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NURS 232 > Nursing Management: Heart Failure > Flashcards

Nursing Management: Heart Failure Flashcards

1
Q

Heart Failure

A

An abnormal clinical syndrome involving impaired cardiac pumping and/or filling

Heart is unable to produce an adequate cardiac output to meet metabolic needs

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2
Q

Heart Failure is Characterized by

A

Ventricular dysfunction
Reduced exercise tolerance
Diminished quality of life
Shortened life expectancy

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3
Q

Heart failure primary Risk factors

A

Coronary artery disease

Hypertension

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4
Q

Other risk factors for Heart failure

A

Diabetes (independent of CAD/ HTN)
Smoking
Obesity
High serum cholesterol

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5
Q

Four main factors that can lead to heart failure

A
  1. Preload
  2. Afterload
  3. Myocardial contractility
  4. Heart rate
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6
Q

Preload

A

This is the initial stretching of the heart muscle before contraction. It’s related to the volume of blood returning to the heart. Increased preload can lead to more forceful contractions, but if it’s too high, it can strain the heart.

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7
Q

Afterload

A

This is the resistance the heart must overcome to eject blood during contraction. Higher afterload means the heart has to work harder, which can weaken it over time.

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8
Q

Myocardial Contractility

A

This refers to the strength of the heart’s contractions. Reduced contractility means the heart cannot pump effectively, leading to decreased cardiac output.

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9
Q

Heart Rate

A

This is the number of times the heart beats per minute. An abnormal heart rate (too fast or too slow) can affect cardiac output and overall heart function.

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10
Q

Heart Failure with Reduced Ejection Fraction (HFrEF)

A

MOST COMMON FORM

Due to inability of heart to pump blood effectively

Caused by:
- Coronary artery disease (CAD)
- hypertension (HTN)
- Myocardial infarction (heart attack)
- Cardiomyopathy

Patients with EF of __less than 40%__ require specialist intervention

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11
Q

Heart Failure with Reduced Ejection Fraction (HFrEF) Hallmark finding:

A

Decrease in the left ventricular (LV) ejection fraction (EF) (LV loses ability to generate enough pressure to eject blood forward through high-pressure aorta.)

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12
Q

EF (ejection fraction)

A

fraction or % of total amount of blood in LV that is ejected during each ventricular contraction; normal EF is >55% of ventricular volume

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13
Q

Heart Failure with Preserved Ejection Fraction (HFpEF)

A

Inability of the ventricles to relax and fill during diastole

Results in decreased stroke volume and CO

Caused by:

  • Hypertension
  • Diabetes
  • Obsesity
  • Coronary artery disease

Diagnosis based on the presence of HF symptoms with an EF of 50% or greater

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14
Q

What is HFpEF

A

is characterized by the inability of the ventricles to relax and fill properly during diastole, resulting in decreased stroke volume and cardiac output.

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15
Q

What is HFrEF

A

HFrEF (Heart Failure with Reduced Ejection Fraction) is a condition where the heart muscle is weak and cannot pump blood efficiently, resulting in an ejection fraction of less than 40%. This leads to inadequate blood flow to meet the body’s needs, causing symptoms like shortness of breath and fatigue.

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16
Q

Increased sympathetic nervous system stimulation

A

Often 1st mechanism triggered but least effective; ↑ epinephrine & norepinephrine → ↑ HR, myocardial contractility, & peripheral vascular constriction

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17
Q

Neurohormonal responses

A

Renal system is particularly sensitive to reductions in blood flow & renal perfusion, activating renin-angiotensin-aldosterone mechanism;

renin-angiotensin secretion causes vasoconstriction & leads to an increase in aldosterone secretion, which causes retention of salt & water; retention of salt & water causes an increase in preload; although helpful at first, sodium & water retention becomes excessive, resulting in signs of systemic venous congestion & edema.

Over time, a systemic inflammatory response is mounted & accounts for cardiac wasting, muscle myopathy, & fatigue (advanced HF).

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18
Q

Cardiac Decompensation

A

Compensatory mechanisms can no longer maintain adequate CO & insufficient tissue perfusion results

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19
Q

Ventricular Remodelign

A

Hypertrophy of cardiac myocytes -> large, abnormal cells

Eventually leads to ↑ ventricular mass, changes in ventricular shape, & impaired contractility

End result is a bigger, but less effective pump

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20
Q

Ventricular dilation

A

Enlargement of chambers of heart due to elevated pressure over time

cardiac muscle can dilate & increase stretch of its fibers, which increases the force of contraction.

initially an adaptive mechanism to cope with increased blood volume -> decreased elasticity in the muscle fibers leads to decreased CO

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21
Q

Ventricular hypertrophy

A

Increase in muscle mass & cardiac wall thickness due to overwork & strain

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22
Q

Compensatory Mechanisms

A
  • Increased Sympathetic nervous system stimulation
  • Neurohormonal responses
  • Cardiac Decompensation
  • Ventricular Remodeling
  • Ventricular dilation
  • Ventricular hypertrophy
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23
Q

