Heart Failure

Question 1

What can cause heart failure?

Answer 1

Coronary artery disease
Cardiomyopathy
Chronic HTN
Heart valve disease/disorders
Myocardial Infarction
Dysrhythmias such as Atrial Fibrillation

Question 2

What events lead to left sided heart failure?

Answer 2

Increased peripheral vascular resistance

Increased afterload

Question 3

If left sided heart failure occurs, what happens to blood flow?

Answer 3

The left ventricle weakens and is unable to keep up with the high demand of work

Blood backs up from the left ventricle, through the mitral valve, to the left atrium, through the pulmonary vein, and into the lungs

Question 4

When blood backs up into the lungs, what occurs?

Answer 4

Increased pulmonary pressure
Alveolar Edema (leads to Pulmonary Edema)

This causes decreased gas exchange

Question 5

List signs and symptoms of left sided heart failure

Answer 5

Paroxysmal Nocturnal Dyspnea
Elevated pulmonary pressure
Pulmonary Congestion/Edema --> cough, crackles, wheezes, pink frothy sputum, tachypnea
Restlessness and confusion
Orthopnea
Tachycardia
Exertional Dyspnea
Fatigue
Cyanosis

Question 6

What ventricle usually fails first?

Answer 6

Left ventricle

Question 7

What is a primary reason right sided heart failure develops

Answer 7

Due to left sided heart failure

Question 8

List signs and symptoms of right sided heart failure

Answer 8

Fatigue
Increased peripheral venous pressure
Ascites
Hepatomegaly
Spleenomegaly
Jugular Venous Distention
Anorexia
GI Distress: feelings of fullness, loss of appetite
Weight gain
Dependent edema

Question 9

What compensatory mechanisms occur to increase cardiac output during heart failure?

Answer 9

Activation of Sympathetic Nervous System
Activation of Renin Angiotensin Aldosterone System
Dilation of heart chambers
Hypertrophy of heart chambers

Question 10

What blood test can diagnose heart failure?

Answer 10

Brain Natriuretic Peptide

Question 11

Will troponin be elevated when a patient has chronic heart failure?

Answer 11

Not usually

Question 12

When would troponin be elevated in a patient with chronic heart failure?

Answer 12

During an acute exacerbation of the chronic heart failure

Question 13

If a patient has chronic heart failure without acute exacerbation, the Brain Natriuretic Peptide level is most likely in what range (hundreds or thousands)

Answer 13

Hundreds to low thousands

Question 14

If a patient has chronic heart failure with acute exacerbation, the Brain Natriuretic Peptide level is most likely in what range (hundreds or thousands)

Answer 14

Low thousands to high thousands

The higher the value, the more severe the exacerbation

Question 15

What nursing interventions should be implemented when a patient has chronic heart failure?

Answer 15

Weigh the patient daily
Apply oxygen if necessary
Balance rest and activity
Position in high fowlers
Restrict fluids
Create an individualized activity plan
Administer medications and educate on medications the patient is taking
Encourage a low sodium diet
Educate on s/s of heart failure
Help patient learn to cope with the disease

Question 16

When should the nurse be considered about weight gain in the patient with chronic heart failure?

Answer 16

Greater than 2 pounds gained in 24-48 hours

Question 17

What nursing diagnoses are applicable for chronic heart failure?

Answer 17

Impaired gas exchange
Decreased cardiac output
Excess fluid volume

Question 18

What evidence may be present if the nursing diagnosis impaired gas exchange is chosen?

Answer 18

Decreased oxygen saturation, adventitious lung sounds, tachypnea, dyspnea, capillary refill >3 seconds, cool extremities, cyanosis, etc.

Question 19

What evidence may be present if the nursing diagnosis Excess fluid volume is chosen?

Answer 19

Weight gain, edema, jugular venous distention, ascites, anorexia, dyspnea, fatigue, crackles in the lobes

Question 20

What is the end goal of chronic heart failure after implementation of therapeutic interventions

Answer 20

To improve the heart’s pumping ability
Decrease the hearts oxygen demands
Decrease the cardiac workload

Question 21

What medication drug classes can be administered either together or separately to help manage chronic heart failure and its symptoms?

Answer 21

Diuretic
Angiotensin Converting Enzyme inhibitor
Angiotensin 2 Receptor Blocker
Beta Blocker
Digoxin
Vasdilator

Question 22

Why is a patient with heart failure is given an Angiotensin Converting Enzyme inhibitoror an Angiotensin 2 Receptor blocker?

Answer 22

To block Renin Angiotensin Aldosterone System: decrease fluid volume, decrease serum sodium, promote vasodilation, decrease sympathetic nervous system response
(Reduce cardiac preload and afterload –> decrease cardiac workload)

Question 23

What vital signs must the nurse monitor when administering an Angiotensin Converting Enzyme inhibitor or an Angiotensin 2 Receptor blocker to a patient with chronic heart failure?

Answer 23

Blood pressure

Even though these medications aren’t given to treat hypertension, they can still alter the blood pressure and lower it.

Question 24

Which medication drug class is the first line therapy for chronic heart failure treatment?

Answer 24

Angiotensin Converting Enzyme inhibitor