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Unit 2 > Perfusion: Heart Failure > Flashcards

Perfusion: Heart Failure Flashcards

1
Q

Heart Failure: Defined

A

The inability of the heart to work effectively as a pump

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2
Q

Heart Failure: Pathophysiology

A

Chronic; acute episodes; life threatening if not adequately treated or if pt does not respond to treatment

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3
Q

Types of Heart Failure

A

Left-sided, right-sided, and high-output failure; Most begin with left-sided failure and progresses to both sides

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4
Q

Causes of Left sided HF

A

Hypertension, coronary artery disease, valvular disease; decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels indicate left-ventricular failure

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5
Q

Left-sided HF: systolic heart failure path

A

Heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation; preload increases with decreased contractility; afterload increases as a result of peripheral resistance

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6
Q

Systolic heart failure: ejection fraction

A

Normal: 50-70%; EF drops down to below 40% with ventricular dilation; tissue perfusion diminishes and blood accumulates in the pulmonary vessels; EF

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7
Q

Left-sided HF: diastolic heart failure path

A

Left ventricle cannot relax adequately during diastole; stiffening prevents ventricle from filling with sufficient blood to ensure an adequate cardiac output

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8
Q

Systolic dysfunction manifestations

A

Inadequate tissue perfusion, pulmonary and systemic congestion

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9
Q

Diastolic dysfunction manifestations

A

Inadequate tissue perfusion, pulmonary and systemic congestion

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10
Q

Causes of right-sided HF

A

Left ventricular failure, right ventricular myocardial infarction, or pulmonary hypertension

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11
Q

Right-sided HF path

A

Right ventricle cannot empty completely; increased volume and pressure develop in venous system and peripheral edema occurs

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12
Q

High-output HF causes

A

Increased metabolic needs or hyperkinetic conditions, ie: septicemia, high fever, anemia, and hyperthyroidism

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13
Q

High-output HF path

A

Cardiac output remains normal or above normal

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14
Q

Compensatory mechanisms for HF

A

Stimulation of the sympathetic nervous system, renin-angiotensin system activation, other chemical responses, and myocardial hypertrophy; may initially increase cardiac output but eventually have a damaging effect on pump function

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15
Q

Stimulation of the sympathetic nervous system

A

Most immediate compensatory mechanism; increases HR and BP from vasoconstriction

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16
Q

Renin-Angiotensin system activation

A

Reduced blood flow to the kidneys activates RAS; vasoconstriction becomes more pronounced; preload and afterload increase

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17
Q

Other chemical responses

A

Immune response r/t MI; increased B-type natriuretic peptide produced and released by ventricles; vasopressin which worsens HF; endothelin secreted when heart muscles are stretched to increase peripheral resistance and hypertension

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18
Q

Myocardial hypertrophy

A

enlargement of the myocardium; walls of the heart thicken; produces more forceful contractions; increases cardiac output; my hypertrophy d/t slight oxygen deprived state

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19
Q

HF general assessment

A

Medical hx, perception of activity tolerance, breathing pattern, sleeping pattern urinary pattern, fluid volume status, and knowledge of HF

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20
Q

Left-sided HF assessment

A

Activity tolerance; simultaneous leg and arm work; identify most strenuous activity in the past week; chest discomfort, palpitations, skipped beats, fast heartbeat; cough; frothy pink-tinged sputum; dyspnea (exertional, orthopnea, paroxysmal nocturnal)

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21
Q

Right-sided HF assessment

A

Peripheral edema; weight gain; nausea; anorexia (liver engorgement); ascites; increased abdominal girth; diuresis at rest; nutritional hx; fluid intake (may have excessive thirst d/t sodium retention

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22
Q

Left-sided HF manifestations

A

Fatigue, weakness, oliguria during the day, angina, confusion, restlessness, dizziness, tachycardia, palpitations, pallor, weak peripheral pulses, cool extremities, hacking cough (worse at night), dyspnea, breathlessness, crackles or wheezes in lungs, frothy pink tinged sputum, tachypnea, S3/S4 summation gallop

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23
Q

Right-sided HF manifestations

A

JVD, enlarged liver and spleen, anorexia and nausea, dependent edema, distended abdomen, swollen hands and fingers, polyuria at night, weight gain, increased BP (excess volume) or decreased BP (failure)

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24
Q

Psychosocial assessment HF

A

Anxiety, frustration and depression are common; ask about usual methods of coping and if there is hx of mental health issues; social involvement

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25
Q

Lab assessment HF

A

Serum electrolytes, BUN/Creatinine, Hgb/Hct, B-type natriuretic peptide, urinalysis, arterial blood gasses; microalbuminuria is early warning of decreased heart compliance

