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Nursing Theory > Heart Failure and Atrial Fibrillation > Flashcards

Heart Failure and Atrial Fibrillation Flashcards

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1
Q

How many people over 40 have heart failure in their lifetime?

A

1 in 5

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2
Q

What increases the prevalence of heart failure?

A

Age

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3
Q

What are the two primary risk factors for heart failure?

A
  1. coronary artery disease

2. hypertension

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4
Q

What is heart failure?

A

An abnormal condition involving impaired cardiac pumping/lifting

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5
Q

With heart failure, the heart is unable to produce adequate ____?

A

cardiac output (CO)

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6
Q

What does decreased cardiac output result in?

A

Decreased perfusion and therefore decreased oxygenation to the body

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7
Q

What are some of the causes of heart failure?

A
  • acute MI and CAD
  • dysrhythmias
  • infection (endocarditis, myocarditis)
  • hypertension
  • pulmonary disease
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8
Q

What is preload?

A
  • the volume of blood in the ventricle at the end of diastole, before the next contraction
  • determines the amount of stretch placed on the myocardial fibers
  • too much stretch, unable to pump effectively
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9
Q

What is afterload?

A
  • the peripheral resistance against which the left ventricle must pump
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10
Q

What is myocardial contractility?

A
  • the ability of the heart muscle to contract and move blood to the lungs or body
  • can be impacted by electrolyte levels (calcium) and myocardial oxygen supply
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11
Q

What is heart rate?

A
  • amount of blood that is circulated is impacted by the rate in which the ventricles contract
  • lower blood volumes can increase heart rate which increases the workload on the heart
  • heart failure patients have a decrease in heart’s ability to pump which causes a decrease in cardiac output
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12
Q

What is cardiac output?

A
  • the amount of blood pumped by each ventricle in 1 minute
  • CO = heart rate X stroke volume
  • normal range is 4-8 L/min for adults at rest
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13
Q

What is stroke volume?

A
  • the volume of blood pumped from the left ventricle per beat
  • ## calculated from ventricle measurements taken from an echocardiogram
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14
Q

What is ejection fraction?

A
  • the measurement of the percentage of blood leaving the heart each time it contracts
  • normal range is 50-70%
  • patient’s with heart failure often have decreased ejection fraction (impaired left ventricle function = decreased cardiac output)
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15
Q

What is the term used for when the heart makes up for heart failure by activating the sympathetic nervous system?

A

Compensation

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16
Q

What hormone is released in response to a decrease in cardiac output?

A

Epinephrine

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17
Q

What does epinephrine do to compensate for heart failure?

A
  • increases heart rate
  • increases cardiac contractility
  • vasoconstriction
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18
Q

What does long term heart compensation increase?

A

The workload of the heart (worsening left ventricle performance

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19
Q

What does decreased cardiac out put do to the kidneys?

A

Causes less blood flow to the kidneys (normally 40% CO)

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20
Q

What system do the kidneys activate when cardiac output decreases and there is less blood flow to the kidneys

A

RAAS system

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21
Q

What does activating the RAAS system do?

A

Results in vasoconstriction and sodium and water retention

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22
Q

What receptor in the brain and what part of the brain detects decreased cardiac output and decreased blood flow to the brain?

A

Osmoreceptors in the hypothalamus

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23
Q

What does activation of the osmoreceptors in the hypothalamus trigger?

A

Triggers the posterior pituitary to release antidiuretic hormone (ADH)

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24
Q

What does ADH hormone?

A

Increases water reabsorption in the renal tubules which leads to fluid retention and increased blood volume

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25
Q

What is ventricular dilation a result of?

A

compensation

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26
Q

What is ventricular dilation?

A
  • decreased CO—> compensation —> increased CO
  • increased pressure in left ventricle causes enlargement of the chambers of the heart
  • initially an adaptive mechanism
  • too much stretch in the ventricle = reduced ability of the myocardium to contract
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27
Q

What is hypertrophy a result of?

A

Compensation

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28
Q

What is hypertrophy?

A
  • when there is chronic dilation (from increased pressure), it causes an increase in muscle mass and cardiac wall thickness
  • causes poor contractility
  • higher O2 needs
  • poor coronary artery circulation
  • risk for ventricular dysrhythmias
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29
Q

What are natriuretic peptides?

A

Hormones produced by the heart muscle in response to increase atrial and ventricular blood volumes (compensation)

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30
Q

What are the two types of natriuretic peptides?

A
  1. atrial natriuretic peptide (ANP)

2. B-type natriuretic peptide (BNP)

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31
Q

What do natriuretic peptides do?

A
  • promote venous and arterial vasodilation, reducing preload and afterload
  • increase glomerular filtration = diuresis
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32
Q

Does chronic heart failure lead to a surplus or depletion of natriuretic peptides?

