Heart Failure (M4D) Flashcards
1
Q
heart failure
A
- inability of the ventricles to pump enough blood to meet the body’s metabolic demands
- clinical syndrome
- fluid overload, inadequate tissue perf
- d/t disorder that affects heart’s ability to receive and eject blood
- chronic, progressive syndrome
- manage by lifestyle changes & meds
- no cure, only Tx
2
Q
systolic HF
A
- results in dec blood vol being ejected from the ventricles
- where HF begins
- dec CO, dec systemic BP, dec perf to kidneys
- forces body to go into RAAS (inc aldosterone, activate baroreceptors, leads to diastolic HF)
- ventricular remodelling (inc hypertrophy to meet demands but it makes heart work harder to pump)
- heart does not pump sufficient blood through body –> stimulates heart to work harder –> heart cannot respond –> failure progresses and gets worse and worse
3
Q
L sided HF
A
- L side of heart pumps O2-rich blood around the loop, blood coming from the lungs
- if L side of heart cannot keep up w amount of blood returning from the lungs, fluid backs up into pulm circulation
- blood returned from pulm vessels dec as pressure in L side of heart inc
- inc pressure of blood working to return L side of heart forces fluid from pulm capillaries to push into pulm tissues and alveoli –> pulm edema and impaired gas exchange
- leads to R sided HF
4
Q
R sided HF
A
- R side of heart accepts deoxygenated blood from the body
- if blood trying to return to R side but not able to accomodate it, it will back up and venous return congested
- results in congestion in peripheral tissues and viscera
5
Q
HF risk factors
A
- CAD
- cardiomyopathy
- valvular heart disease
- HTN
- renal dysfx
- age
- DM
- metabolic syndrome
- hyperlipidemia
- A-fib
- smoking
6
Q
L side HF S&S
A
- dyspnea
- SOB
- orthopnea (difficulty breathing while lying flat)
- dry-nonprod cough that leads to frothy pink blood-tinged sputum
- crackles in lungs
- fatigue
7
Q
R side HF S&S
A
- inc jugular vein distention
- edema in lower extremities
- enlargement of liver & spleen
- anorexia
- nausea
- weakness
- weight gain (d/t retention of fluid)
8
Q
interventions for HF
A
- nutrition (DASH diet)
- fluid vol interventions
- activity intolerance
- control SOB
- control anxiety
- impaired sleep
9
Q
fluid volume interventions
A
- diuretic therapy
- daily weight
- fluid restrictions (in/out)
- respiratory assessment
- positioning to reduce preload (semi-fowlers)
- assess for skin breakdown
10
Q
activity intolerance interventions
A
- rest during times of exacerbation (dec workload of heart)
- individualized period of daily exercise gradually inc in duration
- do not exercise in extreme weather (can inc workload on heart)
- pt should be able to talk while exercising
- stop exercising if experiencing SOB, pain, dizziness
- cool-down activities after exercising
11
Q
SOB interventions
A
- supplemental O2; monitor O2 sats
- rest when SOBOE
- raise HOB (never let pt lay flat w/ HF)
- complete respiratory assessment (use of accessory muscles, RR, WOB)
12
Q
controlling anxiety interventions
A
- admin O2 if required
- promote physical comfort and psychological support
- relaxation techniques
- screen for depression
13
Q
impaired sleep interventions
A
- provide required pillows for easy of breathing
- provide chair for pt if they cannot get comfy in bed
- do not lie flat for pts w HF
14
Q
assessments / monitoring for HF
A
- assess Na, K levels and fluid balance
- weigh daily
- respiratory assessments
- assess for JVD
- monitor and evaluate severity of edema
- examine skin turgor & monitor for signs of dehydration
- monitor pulse, BP, signs of postural hypotension
15
Q
evaluation for HF pts
A
- demonstrates tolerance for inc activity
- maintains fluid balance
- demonstrates less anxiety
- makes decision regarding Tx and care
- adheres to self-care regimen
16
Q
diagnostics for HF
A
- echocardiogram (EF)
- chest X-ray
- angiogram
- BNP
- K+ and Na+ (electrolytes)
- CBC, renal fx, LFT
- thyroid stimulating hormone
- urinalysis
- digoxin therapeutic levels
17
Q
lab tests for HF
A
- CBC
- electrolytes
- GFR, creatinine
- digoxin level
- BNP
18
Q
electrolyte imbalances
A
- hypokalemia: HTN, ventricular dysrhythmias, muscle weakness
hyperkalemia: SE of ACE inhibitors and ARBs, spirolactone, dysrhythmias - hyponatremia: S&S = disorientation, fatigue, malaise, muscle cramps
19
Q
brain natriuretic peptide (BNP)
A
- secreted by ventricles of heart in response to excessive stretching of cardiac muscle cells
- to determine if pt is in HF and severity of HF
- also used as an indicator if Tx improving HF condition
20
Q
fluid balance
A
- intravascular fluid (in vessels)
- extravascular fluids (lymph or CSF)
- interstitial spaces (spaces b/w cells, tissues & organs)
- isotonic (soln equal conc of solns across membranes)
- osmotic pressure (fluid shifting from low to high conc until soln equal conc)
- colloid osmotic pressure (similar to osmosis but w proteins)
21
Q
drugs used to treat HF
A
- diuretics
- ACE inhibitors
- ARBs
- direct vasodilators
- beta blockers
- cardiac glycosides (digoxin)
22
Q
preload reducers
A
- reduce myocardial workload by reducing amount of vol coming back to heart
- ex. diuretics, vasodilators
23
Q
worst thing that can happen when taking preload reducers…
A
- inadequate CO by pooling of blood in extremities
- hypotension (orthostatic)/dehydration
- electrolyte imbalance
24
Q
afterload reducers
A
- reduce myocardial workload by dec resistance heart has to pump against
- ex. ACE inhibitors, ARBs, diuretics
- look for retained high K+ levels and low Na+ levels
- given in combination w/ diuretics
- assess HR, BP, blood values, and electrolytes
- monitor urine output, dry mucous membranes, high HR, low BP, arrhythmias, blood values
25
worst thing that can happen when taking afterload reducers...
