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N465A: Med-Surg > Heart Failure and Nursing Management > Flashcards

Heart Failure and Nursing Management Flashcards

1
Q

About half of people who develop heart failure die within ____ years of diagnosis.

A

5

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2
Q

Heart failure = __________ _________

A

Ineffective pump

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3
Q

Describe the pathophysiology behind heart failure

A

-Heart chambers are unable to pump enough blood to meet tissues’ O2 requirements
-A syndrome of pulmonary and/or systemic congestion due to DECREASED cardiac output
-Increased pulmonary pressure → fluid in alveoli (PULMONARY EDEMA)
^Left-sided heart failure
-Increased systemic pressure → fluid in tissues (PERIPHERAL EDEMA)
^Right-sided heart failure

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4
Q

Primary risk factors of heart failure

A

CAD
Advancing age
HTN
DM
Tobacco use
Obesity
High serum cholesterol
Inactive lifestyle

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5
Q

Heart failure is caused by systemic hypertension in ______ of cases.

A

75%

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6
Q

Heart failure is characterized by
decreased _________ ___________.

A

ejection fraction (<40%)

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7
Q

In addition to decreased ejection fraction, heart failure is also characterized by? (4 things)

A
  1. Ventricular dysfunction- systolic or diastolic
    a. Systolic HF- decreased contractility of left ventricle, decreased inotrope
    b. Diastolic HF- decreased ability of ventricle to relax/stiff!
  2. Reduced exercise tolerance
  3. Diminished quality of life
  4. Shortened life expectancy
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8
Q

What is the formula for ejection fraction (%)?

A

Amount of blood pumped out of the ventricle/Total amount of blood in ventricle

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9
Q

What is ejection fraction?

A

Measurement of the percentage of blood leaving your heart each time it squeezes.

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10
Q

What is a normal ejection fraction?

A

55-70%

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11
Q

What is an echocardiogram used for?

A

-Uses sound waves to create pictures of the heart. This common test can show blood flow through the heart and heart valves.
-Helps diagnose heart failure, non-invasive, ultrasound.

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12
Q

What is a transesophageal echocardiogram (TEE) used for?

A

Gives more detail than a standard echo
Helps with diagnosing heart failure***
Uses endoscope to guide ultrasound to go via mouth, esophagus, and visualize heart

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13
Q

What is the primary goal of diagnostic studies related to heart failure?

A

Determine and treat underlying cause.

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14
Q

What is BNP? What does a BNP diagnostic study test?

A

Released in response to increase in atrial Volume and ventricular pressure
High specificity, high sensitivity for diagnosis*
Over > 400 pg/mL in patients with dyspnea due to heart failure.**
Lavender top tube
If you patient has heart failure, need BNP on you care plan, helps diagnosis and monitor these trends for HF severity and risk stratification!!!****

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15
Q

What type of diet is used for treatment in patients with heart failure?

A

Low salt diet – 2-4 gram of salt per day with fluid restriction.

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16
Q

What medications decrease fluid load, preload, and afterload?

A

ACE inhibitors & Diuretics

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17
Q

What medications improve contractility?

A

Digoxin

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18
Q

What medications decrease workload of the heart?

A

Beta-blockers

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19
Q

List pharmacotherapy used for patients with heart failure

A

diuretics (get rid of fluids on board), ACEI (helps w/BP and cardiac remodeling), inotropes (increases efficacy of pumping function of heart)

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20
Q

What are some education topics to provide patients with heart failure?

A

Education-weight reduction, compliance with meds, cardiac rehab, oxygen use prn, obtain daily weights, report weight gain over 2/3 lbs in one day**HAVE TO NOTIFY, alcohol cessation, medication compliance.

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21
Q

Heart failure is caused by _________ in 75% of cases.

A

systemic hypertension

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22
Q

To help decrease the risk for volume overload leading to hospitalization in heart failure patients, fluid should be restricted to about _____ L of all liquids daily.

A

2

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23
Q

What is the purpose of monitoring daily weights in relation to diuretics?

A

To dose diuretics on an as-needed basis.

24
Q

Why is it important to educate patients on the importance of medication compliance?

A

It is crucial to prevent decompensated episodes of HF.

25
Q

What purpose do diuretics serve in heart failure patients?

A

To help relieve symptoms of fluid volume overload

26
Q

What is one of the main concerns regarding loop diuretics?

A

Loss of potassium - must check K+ levels prior to administering, so loop diuretics are usually given with Potassium supplement.

