Special cardiac conditions

Question 1

This complication is defined as the inability of the heart to pump enough CO to meet the tissue’s O2 demands, which results in inadequate peripheral tissue perfusion

Answer 1

Heart Failure

Question 2

Name 5 underlying conditions that cause HF

Answer 2

ischemia heart disease, MI, cardiomyopathy, valvular heart disease, and hypertension

Question 3

of people with HF in US

Answer 3

5.8 million

Question 4

HF is accountable for how many hospitalizations a year and how many hospital days

Answer 4

1 million, 6.5 million days

Question 5

True or False, HF is a disease

Answer 5

False, HF is a complication of cardiac and non cardiac abnormalities

Question 6

What is hospitalized heart failure (HHF)

Answer 6

new onset or worsening signs and symptoms that require urgent therapy and hospitalization

Question 7

Non cardiac precipitation factors of AHF include

Answer 7

COPD and pneumonia, non adherence to therapeutic regimen, infection, ETOH, diabetes, surgery

Question 8

Two dysfunction types of HF include

Answer 8

systolic and diastolic failure

Question 9

Systolic HF

Answer 9

leads to problems with contraction and ejection of blood resulting in increased system vascular resistance. Increased SVR causes increase in afterload.Also reduced EF

Question 10

Diastolic HF

Answer 10

stiff myocardium doesn?t allow left ventricle to fill up with blood which leads to increased pressure in left atrium and pulmonary vasculature. Preserved EF

Question 11

Signs of left-sided heart failure

Answer 11

pulmonary congestion, dyspnea, tachypnea, crackles, dry cough, paroxysmal nocturnal dyspnea, increase BP form fluid excess or decreased BP from pump failure

Question 12

LEFT sided heart failure FORWARD failure) description

Answer 12

Results in PULMONARY congestion due to the inability of the LEFT ventricle to pump blood to the periphery.

Question 13

Symptoms of left sided failure include

Answer 13

SOB, dyspnea on exertion, paroxysmal noctural dyspnea, orthopnea, pulmonary edema, dry & unproductive cough that occurs mostly at night, tachycardia, fatigue, anxiety, restlessness, confusion, tachycardia S3 ventricular gallop

Question 14

RIGHT sided failure ( BACKWARD failure) description

Answer 14

results in PERIPHERAL congestion due to the inability of the RIGHT ventricle to pump blood out to the lungs; often results due from left-sided failure or pulmonary disease

Question 15

Symptoms of RIGHT sided failure

Answer 15

edema in ankles, unexplained weight gain, abdominal pain assoc. with liver congestion, JVD, abnormal fluid in body cavities (pleural space, abd. Cavity), anorexia and nausea assoc. w/ hepatic and visceral engorgement, nocturia, weakness

Question 16

How many pounds must you gain to have pitting edema?

Answer 16

10 lbs or 4.5kg of fluid

Question 17

Pneumonic to remember the difference between left and right sided HF

Answer 17

Right= Rest of the body. Left = Lungs

Question 18

Ejection fraction

Answer 18

Measurement of volume of blood pushed out by ventricles seen on an echo. Normal 55-60%. < 40 =HF or cardiomyopathy. > 75= hypertrophic cardiomyopathy

Question 19

Treatment for HF

Answer 19

treat reversible cause, heart transplant, drugs, cardiac resynchronization therapy

Question 20

Drugs used to treat HF include

Answer 20

digitalis, diuretics, ace inhibitors of beta blockers

Question 21

2 common digitalis

Answer 21

digitoxin and digoxin

Question 22

Indications and actions of digitalis

Answer 22

HF. Increases the contractility of cardiac muscle and slows HR and conduction by blocking Na/K atpase converting to Ca++.

Question 23

Digitalis neurohormonal control decreases what 3 things and increases what 1 thing.

Answer 23

decreases plasma noradrenaline, peripheral nervous system activity, and RAAS activity, and increases vagal tone

Question 24

Nursing implications for digitalis

Answer 24

check apical pulse prior to administration. Call provider if HR< 60 or > 120 bpm or has a markedly changed rhythm

Question 25

What increases risk for digitalis side effects and toxicity?

Answer 25

hypokalemia

Question 26

5 signs of digitalis toxicity

Answer 26

bradycardia, tachycardia, dysrhythmias, n & v, headache

Question 27

Indication and actions of ACE inhibitors

Answer 27

decreases BP by suppressing renin-angiotensin aldosterone system and inhibiting conversion of angiotensin 1 into angiotensin 2

Question 28

Drugs ending in -prol belong to what class of drugs?

