year
- evaluation of EF
Joint commission core measure: discharge
- ACEI or ARB for EF <40%
- discharge instructions: activity level, diet, daily weight monitoring, what to do if symptoms worsen
HF Eval (5)
- 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
Complications of HF
- pleural effusion
- dysrhythmias
- LV thrombus
- hepatomegaly
- renal failure
What is pleural effusion?
increase pressure in pleural capillaries caused by excess fluid in the pleural cavity
Dysrthymias in HF (_____of heart chambers cause changes in ____ _____ _____. _____ fire spontaneously and rapid risk for thrombus formation which causes a risk for ____.)
- enlargment of heart chambers cause changes in normal electrical pathways
- afib-fire spontaneously and rapid-risk for thrombus formation-risk. for CVA
LV Thrombus in HF (due to, risk for)
- due to enlarged LV and decrease CO
- risk for CVA
Hepatomegaly in HF (liver congested with ____ ____. Eventually liver cells die, ___ occurs and ____ develops)
- liver congested with venous blood
- eventually liver cells die, fibrosis occurs, and cirrhosis develops
Renal failure in HF
due to decreased perfusion
thromboembolism in HF –> HF pts at risk for (arterial) and (venous)
- HF patients at risk for arterial thromboembolism: Stroke, MI, PE, AFIB
- Venous thromboembolism: decreased mobility, venous stasis, (DVT may lead to PE)
Pulmonary embolism s/s
-dyspnea, chest pain, tachypnea, cough, hemoptysis, tachycardia, hypotension
Diagnosis for pulmonary embolism
- CXR
- V/G lung scan
- CT scan
- angiogram
-D-dimer: Rule out PE or DVT, diagnosis of DIC (disseminated intravascular coagulation)
pulmonary embolism treatment
- thrombolytic therapy for emboli with hypoxia, hypotension and shock
- heparin, Lovenox, fondaparinux
- long term warfarin (6 months)
Prevention of pulmonary embolism
-pharmacological preferred, mechanical acceptable for patients who cannot tolerate anticoagulants
What is HF?
the inability of ventricles to fill with blood or eject blood
Two main signs of HF
- fluid overload
- Inadequate tissue perfusion
What is the main complication of HF? S/S?
Acute decompensated heart failure –> severe respiratory distress and poor systemic perfusion - cold extremities and low O2 sat
Abbreviation for diastolic HF
HfpEf (heart failure with preserved ef)
Abbreviation for systolic HF
HfrEf (heart failure with reduced ef)
Beta Blocker pt ed
- early phase –> may worsen
- Improvement may take 2-4 weeks
- may need dosage adjustment in 2-4 weeks
