Module 4 Part 4 Heart Failure Flashcards
what is preload? and what is the greatest determinant?
- ‘the degree to which myocardial fibers are stretched at the end of diastole…just before systole’
- greatest determinant is venous blood return to heart
what is afterload? and what is the greatest determinant?
- resistance in aorta that the heart has to pump its volume against
- greatest determinant is peripheral arterial vasoconstriction
what is contractility?
contractile strength of the heart pump
what happens with the blood in R sided heart failure?
- back up of blood to body
- decreased blood in lungs
what happens with the blood in L sides HF?
-dec. of blood to body
mnfts of L sided HF (9)
- dyspnea
- elevated pulmonary capillary wedge pressure
- pulmonary congestion: cough, crackles, wheezes, tachypnea, blood-tinged sputum
- restlessness
- confusion
- orthopnea
- tachycardia
- fatigue
- cyanosis
mnfts of R sided HF (8)
- fatigue
- inc. peripheral venous pressure
- ascites
- enlarged liver and spleen
- distended jugular veins
- anorexia and complaints of GI distress
- weight gain
- edema
modifiable risk factors for HF (6)
- ischemic heart disease
- HTN
- diabetes
- metabolic syndrome
- hyperlipidemia
- smoking
what are the overall goals of HF management?
-ELIMINATE OR REDUCE CONTRIBUTORY FACTORS -REDUCE WORKLOAD ON THE HEART (prelaod/afterload) -OPTIMIZE ALL THERAPEUTIC REGIMENS -PREVENT EXACERBATIONS OF HF
drugs for L sided HF
- diuretics
- ACE inhibitors
- angiotensin 2 receptor blockers
- direct vasodilators
- beta blockers
- cardiac glycosides (digoxin)
what do preload reducer drugs do?
Reduce myocardial workload by reducing the amount of volume coming back to the heart
what is the worst thing that could happen if someone takes a preload reducer drug?
- inadequate cardiac output by pooling of blood in extremities
- hypotension (orthostatic)/dehydration
- electrolyte imbalance
2 examples of preload reducer drug classifications?
-diuretics, vasodilators
what do afterload reducer drugs do?
Reduce myocardial workload by decreasing the resistance that the heart has to pump against
what is the worst thing that could happen if someone takes a afterload reducer drug?
- hypotension, hypovolemia, hyperkalemia
- aggravated heart failure
examples of afterload reducer drug classifications?
ace inhibitors, angiotensin 2 blockers, diuretics
what do contractility (& afterload) reducers drugs do?
- reduce myocardial workload by reducing contractile force
- reduce myocardial workload by reducing after load
what is the worst thing that could happen if someone takes a contractility (& afterload) drug?
inadequate CO from reduced contractility
examples of contractility (& afterload) drug classifications?
-extended release of beta blockers only*: carvedilol and metoprolol b/c of their afterload reduction properties
what do positive inotrope drugs do?
increase the contractile force of the myocardium and slow HR
what is the worst thing that could happen if someone takes a positive inotrope drug?
-increase myocardial workload by increasing oxygen demands, digoxin toxicity (digoxin levels!!!)
example of a class for positive inotropes?
cardiac glycosides (digoxin)
what Dx would you want for HF (8)
-chest xray
-echo (ejection fraction)
-ECG
-angiogram
-BNP
-CBC and renal Fx
-Na and K (electrolytes)
digoxin therapeutic levels
what lab values would you be interested in for HF?
- CBC
- electrolytes
- GFR, creatinine
- digoxin level
- BNP
what is BNP?
Brain Natriuetic Peptide- LAB
- secreted by the ventricles in response to excessive stretching of cardiac muscle cells
- WILL BE POSITIVE IF THERE’S HF
what are the two actions of BNP?
- actions include:
1. dec. in systemic vascular resistance and central venous pressure
2. increase in natriuresis: the process of excretion of Na in urine via the kidneys
whats a nutritional intervention for people with HF?
DASH diet (DIETARY APPROACHES TO STOP HTN) -reducing sodium in diet reduces fluid retention and decreases circulating BV
how is fluid volume managed? (6)
- diuretic therapy
- daily weight
- fluid restrictions (ins/outs)
- respiratory assessment
- positional to reduce pre-load
- assessing skin for breakdown
what is nursing mngmt for activity intolerance?
- rest
- individualized period of daily exercise gradually increasing in duration
what is nursing mngmt for SOB?
- supplemental oxygen; monitor O2 sats
- for SOBOE, have pt rest, raise HOB
- complete respiratory assessment
what is nursing management for controlling anxiety?
- admin o2 if reqd
- promote physical comfort and psychological support
- relaxation techniques
- screen for depression
what is nursing management for impaired sleep?
- providing reqd pillows for ease of breathing
- provider chair for pt if they cannot get comfortable in bed
what is a crystalloid fluid?
aqueous solution of mineral salts and other small, water-soluble molecules
why would you administer crystalloids?
they contain electrolytes so they increase circulatory volume without altering chemical balances in the vascular spaces
what are the negative side effects of crystalloids?
electrolyte balance, coagulation, liver and kidney function
what is a colloid fluid?
-homogeneous noncrystalline substance consisting of large molecules dispersed through a second substance
why would you administer colloids?
restores the intravascular volume with minimal risk of tissue edema in comparison with crystalloid solutions alone
what are the negative side effects of colloids?
Intravascular volume overload, dilutional coagulopathy, extravascular extravasation across leaky capillary membranes, and anaphylactoid reactions
what is heart failure?
the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
in the past, what was heart failure often referred to as? and why?
often referred to as congestive heart failure because many patients experience pulmonary or peripheral congestion
what is HF characterized by?
characterized by S+S of fluid overload or of inadequate tissue perfusion
what occurs with left sided HF (pulmonary congestion)?
when the left ventricle cannot effectively pump blood out of ventricle into the aorta and systemic circulation
what occurs with R sided HF?
there is congestion in the peripheral tissues and the viscera predominates
