Special cardiac conditions Flashcards
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
Heart Failure
Name 5 underlying conditions that cause HF
ischemia heart disease, MI, cardiomyopathy, valvular heart disease, and hypertension
of people with HF in US
5.8 million
HF is accountable for how many hospitalizations a year and how many hospital days
1 million, 6.5 million days
True or False, HF is a disease
False, HF is a complication of cardiac and non cardiac abnormalities
What is hospitalized heart failure (HHF)
new onset or worsening signs and symptoms that require urgent therapy and hospitalization
Non cardiac precipitation factors of AHF include
COPD and pneumonia, non adherence to therapeutic regimen, infection, ETOH, diabetes, surgery
Two dysfunction types of HF include
systolic and diastolic failure
Systolic HF
leads to problems with contraction and ejection of blood resulting in increased system vascular resistance. Increased SVR causes increase in afterload.Also reduced EF
Diastolic HF
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
Left ventricle can’t pump enough blood out to system circulation, blood backs up into pulmonary circulation and pressure increases in pulmonary venous system, CO falls and weakness and fatigue occur
systolic dysfunction
ability of left ventricle to relax and fill during diastole is reduced and stroke volume falls, high volumes needed in ventricles to maintain CO
diastolic dysfunction
Signs of left-sided heart failure
pulmonary congestion, dyspnea, tachypnea, crackles, dry cough, paroxysmal nocturnal dyspnea, increase BP form fluid excess or decreased BP from pump failure
LEFT sided heart failure FORWARD failure) description
Results in PULMONARY congestion due to the inability of the LEFT ventricle to pump blood to the periphery.
Symptoms of left sided failure include
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
RIGHT sided failure ( BACKWARD failure) description
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
Symptoms of RIGHT sided failure
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
How many pounds must you gain to have pitting edema?
10 lbs or 4.5kg of fluid
Pneumonic to remember the difference between left and right sided HF
Right= Rest of the body. Left = Lungs
Ejection fraction
Measurement of volume of blood pushed out by ventricles seen on an echo. Normal 55-60%. < 40 =HF or cardiomyopathy. > 75= hypertrophic cardiomyopathy
Treatment for HF
treat reversible cause, heart transplant, drugs, cardiac resynchronization therapy
Drugs used to treat HF include
digitalis, diuretics, ace inhibitors of beta blockers
2 common digitalis
digitoxin and digoxin
Indications and actions of digitalis
HF. Increases the contractility of cardiac muscle and slows HR and conduction by blocking Na/K atpase converting to Ca++.
Digitalis neurohormonal control decreases what 3 things and increases what 1 thing.
decreases plasma noradrenaline, peripheral nervous system activity, and RAAS activity, and increases vagal tone
Nursing implications for digitalis
check apical pulse prior to administration. Call provider if HR< 60 or > 120 bpm or has a markedly changed rhythm
What increases risk for digitalis side effects and toxicity?
hypokalemia
5 signs of digitalis toxicity
bradycardia, tachycardia, dysrhythmias, n & v, headache
Indication and actions of ACE inhibitors
decreases BP by suppressing renin-angiotensin aldosterone system and inhibiting conversion of angiotensin 1 into angiotensin 2
Drugs ending in -prol belong to what class of drugs?
beta blockers
Drugs ending in -pril belong to what class of drugs?
Ace Inhibitors
Indication and actions of Beta Blockers
Increase density of B1 receptors, inhibits cardiotoxicity of catecholamines, decrease neurohormonal activation and decrease HR
Why are Beta Blockers not good for diabetics?
may mask symptoms of hypoglycemia or may prolong hypoglycemic reaction
Nursing implications for Beta Blockers
check apical or radial pulse daily, monitor for GI distress, watch for SOB
Cardiac Resynchronization Therapy (CRT)
Useful for dilated cardiomyopathy. It is a cardiac pacing that stimulates both ventricles simultaneously. Standard pacemakers only stimulate the right ventricle.
Adverse effects of ACE-Inhibitors
hypotension ( 1st dose), worsening renal function, hyperkalemia, cough, angioedema, rash, aguesia (taste), neutropenia
There are 5 anti-______ associated with beta blockers, what are they?
antiischemic, antihypertensive, antiarrhythmic, antioxidant, antiproliferative
Hypotension, fluid retention/worsening HF, fatigue, bradycardia/heartblock are all adverse effects of what class of drugs?
beta blockers
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
review tx (+/- diuretics or other meds), reduce dose, consider cardiac pacing, discontinue beta blockers in severe cases only
What are some common non-pharmacological tx of CHF?
restrict Na to 2-3 g/day, ETOH to 1 drink a day, avoid excess fluid intake, exercise, and treat underlying cause (HTN, arrhythmia)
What do you assess in a patient with acute HF?
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
Interventions for pt. with CHF.
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
How do you observe for edema?
check daily weights, monitor I & O, measure abdominal girth, observe ankles and fingers
What is the indication for a heart transplant?
end-stage heart disease not remediable by more conservative measures
What types of meds might a person be on after a heart transplant?
anti-rejection, anti-infective
Tacrolimus (prograd), cyclosporine, azathiprine (imuran), steroid (prednisone) are all examples of what type of drug?
Anti-rejection
4 types of anti-infectives
ganciclovir, spetra, acyclovir, nystatin
After the patient’s heart is removed, why are there 2 p waves?
a remnant of the client’s atria remains
What are symptoms of heart rejection?
hypotension, dysrhythmias, weakness, fatigue, dizziness
What is the triple therapy anti-rejection treatment most transplant patient receive?
cyclosporine, azathioprine and prednisone
After transplant, when is the patient likely to have a rejection?
6 to 12 weeks.
true or false, a patient that receives a heart transplant will require lifelong immunosuppresants?
TRUE
Lack of or gain of independence / dependence, marital /partner stresses and donor guilt are all what?
psychological issues with transplant patients
What are common electrolyte problems associated with transplant patients?
Mg, K, Phosphate
