Heart Failure & Digoxin

Question 1

The following flashcards are going to be based on the simple nursing video

Question 2

What is heart failure?

Answer 2

the heart failures to pump blood forward, so heavy fluid pumps back into the lung or the rest of the body

Question 3

What are the two forms of heart failure?

Answer 3

Left and right sided

Question 4

what is a great way to remember what left sided heart failure is?
what is a great way to remember what right sided is?

Answer 4

left sided- fluid goes into Lungs (pulmonary edema)
Right sided- Rocks the body with Fluid ( peripheral edema )

Question 5

any form of weight gain in a patient who has heart failure is considered to be water gain from that fluid retatining.
How many pounds in a day and how many pounds in a week is considered extremely bad for our patient?

Answer 5

3 pounds in a day
5 pounds in a week

Question 6

what are some right-sided heart failure symptoms?

Answer 6

peripheral edema
JVD (big neck veins)
ascites
hepatomegaly
splenomegaly

Question 7

what are some left-sided heart failure symptoms?

Answer 7

crackles
Frothy pink sputum - pulmonary edema
Dyspnea
orthopnea - shortness of breath while laying flight

Question 8

between left sided and right sided heart failure, which would you say is worse to have and why?

Answer 8

left sided because it directly impacts our ABC’s, or to be more specific, our lungs

Question 9

Simple nursing provides a great and in depth explanation on keywords that we should look out for when talking about a patient with heart failure.
key words like
new,sudden,worsening, rapid
pink frothy, crackles, edema

all of these things can indicate what?

Answer 9

a priority patient that needs to be quickly treated

Question 10

The number one form of treatment to aid a patient in heart failure is what?

Answer 10

diuretics - furosemide and bumetanide

Question 11

What is the anagram that simple nursing provides on the immediate action to do when a patient with heart failure comes into the hospital for?

Answer 11

Hope

Question 12

what does HOPE anagram stand for when It comes to the immediate interventions for a patient in heart failure ?

Answer 12

h - head of the bed at 45+, semi or high flowers
o - oxygen
p - push furosemide and morphine
e - end sodium and fluids
( sodium swells, NPO, Stop IV fluids )

Question 13

Common nclex questions
1. how does the nurse know that the treatment is successful for a patient with heart failure?

2. why would the nurse question the doctors order regarding administering fluids?
3. why do you want to reassess a patient who is being transferred over to another unit? in this case talk about a heart failure patient.
4. what does sodium do to the body? can you provide examples on things with high sodium?

Answer 13

1. we are going to hear clearer lung sounds, decrease heart rate
2. they have heart failure, they are not going to be able to get rid of that fluid, remember the anagram HOPE
3. because we want to see if they have any worsening crackles or heart sounds
4. sodium causes fluid retention so we want to avoid giving that to our patient. Some examples are package foods, salad dressings, nothing over the counter, cold or flu medicine

Question 14

What is the function of the veins?
what is the function of the left-side of the heart?

Answer 14

veins pump deoxygenated blood back to the right side of the heart to get more oxygen from the lungs

the left side of the heart pumps that oxygen rich blood out to the body

Question 15

what is the definition of cardiac output?

Answer 15

oxygen-rich blood OUT to the body

Question 16

what is the number one risk factor for a patient developing heart failure?

Answer 16

hypertension!

some common others are
- valve dysfunction
- afib
- hypertrophic cm
- restrictive cm
- dilated cm

Question 17

explain to me the patho a little bit more in depth on how the simple nursing video did it.

so to start off, typically left sided heart failure or in general heart failure starts after a long time having hypertension and all that tension is on the heart, or after a really big attack on the heart, like a myocardial infarction - keep going now

Answer 17

it can be from a MI or Coronary artery disease that patients end up developing heart failure ; so fluids will start to fill up the lungs and start to put pressure on the vein and valves.

This pressure is considered as pulmonary hypertension.
After some time, this can cause pressure on the right side of the heart and now we have right sided heart failure.

Typically right sided heart failure develops from left sided heart failure

Question 18

what is another commonly used name to describe right sided heart failure?

Answer 18

cor pulmonale

Question 19

right sided heart failure is typically caused by left sided, however the simple nursing video provides other examples on how it can be. what are those examples ?

Answer 19

years of smoking - COPD
obstructive sleep apnea

Question 20

ironically we understand the when having heart failure, we are going to have less cardiac output, which in return means less oxygen out to the body. What does the kidneys have to say about this? think about how if anything is down, the first thing that its going to do is the kidneys will try to compensate by doing what?

