Module E (CHF ONLY) Study Guide

Question 1

What are the three types of heart failure?

Answer 1

Left Sided, Right Sided, High-Output Failure

Question 2

What is left sided heart failure? Causes?

Answer 2

b. There are two types: systolic & diastolic
i. Systolic: results when heart cannot contract forcefully enough during systole to eject enough blood.
ii. Diastolic: Occurs when left ventricle cannot relax enough during diastole, preventing it from filling adequately.

Question 3

What are L-Sided Heart Failure s/s? Complications? Treatment?

Answer 3

Treatment for L sided heart failure: ACE Inhibitors (it decreases afterload), Naturecore (gets rid of excess fluid, check kidney function first)

Question 4

What is the ejection fraction? Why is it important?

Answer 4

It is important to know the ejection fraction so you know how well the heart if functioning. The lower the fraction, the worse the heart is doing. Anything below 55% is bad.

Question 5

What is the difference between systolic and diastolic heart failure?

Answer 5

Systolic is when the heart cannot contract enough to pump out adequate amounts of blood, and diastolic is when it cannot relax long enough, or it is too stiff to relax enough to allow enough blood into the ventricles.

Question 6

What is high output failure?

Answer 6

This happens when you’re septic. Occurs when cardiac output remains normal or above normal. Caused by increased metabolic needs or hyperkinetic conditions, like septicemia, high fever, anemia, and hyperthyroidism.

Question 7

What is stroke volume? Cardiac output?

Answer 7

The volume of blood pumped out of the heart each contraction. Cardiac output is the amount pumped out of the heart each minute.

Question 8

What is preload? Afterload?

Answer 8

Preload is the amount of blood coming into the heart (i.e. when it fills up) Afterload is when leaving?

Question 9

What is the BNP? How does this affect HF?

Answer 9

B-type nutremic peptide. This affects HF because if it is high it is an indicator of heart failure. Normal BNP is below 100.A BNP can also show fluid overload.

Question 10

What effect does ADH have on HF?

Answer 10

It causes vasoconstriction and fluid retention. If you do not have enough, you’re retaining fluid. ADH is made in the pituitary gland. If they have endocrine problems they might have problems with adh.

Question 11

What is endothelin?

Answer 11

Protein that constricts blood vessels and increases blood pressure. Normally kept in balance by other mechanisms but can contribute to high blood pressure and heart disease.

Question 12

What is myocardial hypertrophy?

Answer 12

An enlarged heart. The bigger the heart, the less oxygen it gets and it doesn’t pump very well

Question 13

What is right sided heart failure? Causes?

Answer 13

Right sided heart failure is systemic. Coronary artery disease.

Question 14

What are its s/s (of R sided heart failure)? Complications? Treatment?

Answer 14

Right sided you’ll have pitting edema and fluid overload. Edema in the extremeties. Complications include arrhythmias, repeated hospitalizations, worsening of the HF.

Question 15

What diagnostic tests are run to diagnosis HF?

Answer 15

X ray, Pro BNP, BMP, Electrolyte levels, EKG/ECG, Echocardiogram (which determines whether or not the heart is putting out the right amount of fluid)

Question 16

What are ACEs and ARBs? How do they work? Name some?

Answer 16

y. ACEIs are Angiotensin-Convertine Enzyme Inhibitors.
z. ARBs are Angiotensin-Receptor Blockers.
aa. They both improve function and quality of life for patients with HF.
bb. ACE inhibitors prevent conversion of angiotensin I to angiotensin II, resulting in arterial dilation and increased stroke volume.
cc. ARBs block effect of angiotensin II receptors and decrease arterial resistance and arterial dilation.
dd. These drugs also block aldosterone, which prevents sodium and water retention and increases fluid overload.
ee. Some ACE inhibitors are Vasotec and Fosinopril.
ff. ARBs are Diovan, Avapro, and Cozaar.

Question 17

What are some complications of these?

Answer 17

Complications are Orthostatic Hypotension, Decreased urine output in folks with low systolic BP, poor peripheral perfusion,

Question 18

What is Natrecor? How does it work?

Answer 18

It is synthetic BNP. It is used to treat heart failure. It helps bring down blood pressure and get rid of fluid.

Question 19

Why is a low sodium diet recommended?

Answer 19

Sodium retains water. You don’t want this with HF.

Question 20

Why would you give Morphine sulfate for CHF?

Answer 20

It helps the patient relax and breathe, it also helps their pain level.

Question 21

What diuretics are best for CHF? Name them?

Answer 21

Loop diuretics. Lasix, Butrex. Remember, Aldactone is the only potassium sparing diuretic.

Question 22

Why are creatinine levels important when administering certain medications?

Answer 22

Creatinine levels indicate kidney function.

Question 23

Why are nitrates used for HF?

Answer 23

They are vasodilators. Just monitor blood pressure and heart rate. Nitrates will reduce both and they will also have headaches. Example of nitrate: nitroglycerin. Sublingual, topical, and iv drip are routes for nitrates.

Question 24

What does Digoxin do? What are some complications in its use?

Answer 24

It increases the contractability of the heart. #1- check the heart rate! Do not give if HR is below 60. You also have to continually check dig levels. Normal is 0.8-2.0 if it is greater than 2.0 HOLD the medication.

Question 25

What is Dobutamine? What is Primacor? What is Simdax?

Answer 25

Dobutamine is used for short term treatment for HF. It gets rid of fluid. Primacor and Simdax are also used to treat CHF

Question 26

What are Beta Blockers? How are they used? Name some? Complications of use?

Answer 26

Beta blockers end in -lol. Lopressor is an example. Complications include: Bradychardia, ringing in the ears.

Question 27

How does a CPAP help?

Answer 27

It helps expand the lungs which pushes water out into the system. It improves oxygenation.

Question 28

What is CRT? How does this help?

Answer 28

CRT is cardiac resynchronization therapy. It uses a permanent pacemaker alone or is combined with an implantable cardioverter/defibrillator.

Question 29

What are some nursing diagnosis for heart failure?

Answer 29

Impaired gas exchange r/t… decreased cardiac output, fatigue and weakness, anything that has to do with fluid overload.

Question 30

What are some nursing interventions for heart failure?

Answer 30

Airway!! (raise had of bed, make sure they are breathing well, give oxygen, etc), Elevate feet, daily weights, strict I/O, low sodium diet.1500-2000 mL of fluid a day, no more. (this is fluid restriction)

Question 31

Why is weight and I&O important for these patients?

Answer 31

This gives you a baseline. 1L = 2.2 pounds.

Question 32

What type teaching would you do for discharge of HF patients?

Answer 32

DIET (low sodium), possible fluid restriction, teach about new meds they are on and why they have to take them. Exercise,

Question 33

Where can you hear a bruit?

Answer 33

Carotid

Question 34

Common symptoms with ACE inhibitors?

Answer 34

Dry nagging cough. This is not part of chf, but I’m adding it anyway.