Counterregulatory Mechanisms

A
  • ANP
  • BNP

Both hormones produced by the heart muscle in response to increased blood volume in the heart

Have renal, CV, and hormonal effects

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24
Q

ANP

A

atrial natriuretic peptide

released from the atria

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25
BNP
Beta-type natriuretic peptide Released from the ventricles
26
Types of Heart failure
- Left-sided HF (Most common) - Right-sided HF
27
Left-sided HF (Most common)
- Backup of blood into the left atrium and pulmonary veins Manifested as pulmonary congestion
28
Right-sided Heart Failure
Causes backward blood flow to the right atrium and venous circulation Results in peripheral edema, ascites, hepatomegaly, and jugular venous distention (JVD)
29
Clinical Manifestations: Acute Decompensated Heart Failure (ADHF)
Compensatory mechanisms fail Manifests as pulmonary edema, often life-threatening. Symptoms include: 1. Dyspnea (shortness of breath) 2. Orthopnea (difficulty breathing while lying flat) 3. Cough with frothy, blood-tinged sputum 4. Crackles, wheezes, rhonchi in lung sounds 5. Tachypnea (rapid breathing) 6. Anxious, pale, possibly cyanotic (bluish skin due to lack of oxygen)
30
Chronic Manifestation of HF Left-Side: Respiratory
Pulmonary congestion Dyspnea Bilateral crackles Frothy productive cough Hemoptysis Orthopnea Acute pulmonary edema
31
Chronic Manifestation of HF Left-Side: Cardiovascular
Pallor and cool skin Hypotension Third heart sound Enlarged ventricle (PMI shift to left)
32
Chronic Manifestation of HF Left-Side: Urinary
Decreased output  oliguria Nocturia is common ↑ BUN
33
Chronic Manifestation of HF Right-side
Weight gain Ascites Anasarca Liver enlargement Peripheral edema Dependent edema JVD
34
General S&S of heart failure
Tachycardia Reduced exercise tolerance Fatigue Anorexia and cachexia Behavioural changes
35
Goal of therapy is to improve left ventricular function by:
Decreasing intravascular volume - _______? Decreasing venous return (preload) ________? Decreasing afterload ____________? Improving gas exchange & oxygenation _____? Improving cardiac function ___________? Reducing anxiety _____________?
36
Decreasing intravascular volume:
Administer diuretics, such as furosemide, to reduce fluid overload.
37
Decreasing venous return (preload):
Position the patient in a high Fowler's position with legs down. Administer vasodilators, such as nitroglycerin.
38
Decreasing afterload:
Administer medications like ACE inhibitors or ARBs to lower vascular resistance. Use vasodilators like nitroprusside.
39
Improving gas exchange & oxygenation:
Administer supplemental oxygen. Use non-invasive ventilation like CPAP or BiPAP if needed.
40
Improving cardiac function:
Administer inotropic agents like dobutamine or milrinone. Ensure adequate cardiac monitoring.
41
Reducing anxiety
Provide calm and reassuring communication. Administer anxiolytics if necessary.
42
Interprofessional Care Chronic Heart Failure
- O2 administration - Self-Management Teaching - Regular exercise & activity Supportive Devices: - Cardiac resynchronization therapy - Implantable Cardioverter-Defibrillator - Mechanical Circulatory Support Cardiac transplantation is an option in only a VERY SMALL number of patients!
43
Medication Therapy
Therapeutic objectives: 1. Identify the type of HF and causes 2. Correction of Na+ and H2O retention & volume overload 3. Reduction of cardiac workload 4. Improve myocardial contractility 5. Control of precipitating and complicating factors
44
Common medication for HF
- Diuretics - ACE inhibitors - B-Adrenergic blockers - Neprilsyn Inhibitors - Vasodilators - Digitalis
45
Diuretics
(Example: Furosemide) Reduces preload by reducing intravascular volume. Reduces preload.
46
ACE inhibitors
Examples: Lisinopril, Enalapril) 1st line therapy. Vasodilator (Lowers BP), decreases systemic vascular resistance, Cardiac output (CO). ARBs (ie Cozaar) in pts who can’t tolerate d/t angioedema or cough.
47
β-Adrenergic blockers
(Examples: Metoprolol, Carvedilol) Reduces cardiac oxygen demand by decreasing HR and BP.
48
Neprilysn Inhibitors
(Example: Sacubitril) This class inhibits neprilysin, reducing the degradation of natriuretic peptides, bradykinin, and adrenomedullin, leading to decreased vasoconstriction, sodium retention, and maladaptive remodeling.
49
Vasodilators: nitrates
Reduces afterload by dilating peripheral blood vessels Increases myocardial oxygen supply by dilating cardiac blood vessels First-line medication in the management of chest pain
50
Digitalis
Increases cardiac output (↓ HR → ↑ ventricular filling and contractility) Small therapeutic window: watch for manifestations of toxicity Important assessments here: Monitor for signs of digitalis toxicity (e.g., nausea, vomiting, visual disturbances). Regularly check electrolyte levels (especially potassium).
51
Inotropic Drugs do what?
Inotropic drugs affect the strength of the heart's contractions: Positive inotropic drugs: Increase the force of contractions, helping the heart pump more blood (e.g., dobutamine, digoxin). Negative inotropic drugs: Decrease the force of contractions, reducing the heart's workload (e.g., beta-blockers, calcium channel blockers).