A

Depletion

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33
Q

What is the normal value for B natriuretic peptide (BNP)?

A

< 100mcg/L

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34
Q

Is left sided or right sided heart failure more common?

A

Left (left ventricular dysfunction)

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35
Q

Where does blood back up into in left sided heart failure?

A

The lungs

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36
Q

What are the signs of left sided heart failure?

A
  • shortness of breath, tachypnea
  • cough, restlessness, fatigue
  • exertional dyspnea, cyanosis
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37
Q

What is right sided heart failure caused by?

A
  • left sided heart failure

- right ventricular injury (MI)

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38
Q

Where does blood back up into in right sided heart failure?

A

The venous systemic circulation

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39
Q

What are the signs of right sided heart failure?

A
  • jugular venous distension (JVD)
  • hepatomegaly, splenomegaly, anorexia, GI discomfort
  • dependent peripheral edema weight gain
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40
Q

What are the diagnostic tests for heart failure?

A
  • echocardiogram
  • chest x-ray
  • ECG
  • lab studies
  • stress test
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41
Q

What does an echocardiogram measure?

A

The ability to pump; calculate ejection fraction

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42
Q

What does a chest x-ray look at?

A

Lung status

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43
Q

What does an ECG measure?

A

Rate and rhythm

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44
Q

What do lab studies look at for heart failure?

A
  • cardiac enzymes

- BNP

45
Q

What does a stress test measure?

A

Cardiac function

46
Q

What does decompensated heart failure often manifest as?

A

Pulmonary edema

47
Q

What is pulmonary edema?

A

Abnormal and life threatening accumulation of fluid in the alveoli and interstitial spaces of the lungs

48
Q

What are some early signs of pulmonary edema?

A
  • mild increase in respiratory rate

- decrease in pulse oximetry (SpO2) levels

49
Q

What are some nursing interventions for decompensated heart failure?

A
  • place patient in high Fowlers position
  • provide supplemental oxygen
  • diuretics (furosemide, monitor potassium levels)
  • morphine sulfate can decrease myocardial oxygen demands (monitor for respiratory depression)
  • reduce anxiety (monitor for sedation)
  • frequent focused respiratory and cardiac assessments
  • strict intake and output monitoring
50
Q

What do the signs and symptoms of heart failure depend on?

A
  • the patient’s age
  • extent of the disease
  • type pf heart failure (right vs left)
  • any co-morbidities
51
Q

What should be included in a nursing assessment for heart failure?

A
  • past health history
  • risk factors; MI, hypertension, valve disorders
  • family history of heart disease
  • functional health patterns (ability to do ADL’s (fatigue), changes over time (last 6 months))
  • medications (use of diuretics, OTC, herbal remedies)
52
Q

What are some early signs of heart failure?

A
  • fatigue after activities that are normally not tiring
  • dyspnea with mild exertion or at rest
  • orthopnea (SOB when lying down)
  • paroxysmal nocturnal dyspnea (wakes patient at night with feelings of suffocation)
  • cough (begins as a dry cough, not relieved by position change) (an attempt to open airways and improve oxygenation)
53
Q

What are some other signs and symptoms of chronic heart failure?

A
  • tachycardia
  • edema; peripheral edema (lower extremities), abdomen (ascites), weight gain 3-4 lbs over 2 days = exacerbation of HF
  • nocturia (cardiac workload is lessened at night = increased perfusion to the kidneys = diuresis
  • skin changes (skin may appear dusky; hair growth diminished, chronic swelling leads to pigment changes
54
Q

What are the later stages of chronic heart failure?

A
  • restlessness, confusion
  • inability to concentrate (poor gas exchange)
  • chest pain (angina) (decreased coronary artery perfusion - poor cardiac output)
55
Q

How do thiazide diuretics work?

A
  • they inhibit sodium reabsorption in the tubules which promotes water loss
  • potassium and magnesium loss
56
Q

How do loop diuretics work?

A
  • promotes sodium, chloride, and water secretion in the ascending loop of Henle
57
Q

What interventions need to be done when a patient is on diuretics?

A
  • I & O
  • daily weights
  • electrolyte monitoring
58
Q

What do ACE inhibitors do?

A
  • inhibit the conversion of angiotensin I to II which prevents vasoconstriction
  • less pressure in the vascular system, easier for the heart to pump
59
Q

What needs to be monitored when a patient is taking ACE inhibitors?

