Heart Failure (Week 6) Flashcards
What is heart failure? (pathophysiology)
decreased cardiac output (CO) which leadds to a decrease in blood flow to the kidneys & other vital organs / tissues
What do the following adrenergic receptors do?
- Alpha
- Beta 1
- Beta 2
- Dopaminergic
KNOW THIS!!!
- Alpha: vasoconstriction of peripheral arterioles
- Beta 1: increased HR, conduction, & contractility
- Beta 2: Vasodilation of peripheral arteries & bronchodilation
- Dopaminergic: Dilation of renal & mesenteric arteries
What are ALPHA adrenergic receptors responsible for?
KNOW THIS!!!
Vasoconstriction of peripheral arterioles
What are BETA 1 adrenergic receptors responsible for?
KNOW THIS!!!
Increased heart rate, conduction, & contractility
What are BETA 2 adrenergic receptors responsible for?
KNOW THIS!!!
vasodilation of peripheral arteries & broncho dilation
What are DOPAMINERGIC receptors responsible for?
KNOW THIS!!!
dilation of renal & mesenteric arteries
What is preload?
KNOW THIS!!!
VOLUME in the ventricles at the end of diastole
more volume = higher pressure
What is afterload?
KNOW THIS!!!
Pressure or resistance the ventricles have to push against
What does afterload impact?
cardiac performance
inverse relationship
- ↑ afterload = ↓ cardiac output
- ↓ afterload = ↑ cardiac output
What happens to preload in the following situations?
1.) Patient is in Hemorrhagic Shock
2.) Patient is given a Fluid Bolus
KNOW THIS!!!
1.) Hemorrhagic Shock causes a decrease in preload (loss of fluid = low BP)
2.) Fluid Bolus causes increase in preload (giving fluid to the pt = increased BP)
What happens to afterload during the following scenarios?
1.) Septic Shock
2.) Patient is on or is given Nipride, Nitroglycerin, Lasix, Morphine, or ACE inhibitiors
3.) Patient is on or is given a vasopressor like Levophed
KNOW THIS!!!
1.) Septic Shock causes INCREASED afterload (ventricles must overcome a greater pressure than usual)
2.) Patient is on or is taking Nipride, Nitroglycerin, Lasix, Morphine, or ACE Inhibitors causes decreased afterload (ventricles must overcome a lower presser than usual)
3.) Patient is on or is given Vasopressors like Levophed causes INCREASED afterload
- INCREASED afterload: ventricles must overcome a greater pressure than ususal
- decreased afterload: ventricles must overcome a lower pressure than usual
What is one unique thing about ACE Inhibitors regarding preload & afterload?
ACE Inhibitors decrease BP but there is NO Reflex Tachycardia
- Reflex Tachycardia: due to a lowered BP, the body tries to compensate by increasing the HR
Common side effects of ACE Inhibitors
KNOW THIS!!!
- ANGIOEDEMA
- Headache
- Nagging dry cough
What is contractility?
force the heart beats with & how effective the heart is beating
What do the following drugs / disorders / treatments do to contractility?
- Dobutamine (vasopressor)
- Digoxin
- Acidosis
- Fluid bolus administration
- Dobutamine (vasopressor) decreases contractility
- Digoxin INCREASES contractility (pts w/ A-fib have poor contractility
- Acidosis decreases contractility
- Fluid bolus administration INCREASES contractility
What is End Diastolic Volume?
How much blood is in the ventricles before contraction
What is normal ejection fraction (EF)?
greater than (>) 55%
What is the difference in depressed/reduced CHF (HFrEF / systolic HF) and preserved CHF (HFpEF / diastolic HF)?
KNOW THIS!!!
- Reduced CHF (HFrEF / Systolic) = EF under 40%
- Preserved CHF (HFpEF / Diastolic = EF > 40%
What is Reduced CHF / HFrEF (systolic HF)?
EF under 40%
What is Preserved HF / HFpEF (diastolic HF)?
EF over 40%
What are the symptoms of left sided heart failure?
KNOW THIS!!!!! ON EXAM!!!!!
PULMONARY
* cough
* crackles
* shortness of breath
* pulmonary congestion
* pulmonary edema
* cough with frothy sputum
* orthopnea
* dyspnea
Left Sided = Lungs
What are the symptoms of right sided heart failure?
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PERIPHERAL
* edema (dependent)
* JVD
* weight gain
* ascietes
What is the difference in inotropes & chronotropes?
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- Inotropes affect contractility
- Chronotropes affect the HR
What do inotropes impact?
Contractility
- + inotrope = INCREASED contractility
- - inotrope = decreased contractility
What do chronotropes affect?
heart rate
- + chronotrope = INCREASED HR
- - chronotrope = decreased HR
List drugs that are positive isotropes.
- dobutamine
- dopamin
- digoxin
- epinephrine
Are the following drugs positive or negative chronotropic drugs?
- Dopamine
- Digoxin
- Epinephrine
KNOW THIS!!!!! ON EXAM!!!!!
- Dopamine & Epinephrine = + chronotropes
- Digoxin = - chronotrope
What is pulmonary edema and what are potential causes?
Too much fluid in the lungs
- heroin overdose
- head injury
- anterior wall MI
- cardiomyopathy
What medication is used to treat SVT?
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Adenosine (adenocard)
What medication is used to treat bradycardia?
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Atropine
What medication is used to treat V-Fib, PEA, & asystole?
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Epinephrine
What are the “significant six” in terms of education for patients who are having or have had cardiac resynchronization therapy (CRT)?
1.) Smoking cessation
2.) Weight monitoring
3.) Symptoms to report
4.) Diet
5.) Activity
6.) Medications
What is Left Ventricular Ejection Fraction (LVEF)?
Ratio of stroke volume to end diastolic volume
A patient is diagnosed with heart failure & is prescribed digoxin (Lanoxin) and furosemide (Lasix). Before administering furosemide to the patient, which lab result should the nurse review?
a.) Serum sodium (Na+)
b.) Serum troponin
c.) Serum potassium (K+)
d.) BUN
c.) Serum potassium (K+)
A patient who has a history of pulmonary valve stenosis tells the HCP, “I don’t have a lot of energy anymore, and both my feet get swollen in the late afternoon”. Which of these problems does the HCP conclude is the likely cause of these clinical findings?
a.) Acute pericarditis
b.) DVT
c.) Peripheral artery disease
d.) Right ventricular failure
d.) Right ventricular failure