Answer 28

beta blockers

Question 29

Drugs ending in -pril belong to what class of drugs?

Answer 29

Ace Inhibitors

Question 30

Indication and actions of Beta Blockers

Answer 30

Increase density of B1 receptors, inhibits cardiotoxicity of catecholamines, decrease neurohormonal activation and decrease HR

Question 31

Why are Beta Blockers not good for diabetics?

Answer 31

may mask symptoms of hypoglycemia or may prolong hypoglycemic reaction

Question 32

Nursing implications for Beta Blockers

Answer 32

check apical or radial pulse daily, monitor for GI distress, watch for SOB

Question 33

Cardiac Resynchronization Therapy (CRT)

Answer 33

Useful for dilated cardiomyopathy. It is a cardiac pacing that stimulates both ventricles simultaneously. Standard pacemakers only stimulate the right ventricle.

Question 34

Adverse effects of ACE-Inhibitors

Answer 34

hypotension ( 1st dose), worsening renal function, hyperkalemia, cough, angioedema, rash, aguesia (taste), neutropenia

Question 35

There are 5 anti-______ associated with beta blockers, what are they?

Answer 35

antiischemic, antihypertensive, antiarrhythmic, antioxidant, antiproliferative

Question 36

Hypotension, fluid retention/worsening HF, fatigue, bradycardia/heartblock are all adverse effects of what class of drugs?

Answer 36

beta blockers

Question 37

If you notice your patient is having Hypotension, worsening HF, and bradycardic heartblocks, what might be possible interventions you might bring up with the MD

Answer 37

review tx (+/- diuretics or other meds), reduce dose, consider cardiac pacing, discontinue beta blockers in severe cases only

Question 38

What are some common non-pharmacological tx of CHF?

Answer 38

restrict Na to 2-3 g/day, ETOH to 1 drink a day, avoid excess fluid intake, exercise, and treat underlying cause (HTN, arrhythmia)

Question 39

What do you assess in a patient with acute HF?

Answer 39

Respiratory function- SOB, RR, Crackles. Cardiac- heart sounds, vss, color, peripheral pulses, fluid evaluation, enzymes, daily wts. Renal- U.O., BUN, and creatine. GI- bruits, distention. Other - activity intolerance, med hx, IV mgmt. and review of cardiac tests

Question 40

Interventions for pt. with CHF.

Answer 40

monitor vs q 4; monitor apical hr for dysrhytmias, S3, or S4; assess for hypoxia (restlessness, tachycardia, angina); auscultate lungs (wet sounds or crackles), admin o2 prn., edema, Limit Na intake, elevate lower extremities when sitting, rest, diuretics in AM

Question 41

How do you observe for edema?

Answer 41

check daily weights, monitor I & O, measure abdominal girth, observe ankles and fingers

Question 42

What is the indication for a heart transplant?

Answer 42

end-stage heart disease not remediable by more conservative measures

Question 43

What types of meds might a person be on after a heart transplant?

Answer 43

anti-rejection, anti-infective

Question 44

Tacrolimus (prograd), cyclosporine, azathiprine (imuran), steroid (prednisone) are all examples of what type of drug?

Answer 44

Anti-rejection

Question 45

4 types of anti-infectives

Answer 45

ganciclovir, spetra, acyclovir, nystatin

Question 46

After the patient’s heart is removed, why are there 2 p waves?

Answer 46

a remnant of the client’s atria remains

Question 47

What are symptoms of heart rejection?

Answer 47

hypotension, dysrhythmias, weakness, fatigue, dizziness

Question 48

What is the triple therapy anti-rejection treatment most transplant patient receive?

Answer 48

cyclosporine, azathioprine and prednisone

Question 49

After transplant, when is the patient likely to have a rejection?

Answer 49

6 to 12 weeks.

Question 50

true or false, a patient that receives a heart transplant will require lifelong immunosuppresants?

Answer 50

TRUE

Question 51

Lack of or gain of independence / dependence, marital /partner stresses and donor guilt are all what?

Answer 51

psychological issues with transplant patients

Question 52

What are common electrolyte problems associated with transplant patients?

Answer 52

Mg, K, Phosphate