Answer 20

so with the little cardiac output coming, meaning the kidneys are not being perfused well enough, the kidneys think that its from the fact that we have low blood pressure.
- ironically we have already high blood pressure, so now it’ll increase it even more.

it does this by increasing the sympathetic nervous system to increase the heart rate and constrict the blood vessels

and also by initiating the RAAS system, this helps to help retain the fluids and constrict the blood vessels

Question 21

RAAS
( renin angiosensin aldosterone system )
what does the aldosterone hormone do?

the anagram is AL
simple nursing calls him MR.L

Answer 21

Adds sodium and water into the body
Lets potassium out of the body and into the potty

Question 22

Now why would you want to get rid of Mr.L or aldosterone with medications like startans, ACE and diuretics?

however, what is the biggest downside of this?

Answer 22

because itll get rid of the sodium and water that is being retained in our body

now we ar going to be retaining too much potassium in our body

Question 23

simple nursing provides a great way to remember that these drugs, like the startans, ace inhibitors and potassium sparing diureitcs will do what and we should be careful when we are trying to treat that aldosterone?

Answer 23

retain potassium!

Question 24

what is the diagnostic test that helps confirm heart failure?
gold standard ^

what are some other test?

Answer 24

BNP
b-type natriuretic peptides

echocardiography
ejection fraction

Question 25

what does the BNP typically tell us when seeing the numbers range associated with it examples 100 or less is - normal 300 or more is - mild 600 or more is - moderate ____or more is - severe

Answer 25

BNP, depending on the severity tells us how bad our ventricles are. bnp think of the BULGING VENTRICLES 900+ or more is severe heart failure

Question 26

what is a normal ejection fraction? what % is bad?

Answer 26

55-70% is normal 40% or less is BAD

Question 27

we can also do something called hemodynamic monitoring, or another term is the swan ganz cath, PAC, these guys do what? whats the normal range for the measurement?

Answer 27

they measure central venous pressure (CVP) 2-8 anything over 8 is not great

Question 28

what are the two ways we help treat our patient who has heart failure?

Answer 28

life style changes and medicine ( drugs )

Question 29

what is the anagram we use to help patients remember about heart failure and life style changes ?

Answer 29

DR. BEDSS

Question 30

what does Dr.Bedss stand for when regarding life style changes to help a patient with heart failure to remember and apply?

Answer 30

D - Diet low in sodium & fluid (2g/2L a day or less ) ( no fried foods, always use GRILL, no canned or package ) R - risk for falls ( orthostatic hypotension ) ( slow position changes ) B - BP and BNP ( should not be increasing ) E - elevate legs with pillows, high fowles D - daily weight (3lb/1 day or 5lb/week) S - sex ( 2 flights of stairs without SOB ) S - stocking ( decrease blood pooling, remove daily )

Question 31

remember some over the counter medications contain lots of sodium for these patients. what are the 4 medications that we tell patients with heart failure to avoid? the anaram is CAAN like canned foods with lots of salt!

Answer 31

C- cold and fluid medications A - acetaminophen A - Antacids N - NSAIDS ( ASA, Ibuprofen, Naproxen )

Question 32

patient with heart failure who is constipated! what would the nurse recommended? select all that apply? 1. walking 2. increase fiber 3. stool softerners 4. drink extra water

Answer 32

1,2,3

Question 33

which foods item should the heart failure patient eat ? select all that apply 1. chips 2. fruits 3. veggies 4. grilled chicken and fries 5. canned beans 6. bread

Answer 33

2,3,6 if it was just grilled chicken, it would have been fine, but remember no fries!

Question 34

a client with chronic heart failure took cold medicine for her fluid. She presents with new productive cough with pink frothy sputum and worsening crackles. Which action should the nurse take first? 1. assess the lungs 2. give bumetanide IV push 3. notify the HCP 4. Clock out for lunch

Answer 34

2. give bumetanide IV push

Question 35

what is the long anagram to help remember all the medications we use for patients with heart failure, its a 6 letter anagram

Answer 35

ABC DDD

Question 36

what does ABC DDD stand for? tell me what they all do to the body

Answer 36

ACE & ARBS ( prill and sartan ) - lowers bp Beta blockers ( lol ) - lowers hr and bp Caclium channel blockers (pine) - lowers hr and bp Digoxin - lowers hr dilators ( vasodilates ) diuretics ( ide) - lowers bp

Question 37

ace,arbs, beta blockers, calcium channel blockes, dilators and diuretics all do what that digoxin doesn't do? so that's why we teach patients what?

Answer 37

lowers the bp, orthostatic hypotension slow position change

Question 38

trick question do we give ace and arb medications when the patients heart is below 60? and why or why not?