52
Nutritional Therapy
Diet Education: - Na+ restriction (2.0g/ day in HF; 1.5g/day in HF + HTN) - Fluid restriction (1.5-2L/ day) - 50% should be water Weight Management: - Daily weight - Report gains of 2 kg/ 24h or 2.5kg in one week
53
Nursing diagnoses for HF: Inadequate cardiac output
- Frequent physical assessments -VS, heart sounds, lung sounds, LOC, edema, cap. refill, fluid balance, and lab values. - Pharmacological management - Promote adequate rest - Strict intake and Output. DAILY weights.
54
Nursing diagnoses for HF: Reduced Gas exchange
- Oxygen administration - Incentive spirometer and deep-breathing exercises - Semi-Fowler’s / Fowler’s / Orthopneic position - Diuretic therapy
55
Nursing Diagnoses for HF: Excess fluid volume
1. Monitor daily weight to track fluid retention. 2. Assess for edema in extremities and sacral area. 3. Monitor intake and output to ensure fluid balance. 4. Administer diuretics as prescribed to reduce fluid overload.
56
Nursing Diagnoses for HF: Activity Intolerance:
- Treatment of infections or other disease processes - Prioritize activities (assistance with basic ADL’s may leave energy for activities that are more important to the patient) - Promote sleep - Rest
57
Nursing Diagnoses for HF: Anxiety
Stress management strategies Prompt management of chest pain and dyspnea Environmental considerations
58
Emergency complications of HF: Digitalis Toxicity
Cardiovascular System: Bradycardia, tachycardia; irregular pulse/arrhythmia GI: anorexia, nausea, vomiting, diarrhea, abdominal pain Neuro: headache, drowsiness, confusion, insomnia, muscle weakness, double vision, blurred vision, visual halos Patients have regular serum digoxin levels taken to make sure they are in the therapeutic range.
59
Successful HF mgmt. depends on these principles:
HF is progressive; QoL is paramount Pt self-mgmt. needs to be emphasized Na+ and H2O need to be restricted Regular exercise should be maintained Use of supports is essential to success of tx plan Med adherence is important
60
Patient and Family Teaching Guide
What is heart failure? Health Promotion Exercise & Rest Medication Therapy Dietary Therapy Other Topics Ongoing Monitoring
61
Living with HF: A social support & quality of life perspective
Social support : - Informational support - Tangible support - Psychological / emotional support Quality of life: - Physical, psychological, social, and spiritual responses
62
To evaluate the effects of treatment on a client's right ventricular failure, the nurse will plan to assess and document the client's: breath sounds. pulse quality. capillary refill. peripheral edema.
peripheral edema.
63
The charge nurse is observing a student nurse who is caring for a client with acute decompensated heart failure. Which action by the student nurse indicates that further education about care for clients with heart failure is needed? The student raises the client’s head to 60 degrees. The student titrates the O2 flow to maintain the O2 saturation at 93%. The student elevates the client’s feet. The student administers a prn dose of morphine to the client.
The student elevates the client’s feet.
64
After the home health nurse implements teaching for a client with heart failure, which client action indicates that the teaching has been effective? The client calls the nurse about a weight change from 112 to 117 lb in 24h. The client takes the ordered angiotensin-converting enzyme (ACE) inhibitor whenever the blood pressure is elevated. The client takes the daily furosemide (Lasix) at bedtime. The client stays in bed except to use the bathroom
The client calls the nurse about a weight change from 112 to 117 lb in 24h.
65
70 years old, admitted to the medical unit with increasing dyspnea on exertion. MI when she was 58 25 year Hx of hypertension Increasing dyspnea over last 2 years – can not walk 2 blocks without SOB Recent respiratory tract infection Moist cough Edema in both legs up to knees Sleeps with head elevated on three pillows Not great remembering to take meds 5kg weight gain in 3 days On assessment. . . In resp distress, using accessory muscles, RR-36 Moist crackles at the bases of both lungs Skin cool and diaphoretic 2+ pitting edema in both legs HR – 95 and regular BP – 160/90 O2 – 88% on r/a
Respiratory distress: Using accessory muscles with a respiratory rate of 36 breaths per minute, moist crackles at lung bases, and a moist cough. These indicate significant pulmonary congestion and fluid buildup. Hypoxemia: Low oxygen saturation at 88% on room air, requiring immediate attention to improve oxygenation. Peripheral edema: 2+ pitting edema in both legs, suggesting significant fluid retention and worsening heart failure. Weight gain: A rapid gain of 5 kg (11 lbs) in 3 days, indicating severe fluid overload. Elevated blood pressure: 160/90 mmHg, which can exacerbate heart failure symptoms and require management.

NURS 232 (6 decks)

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