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26
Q

Imaging assessment HF

A

Chest x-rays (enlarged heart), echocardiogram (best tool; detects cardiac valvular changes pericardial effusion, chamber enlargement, and ventricular hypertrophy), radionuclide studies (can indicate the presence and cause of HF)

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27
Q

Other diagnostic assessments HF

A

Electrocardiogram (may show ventricular hypertrophy, dysrhythmias, and myocardial ischemia, injury, or infarction), invasive hemodynamic monitoring (direct assessment of cardiac function and can confirm the diagnosis and guide the management)

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28
Q

Serum electrolytes for HF

A

Evaluates for electrolyte imbalance (Na, K, Mg, Ca, Cl)

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29
Q

BUN/Creatinine for HF

A

Elevated BUN and decreased creatinine in renal function impairment

30
Q

Hgb/Hct for HF

A

Identifies if HF is result of anemia; may be low in fluid volume excess as result of hemodilution

31
Q

BNP for HF

A

Increased in HF differentiates between dyspnea of HF or lung dysfunction

32
Q

Urinalysis for HF

A

Proteinuria, high specific gravity, microalbuminuria (early indicator)

33
Q

Arterial blood gas for HF

A

Hypoxemia (fluid filled alveoli), resp alk (hyperventilation), resp acid (CO2 retention), Met acid (accumulation of lactic acid)

34
Q

Priority problems for pts with heart failure

A

Impaired gas exchange, decreased cardiac output, fatigue and weakness, potential for pulmonary edema

35
Q

HF gas exchange interventions

A

Ventilation assistance, monitor resp rate, rhythm, and quality every 1-4 hrs, ascultate breath sounds every 4-8 hrs

36
Q

HF cardiac output interventions

A

ACE inhibitors, ARBs, diuretics, Human B-type natriuretic peptides, nitrates inotropics (beta-adrenergic agonists, phosphodiesterase inhibitors, calcium sensitiers, digoxin), Beta-adrenergic blockers, surgical and non-surgical management

37
Q

ACE inhibitors and ARBs for HF

A

Reduces afterload by reversing some of the inappropriate vasoconstriction (reduces the number of sacks on the donkey’s wagon); ACE is first line but can cause a nagging dry cough; suppresses the RAS resulting in arterial dilation and increased stroke volume; ARBs decrease arterial resistance and arterial dilation; both block aldosterone to decrease fluid overload; monitor for hyperkalemia, orthostatic hypotension, acute confusion, serum potassium and creatinine

38
Q

Human B-type natriuretic peptides for HF

A

Reduces afterload; lowers pulmonary capillary wedge pressure; improves glomerular filtration; bolus for 60 sec and continuous for up to 48 hrs; monitor BP and pulse; give through separate infusion line; expect increase in BNP after admin

39
Q

Nutrition therapy for HF

A

Reduces preload; decrease the workload of the heart by reducing sodium and water retention; weigh daily; 1 kg gain or loss equals 1 L of retained or lost fluid

40
Q

Diruetics for HF

A

Reduces preload (reduces the number of sacks on the donkey’s wagon); enhances renal excretion of sodium and water; monitor/prevent hyperkalemia (generalized weakness, depressed reflexes, irregular heart rate)

41
Q

Nitrates for HF

A

Reduces preload; venous vasodilators; for pts with persistent dyspnea; returns venous vasculature to a more normal capacity; decreases the volume of blood returning to the heart; improves left ventricular function; may be administered IV, oral, or topical; monitor BP; HA will go away; prevent tolerance by using 12 out of 24 hrs

42
Q

Digoxin for HF

A

Enhances contractility (the carrot place in front of the donkey to make him move); reduces exacerbations and hospitalizations when added to regimen of ACE inhibitors, ARBs, beta blockers, and diuretics; may increase mortality d/t drug toxicity; eliminated by renal excretion

43
Q

Digoxin toxicity

A

Anorexia, fatigue, blurred vision, changes in mental status, dysrhythmias (esp PVCs), bradycardia, loss of P wave; report irregular rhythm in pt with normally regular rhythm and vice versa; monitor serum digoxin and potassium

44
Q

Beta-adrenergic agonists for HF

A

Used for short-term treatment; improves cardiac contractility

45
Q

Beta-adrenergic blockers for HF

A

Enhances contractility (limits the donkey’s speed, saving energy); must be started slowly; monitor for bradycardia or hypotension after first dose; weigh daily; report worsening symptoms of HF; gradually increases drug dose if HF worsens; pt evaluated weekly; resting HR should remain between 55 and 60 and increase slightly with exercise

46
Q

Continuous positive airway pressure (CPAP) for HF

A

Improves cardiac output and ejection fraction; decreases afterload and preload, BP, and dysrhythmias