Answer 38

yes, because neither of these medications lower the heart rate

Question 39

there is an anagram to help remember the signs and symptoms of a patient who is taking an ACE inhibitor. what is it? (4)

Answer 39

A - avoid pregnant A - angioedema C - cough E- elevated potassium

Question 40

we teach patients who are on ACE and Sartan medications to avoid food that are rich in potassium, can you give some examples of that?

Answer 40

Banana orange kidney beans kale swiss chard potato avocado dried apricot collard green

Question 41

what are some signs of a patient who is having hyperkalemia?

Answer 41

muscle spasms heart problems - like Peak T waves or ST elevation

Question 42

what is the first action by the nurse if we think or we see that potassium is too high on a patient ??

Answer 42

place patient on a cardiac monitor

Question 43

what is normal potassium range?

Answer 43

3.5-5.0

Question 44

what is the function of beta blockers?

Answer 44

lowers the heart rate in order to decrease blood pressure

Question 45

what do beta blockers end in?

Answer 45

lol

Question 46

beta blockers provides us the 3 negative neg chronotopic neg inotropic neg dromotropic what do these 3 do ?^

Answer 46

1. lowers heart rate ( resistance ) 2. less force of the heart to pump ( workload ) 3. less beats that heart does ( cardiac output )

Question 47

what are the 4'bs of beta blockers of side effects?

Answer 47

bradycardia ( hold hr less than 60 or less than 100 systolic ) bronchospams bad for heart failure patient ( new edema, rapid weight gain ) Blood sugar masking ( hypoglycemia )

Question 48

what two patients' conditions do we not give beta blockers?

Answer 48

COPD, Asthma

Question 49

what is the function of calcium channel blockers? what does it end with?

Answer 49

lowers heart rate and blood pressure pine

Question 50

whats the anagram to help remember for a patient who is taking calcium channel blockers for their side effects? (3 letter)

Answer 50

C - count hr and bp C - change position slowly B - bad headache

Question 51

what is the function of digoxin?

Answer 51

DIGs for a deep contractility, which results with less heart rate

Question 52

what is the signs and symptoms of digoxin toxicity ?

Answer 52

halo lights nausea and vomiting dizziness difficulty reading

Question 53

digoxin is super toxic towards the kidney, and patients with decrease kidney function. What are the two kidney labs that we take?

Answer 53

creatinine and BUN

Question 54

what is normal creatinine lab?

Answer 54

0.6-1.2 over 1.3 no pee pee

Question 55

do we give patients digoxin if there heart rate is lower than 60?

Answer 55

no!!

Question 56

why do we give dilators to patients with heart failure?

Answer 56

simply to decrease blood pressure, dilate vessel and decrease vascular resistance, in enhance better cardiac output

Question 57

what can we not give to patients who are taking nitrates? or vasodilators?

Answer 57

NO VIAGRA !! - no afil

Question 58

what are the 3 H's of signs and symptoms to remember when it comes to taking nitroglycerin?

Answer 58

Headache hypotension hot flushing "facial redness"

Question 59

what is the function of diuretics?

Answer 59

drain fluid out by urinating

Question 60

what do we need to watch out about potassium-wasting diuretics?

Answer 60

potassium wasting, so low potassium

Question 61

what do we need to watch out about potassium-sparing diuretics?

Answer 61

potassium sparing, so high potassium

Question 62

what does licorice do?

Answer 62

licorice lowers potassium

Question 63

when do we take diuretics? morning or night? what type of movement should the patient do ? do you take daily weights? what type of diet? sunscreen needed?

Answer 63

morning slow position changing yes low sodium diet yes

Question 64

if furosemide is given too fast. what can happen? (2) what if you're giving it for too long? like periods of it (2)

Answer 64

ototoxic hypotension nephrotoxic hypokalemia

Question 65

the following is from the nclex book

Question 66

when a patient has heart failure, what type of activity should we encourage?

Answer 66

activity with balances of rest - avoid isometric activities

Question 67

when having digoxin toxicity, what is the first thing to happen? the gi or the visual changes?

Answer 67

gi - so nausea and vomiting comes first

Question 68

what is the therapeutic range for digoxin?

Answer 68

0.5-2.0

Question 69

who has a higher risk of developing digoxin toxicity?

Answer 69

hypokalemia hypercalcemia hypomagnesemia hypothyroidism

Question 70

if the pulse is lower than 60, before giving the medication what should the nurse to do properly assess the situation?

Answer 70

count the apical pulse for a full minute at the 5th midclavicular intracostal space

Question 71

what is the antidote to digoxin?

Answer 71

digoxin immune fab