A
  • BP and renal function

- potassium levels

60
Q

Name two ACE inhibitors:

A
  1. ramipril

2. lisinopril

61
Q

What do Neprilysin inhibitors do? (sacubitril)

A
  • cause an increase in levels of natriuretic peptides
  • ANP’s are synthesized and secreted by cardiac muscle cells (which also contain volume receptors)
  • ANP is released into the bloodstream via capillary beds when the atria is stretched due to increases in fluid volume
  • the ANP then triggers the kidney to excrete sodium which results in fluid loss
  • effect is reduction in blood pressure and fluid volume
62
Q

What needs to be monitored when patients are taking Neprilysin inhibitors?

A
  • blood pressure
  • I & O and weight monitoring
  • Na+ and K+ levels
63
Q

What do B-adrenergic blockers do?

A
  • blocks stimulus from the SNS

- reduces heart rate and allows the heart to increase its ability to contract = more output

64
Q

Name 2 B-adrenergic blockers?

A
  1. Carvedilol

2. Metoprolol

65
Q

What needs to be monitored when a patient is taking B-adrenergic blockers?

A
  • hypotension
  • bradycardia
  • bronchospasm
  • frequent vital signs initially
66
Q

How much should fluid intake be restricted to with heart failure?

A

1.5-2L/day

67
Q

What nutritional changes should be made for heart failure patients?

A
  • stop using salt shaker
  • do not add salt to food during preparation
  • choose low sodium options
  • eat fresh fruits and vegetables
  • avoid prepared and processed foods
68
Q

What time of day should daily weights be taken?

A

First thing in the morning

69
Q

What is a synchronized cardioversion?

A

A device that helps get the heart back in rhythm

70
Q

What is a pacemaker?

A

A device that helps regulate heart rate, prevents tachycardia, and maximizes medication therapy

71
Q

An ejection fraction of _____ or less can lead to myocardial ischemia:

A

35%

72
Q

What device can be used in heart failure patients with a low ejection fraction who are at increased risk of ventricular dysthymias?

A

An implantable cardioverter defibrillator (ICD)

73
Q

What is an implantable cardioverter defibrillator?

A
  • a lead system that is placed via the subclavian vein to the endocardium
  • monitors the patients heart rate and rhythm and will identify abnormal ventricular rhythms such as ventricular tachycardia (VT) and or ventricular fibrillation (V-fib)
  • detects abnormal ventricular rhythm and it will send a 25 joules of electricity (shock) to the heart to reset the heart back to the normal rhythm
74
Q

What is the patient teaching for someone with a ICD or a pacemaker?

A
  • monitor the site for signs of infection
    keep the incision dry for 1 week post procedure
  • avoid lifting the operative site for 1 week (will lift the leads off the heart)
  • avoid direct blows to the ICD site
  • do not drive until cleared by your physician
  • if ICD fires; lie or sit down, if you are feeling unwell or have repeated firing, contact your physician and or go to the ER
75
Q

What are cardiac dysrhythmias?

A

Abnormal heart rhythms that affect the ability of the heart to effectively pump oxygenated blood throughout the body

76
Q

Can cardiac dysrhythmias be life threatening?

A

Yes

77
Q

What happens when the heart can not pump effectively?

A
  • perfusion to vital organs and peripheral tissue can be impaired
  • oxygenation and perfusion problems
78
Q

What type of cells regulate the heart’s rhythm and possess unique properties

A

Myocardial cells

79
Q

What is automaticity?

A

Ability of cardiac cells to generate an electric impulse spontaneous and repetitively (pacing function)

80
Q

What is excitability?

A

The ability of non-pacemaker heart cells to respond to an electrical impulse and depolarize (react)

81
Q

What is depolarization

A

When the normally negatively charged cells within the heart muscle develop a positive charge

82
Q

What is conductivity?

A

The ability to send an electrical stimulus from cell membrane to cell membrane

83
Q

What is the result of conductivity?

A

Excitable cells depolarize in a rapid succession; sees as a P wave and a QRS complex on a ECG recording

84
Q

What is contractility?

A

The ability of the atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation (the muscle contracts and move blood forward through the heart)

85
Q

Where is the SA node located?

A

Right atrium

86
Q

The SA node is the hearts, primary ____?

A

Pacemaker

87
Q

What is the SA node reflected as on a ECG?

A

P wave

88
Q

What systems are connected with the SA node?

A

Sympathetic and parasympathetic nervous systems

89
Q

What happens after the SA node is activated?

A

Atrial muscle contraction follows

90
Q

Where is the AV node located?

A

Beneath the right atrial endocardium between the tricuspid valve and ostium of coronary sinus

91
Q

What is the zone called in which the AV node is activated?

A

Transitional zone - impulses slow down (delay)

92
Q

What interval is the transitional zone reflected on a ECG?

A

PR interval

93
Q

What’s an atrial kick?