27
Q

What is the normal potassium level?

A

3.5-5.0

28
Q

If hypo or hyperkalemia occurs in patients on loop diuretics, be concerned about potential or already present _____ and place the patient on a ________ ________.

A

arrhythmias; telemetry monitor

29
Q

Provide an example of a loop diuretic.

A

Furosemide (LASIX)- given PO or IV; rare to given without K+ supplement.

30
Q

What is the fx of potassium-sparing diuretics?

A

Maintain potassium so that potassium levels won’t lower.

31
Q

Provide an example of potassium-sparing diuretics.

A

Spironolactone - give PO

32
Q

What are some nursing considerations when a patient is on any diuretic therapy?

A

Chec B/P and I/O; Risk for getting dizzy or orthostatic hypotension, so slowly get pt OOB.

33
Q

Hypo/hyperkalemia can lead to __________.

A

Arrhythmias

34
Q

Foods highest in potassium

A

Dried figs and molasses

35
Q

Foods very high in potassium

A

Dried fruits, nuts, avocados, bran cereals, wheat germ, lima beans

36
Q

Foods high in potassium

A

Vegetables, fruits, and meats.

37
Q

What class of medications are considered the cornerstone of heart failure medical treatment? Why?

A
  • ACE inhibitor - delays cardiac ventricular remodeling from hyperactive RAAS system (retains fluid by blocking the kidneys)
  • decrease vasoconstriction
    -decreases sodium reabsorption
38
Q

List some ACE inhibitor medications.

A

Begin therapy low and titrate up as possible:

  1. Enalapril – 2.5 mg po BID
  2. Captopril – 6.25 mg po TID
  3. Lisinopril – 5 mg po QDaily
39
Q

What are some side effects of ACE inhibitors?

A

ACE – Angioedema, cough, and elevated K+

40
Q

Beta blockers decrease _________, _________, and _________.

A

Symptoms, mortality, and hospitalizations.

41
Q

What are the contraindications for Beta Blockers?

A
  1. Heart rate <60 bpm
  2. Symptomatic bradycardia
  3. COPD, asthma*
42
Q

What is Digoxin (Dig.) toxicity?

A

Bradycardia (pulse < 60), anorexia, diarrhea, N/V, blurred vision, halos with vision, lethargy; older adults more prone to toxicity.

43
Q

____________ makes someone more prone to dig toxicity.

A

Hypokalemia

44
Q

Digoxin (Digitalis) 3 effects on the heart

A
    • inotropic action (increases myocardial contraction)
    • chronotropic action (decreases HR)
    • dromotropic action (decreases conduction of the heart cells)
45
Q

Weight gain of ________ over 2 days or a ___ to ______ gain over a week should be reported to health care provider.

A

3 lbs; 3-5

46
Q

3 lbs of weight gain is equal to how many liters of fluid retention?

A

1.5

47
Q

Not all people with heart failure will experience complications, but some do – what are they?

A

Pleural effusion, renal insufficiency, hepatomegaly, fatal ventricular dysrhythmias, Atrial fibrillation (most common dysrhythmia)**

48
Q

True or false: atrial fibrillation promotes thrombus/embolus formation, increasing the risk for stroke.

A

True

49
Q

Treatment for atrial fibrillation can include what anticoagulant meducation?

A

[Warfarin] Coumadin – high risk; may need a pacemaker inserted.

50
Q

What is the most important lab to check before administering Coumadin (Warfarin)? What other pre-initiation lab tests?

A

INR most important; CBC with platelet, PT/PTT, and liver function tests.

51
Q

What is a normal INR for a patient not on Coumadin?

A

1.0

52
Q

What are the therapeutic ranges when a patient is taking Coumadin?

A

2.0 to 3.0

53
Q

INR levels below ____ may allow easier blood clotting to occur.

A

2

54
Q

INR levels above ____ may cause excessive tendency for the patient to bleed.

A

3

55
Q

What are the 3 direct oral anticoagulants (DOAC’s) and what are they used for?

A
  1. Apixaban (Eliquis)
  2. Dabigatran (Pradaxa)
  3. Rivaroxaban (Xarelto)

Can be used for nonvalvular atrial fibrillation and do not require monthly blood test or frequent monitoring of labs.

56
Q

What are some nursing interventions for heart failure?

A

Promote rest until patient is stable:
-Decreases strain on heart
-Bed rest promotes cardiac efficiency
-Elevate legs to enhance venous return

N465A: Med-Surg (5 decks)

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