- hypotension, hypovolemia, hyperkalemia
| - aggravated HF
26
contractility (& afterload) reducers
- reduce myocardial workload by reducing contractile force
- reduce myocardial workload by reducing afterload
- ex. beta blockers
- assess apex 1 min (HR) and BP
- look at pt's normal HR & BP
27
worst thing that can happen by taking contractility reducers...
- inadequate CO from reduced contractility
| - develop bradycardia, dec urinary output
28
positive inotropes (cardiac glycosides)
- inc the contractile force of myocardium
- slow HR (gives heart more time to fill)
- ex. cardiac glycosides (digoxin)
- do not give digoxin if HR below 60
29
worst thing that can happen by taking positive inotropes...
- inc myocardial workload by inc O2 demands, digoxin toxicity
- bradycardia (dec conduction b/w nodes)
30
assessments/monitoring for positive inotropes...
- assess HR (apex 1min)
- monitor blood values of digoxin (avoid toxicity)
- monitor renal Fx (excreted by kidneys)
- look at last dosage of digoxin
- be aware of S&S of digoxin toxicity (anorexia, nausea, visual disturbances, bradycardia, confusion)
- careful of loop diuretics (dysrhythmias); watch for K+ levels
31
pt teaching w/ digoxin
- S&S of digoxin toxicity (anorexia, nausea, visual disturbances, bradycardia, confusion)
- teach about dosing
- med in liquid form
- keep digoxin tablets in air-tight container protected from light
32
pediatric considerations of HF
- most frequently secondary to structural abnormalities
- congenital heart defects (need Sx)
- myocardial failure, contractility of ventricles impaired (d/t cardiomyopathy, dysrhythmias, severe electrolyte imbalances, ind demand on heart w/ sepsis or severe anemia)
33
goals of HF therapy
- treat underlying issue
- improve cardiac Fx (inc contractility & dec afterload)
- remove accumulated fluid and Na+ (diuretics, test electrolytes regularly, give fludi in small containers, daily weigh ins)
- dec cardiac demands (neutral thermal enviro, treat infect, reduce WOB)
- improve tissue oxygenation and dec O2 consumption (add supplemental O2)
34
crystalloid fluid
supply water and Na+ to maintain osmotic gradient b/w extravascular and intervascular compartments
- if given large amounts --> dec colloid osmotic pressure
35
why admin crystalloids
- admin as maintenance IV fluid
- pt NPO
- dehydration
- hypovolemic shock
- hypotension
- inc urinary flow
- electrolyte imbalances
36
negative SE of crystalloids
- some will inc intracranial pressure
| - peripheral edema (d/t overhydration, low albumin, can cause pulm edema)
37
types of crystalloids
- normal saline (isotonic soln; 0.9% Na)
- hypertonic saline (3% Na)
- some have dextrose in it (dextrose 5% water - hypertonic soln)
- ringers lactate soln (have lactate, Na, K; isotonic soln)
38
colloids
protein substances that inc the colloid osmotic pressure and move fluid from IS compartment to plasma in intravascular space by pulling fluid into blood vessels
- ex. albumin, globulins
- "plasma expanders"
- maintain plasma vol longer
39
why admin colloids
- use w burn pts (damaged blood vessels; skin not intact --> leaky)
- renal pts (give albumin during dialysis run)
40
negative SE of colloids
- more expensive
- be aware of allergies (its a protein)
- no O2 carrying capacity or clotting factors