47
Q

Cardiac resynchronization therapy for HF

A

Permanent pacemaker alone or with an implantable cardioverter/defibrillator; causes more synchronous ventricular contractions to improve EF, CO, and MAP; Indicated for pt with EF of less than 35%

48
Q

Heart transplantation for HF

A

Ultimate choice for end-stage HF

49
Q

Ventricular assist devices (VAD) for HF

A

Mechanical pump is implanted to work with the pts own heart; used short term while awaiting heart transplantation or long term;

50
Q

Heart reduction surgery/Partial left ventriculectomy (PLV) for HF

A

Removal of triangle-shaped section of the weakened heart in the left lateral ventricle to reduce the ventricle’s diameter and decrease wall tension

51
Q

Endoventricular circular patch cardioplasty for HF

A

Removal of portions of the cardiac septum and left ventricular wall and graft a circular patch into the opening; provides a more normal shape to the left ventricle to improve the hearts EF and CO

52
Q

Acorn cardiac support device for HF

A

Polyester mesh jacket that is placed over the ventricles to provide support and avoid overstretching the myocardial muscle

53
Q

Myosplint for HF

A

Electrical stimulation of several tension pads on the outside of the ventricle changes it to a more normal shape to improve function

54
Q

Decreasing fatigue and weakness interventions for HF

A

Physical and emotional rest for energy management; up in chair on hospital day 1, ambulation day 2 (check BP, pulse, and O2 sat before and after); activity intolerance includes dyspnea, fatigue, chest pain, and BP or HR change of more than 20; if pt rates exertion more than 12 (1-20 scale) have pt slow down; PT steadily increases until pt is ambulating 200-400 ft several times/day

55
Q

Prevention/Management of pulmonary edema interventions for HF

A

Monitor for acute pulmonary edema; often admitted to CCU; administer NTG if systolic BP>100 to decrease afterload and preload; Give Lasix IVP over 1-2 minutes; if pt BP is stable, IV morphine may be prescribed to reduce venous return, decrease anxiety, and reduce work of breathing; monitor RR and BP

56
Q

S/S of Pulmonary edema

A

Crackles, dyspnea at rest, disorientation, acute confusion, tachycardia, hypertension or hypotension, reduced urinary output, cough with frothy pink-tinged sputum, premature ventricular contractions and other dysrhythmias, anxiety, restlessness, lethargy

57
Q

Activity patient teaching for HF

A

Lifestyle adjustments (dietary, activity, drug therapy); verbalize fears and concerns; assist in exploring coping skills; health teaching; activity schedule; regular exercise regimen; not to overdo it; if chest pain and dyspnea develop during exercise, slow down; keep diary of time and duration of each exercise session, and HR and symptoms that occur

58
Q

Indications of worsening or recurrent HF

A

rapid weight gain (3 lbs in 1 wk or 1-2 lbs overnight), decrease in exercise tolerance lasting 2-3 days; cold symptoms lasting more than 3-5 days; excessive nighttime urination; dyspnea or angina at rest or worsening angina; increased swelling in the feet, ankles, or hands

59
Q

Drug therapy teaching for HF

A

Provide variety of methods of instruction; teach how to count pulse; take diuretics in the morning; weight each day at same time; if taking ACEIs or ARBs move slowly when changing positions; report dizziness, light-headedness, and cough; Monitor serum K and renal function every few months for diuretics and ACEIs or ARBs; teach K rich foods

60
Q

Nutrition therapy teaching for HF

A

Sodium restriction (3 g for mild-mod, 2 g for severe)

61
Q

Collaboration for HF

A

Case management, physical therapy, occupational therapy, cardiac rehab

62
Q

Flow of electricity in the heart

A

SA node - AV node - Ventricles

63
Q

Premature ventricular contractions (PVCs)

A

Do not need intervention unless it progresses

64
Q

Ventricular tachycardia (V-tach)

A

Check pulse; call code; shockable; epinephrine

65
Q

Asystole

A

Assess pt; start CPR; un-shockable

66
Q

Sinus bradycardia

A

Check if pt is symptomatic; get fluid on board; administer atropine

67
Q

Ventricular fibrillation (V-fib)

A

Assess pt; call code; shockable

68
Q

Premature atrial contractions (PACs)

A

(look this up)

69
Q

Cardiac output

A

Volume of blood pumped per minute by each ventricle of the heart; equal to the stroke volume (SV) x HR

70
Q

Stroke volume

A

Volume of blood pumped from each ventricle in a single heartbeat

71
Q

Ejection fraction

A

Amount of blood in the heart compared to the amount of blood pumped out; should be between 50-70%; less than 40% is considered reduced

72
Q

Paroxysmal nocturnal dyspnea interventions

A

Check on pt several hrs after bed and assist the pt to sit upright and dangle feet when dyspnea occurs

Unit 2 (3 decks)

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