perfusion/circulation week 13 Flashcards
heart failure
chronic progressive cardiac disorder often characterized by s/s of fluid overload and inadequate tissue perfusion
can be managed with lifestyle mods and medication
HF is most common in
people over 75
incidence increases with age
ejection fraction (EF)
a measurement of contractility
diastolic HF
stiff and noncompliant heart muscle
systolic HF
weakened heart muscle
left sided HF
left ventricle cannot effectively pump blood out of the ventricle into the aorta
extra heart sound (S3) caused by abnormal ventricular filling (AKA ventricular gallop)
left sided HF symptoms
pulmonary congestion, cough, orthopnea, paroxysmal nocturnal dyspnea (PND) - dyspnea at night indigestion 2/2 decreased GI perfusion dizziness, confusion, anxiety decreased CNS perfusion palpitations
left sided HF signs
low o2 sats
extra heart sound (S3)
tan/pink frothy sputum from cough
pale, cool clammy skin
right sided HF s/s
increased venous pressure (JVD)
edema in lower extremities
hepatomegaly, ascites
weight gain
ACE inhibitors
promote vasodilation, diuresis
prevents progression of HF
may be first med prescribed for mild HF
-pril
angiotension receptor blockers (ARB)
alternative to ACE inhibitors
no cough side effect
-sartan
hydralazine and isosorbide dintrate side effect
symptomatic hypotension
beta blockers
prescribed in combination with ACE inhibitors; several weeks before effects
caution in asthma patients
beta blocker side effects
bradycardia
symptomatic hypotension
dizziness
fatigue
loop diuretics
decrease fluid volume
used for severe HF
side effects: electrolyte imbalances, renal dysfunction, decreased BP
monitor I&O, take daily weight
aldosterone antagonist
spironolactone
potassium-sparing diuretic
monitor for hyperkalemia, hyponatremia
digoxin
improves cardiac contractility
monitor for bradycardia, toxicity
milrinone
IV HF medication
decreases preload and afterload
side effects: hypotension, dysrhythmias
dobutamine
IV medication for left ventricular dysfunction
increases cardiac contractility and renal perfusion
gerontologic HF
may present with atypical s/s (fatigue, weakness, somnolence)
decreased renal function can make older patients more sensitive to volume changes and less responsive to diuretics
r/o urethral obstruction caused by urethral obstruction from enlarged prostate
physical assessment of HF
mental status
lung sounds
heart sounds
fluid status
goals for HF patient
promote activity
reduce fatigue
relieve fluid volume overload symptoms
decrease anxiety
nursing dx: activity intolerance
bedrest for acute exacerbation
elevate head of bed to facilitate breathing
30-45 min daily activity
wait 2 hrs after eating for physical activity
avoid activity in extreme temperatures