A

When the atria contract and the ventricles fill

94
Q

What systems are connected to the AV node?

A

Sympathetic and parasympathetic nervous systems

95
Q

What is the Bundle of His?

A
  • connects the AV node and through the interventricular septum
  • right bundle; leads to the apex of right ventricle
  • left bundle; leads to the apex of left ventricle
96
Q

What are the Purkinje cells?

A
  • fibers located on the endocardial surface of both ventricles
  • apex to base; threaded through myocardium
  • conducts the electrical impulses throughout the ventricles
  • lead to ventricle depolarization = muscle contraction
97
Q

What is a ECG?

A
  • a graphic representation of the heart’s electrical activity
  • leads placed on the patient’s chest sense electrical activity and are transmitted to monitor which displays the heart’s electrical rhythm
  • direction of the current can have a positive deflection or a negative deflection in relation to the baseline (depends on the placement of the lead)
  • 5 lead, 3 lead, and 12 lead systems that are used to diagnose ischemia or rhythm disturbances
98
Q

What is a normal sinus rhythm?

A
  • originates in the SA nodes
  • atrial and ventricular rate is between 60-100 beats/min
  • rhythm is regular
  • P waves present and consistent (one before each QRS complex)
  • PR interval is 0.12-020 seconds and consistent
  • QR duration between 0.04-0.10 and consistent
99
Q

What is bradycardia?

A
  • heart rate is less than 60 bpm
  • cardiac output is decreased = perfusion problem
  • if patient has an adequate BP then they may be able to tolerate the slow rate (elite athlete)
  • if the BP is too low = problems with oxygenation which can lead to myocardial ischemia
100
Q

What is a permanent pacemaker?

A
  • placed in patient’s with conduction disorders
  • the generator is placed in a subcutaneous pocket near right or left subclavian site
  • leads follow the cephalic or subclavian veins to the endocardium on the right side of the heart
  • pulse sent via leads to the heart to stimulate cells for depolarization
101
Q

What is sinus tachycardia?

A
  • heart rate is over 100 beats/min
  • short cardiac cycle, ventricles do not have time to fill properly, which leads to decreased cardiac output
  • short diastolic time which means less time for blood to perfuse the coronary arteries which can lead to increases in heart rate
102
Q

What happens when cardiac output decreases?

A
  • increased heart rate, decreased bp, decreased urinary output
  • diminished pulses, decreased SpO2
  • weakness, restlessness, anxiety, and confusion
103
Q

How to treat tachycardia?

A
  • treat the cause
  • frequent vital signs
  • supplemental oxygen
  • IV access
  • cardiac monitor
  • medications
  • decrease caffeine, nicotine, cocaine, etc…)
104
Q

What is an atrial dysrhythmia?

A
  • focus of the impulse shifts away from the SA node and is generated from atrial tissues
  • changes the depolarization of the tissues and P wave shape is changed (atrial fibrillation)
  • most common dysrhythmia; associated with hypertension, heart failure, CAD
  • increased risk of stroke, heart failure, thromboembolic events
  • risk factors: obesity, advanced age, Caucasian, excessive alcohol use
  • multiple rapid impulses from many different foci depolarize the atria in a disorganized manner (rate = 300-600 bpm, resulting in a ventricular response of 120-200 bpm)
  • rhythm is chaotic, no clear P waves, no atrial kick (atria quiver which results in a rapid and irregular ventricular rate, decreased filling time, poor cardiac output, poor perfusion)
105
Q

What is drug therapy used for in patients with atrial fibrillation?

A

To slow ventricular conduction or to convert to NSR

106
Q

Name two drugs used to treat atrial fibrillation?

A
  1. Cardizem
    - bolus and infusion, followed by PO therapy
    - calcium channel blocker
    - monitor heart rate, bp, and rhythm
  2. Multag
    - used to treat chronic A fib
    - tolerated better than amiodarone for maintenance
    - monitor heart rate and rhythm (bradycardia), shortness of breath
    - monitor BUN, CR, and liver enzymes
    - take with meals and not with grapefruit juice
107
Q

Name another drug used for atrial fibrillation and what it does?

A

Digoxin

  • IV for acute and PO for maintenance
  • prolongs refractory period in AV node and increases contractility of myocardial contraction = slows heart rate and increases CO
  • monitor heart rate
  • teach patients to report anorexia, nausea, vomiting, confusion, or vision changes
  • monitor potassium levels (hypokalemia results in digoxin toxicity and ventricular dysthymias
108
Q

What should be known about anticoagulants that are given for atrial fibrillation?

A
  • aspirin or warfarin can be used
  • alternatives include; xarelto and eliquis
  • patient is to monitor for bleeding in nose or gums and bruising

Nursing Theory (6 decks)

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