Special cardiac conditions Flashcards

1
Q

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

A

Heart Failure

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2
Q

Name 5 underlying conditions that cause HF

A

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

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3
Q

of people with HF in US

A

5.8 million

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4
Q

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

A

1 million, 6.5 million days

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5
Q

True or False, HF is a disease

A

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

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6
Q

What is hospitalized heart failure (HHF)

A

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

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7
Q

Non cardiac precipitation factors of AHF include

A

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

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8
Q

Two dysfunction types of HF include

A

systolic and diastolic failure

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9
Q

Systolic HF

A

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

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10
Q

Diastolic HF

A

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

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11
Q

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

A

systolic dysfunction

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12
Q

ability of left ventricle to relax and fill during diastole is reduced and stroke volume falls, high volumes needed in ventricles to maintain CO

A

diastolic dysfunction

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13
Q

Signs of left-sided heart failure

A

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

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14
Q

LEFT sided heart failure FORWARD failure) description

A

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

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15
Q

Symptoms of left sided failure include

A

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

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16
Q

RIGHT sided failure ( BACKWARD failure) description

A

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

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17
Q

Symptoms of RIGHT sided failure

A

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

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18
Q

How many pounds must you gain to have pitting edema?

A

10 lbs or 4.5kg of fluid

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19
Q

Pneumonic to remember the difference between left and right sided HF

A

Right= Rest of the body. Left = Lungs

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20
Q

Ejection fraction

A

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

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21
Q

Treatment for HF

A

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

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22
Q

Drugs used to treat HF include

A

digitalis, diuretics, ace inhibitors of beta blockers

23
Q

2 common digitalis

A

digitoxin and digoxin

24
Q

Indications and actions of digitalis

A

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

25
Q

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

A

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

26
Q

Nursing implications for digitalis

A

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

27
Q

What increases risk for digitalis side effects and toxicity?

A

hypokalemia

28
Q

5 signs of digitalis toxicity

A

bradycardia, tachycardia, dysrhythmias, n & v, headache

29
Q

Indication and actions of ACE inhibitors

A

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

30
Q

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

A

beta blockers

31
Q

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

A

Ace Inhibitors

32
Q

Indication and actions of Beta Blockers

A

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

33
Q

Why are Beta Blockers not good for diabetics?

A

may mask symptoms of hypoglycemia or may prolong hypoglycemic reaction

34
Q

Nursing implications for Beta Blockers

A

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

35
Q

Cardiac Resynchronization Therapy (CRT)

A

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

36
Q

Adverse effects of ACE-Inhibitors

A

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

37
Q

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

A

antiischemic, antihypertensive, antiarrhythmic, antioxidant, antiproliferative

38
Q

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

A

beta blockers

39
Q

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

A

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

40
Q

What are some common non-pharmacological tx of CHF?

A

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

41
Q

What do you assess in a patient with acute HF?

A

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

42
Q

Interventions for pt. with CHF.

A

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

43
Q

How do you observe for edema?

A

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

44
Q

What is the indication for a heart transplant?

A

end-stage heart disease not remediable by more conservative measures

45
Q

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

A

anti-rejection, anti-infective

46
Q

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

A

Anti-rejection

47
Q

4 types of anti-infectives

A

ganciclovir, spetra, acyclovir, nystatin

48
Q

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

A

a remnant of the client’s atria remains

49
Q

What are symptoms of heart rejection?

A

hypotension, dysrhythmias, weakness, fatigue, dizziness

50
Q

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

A

cyclosporine, azathioprine and prednisone

51
Q

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

A

6 to 12 weeks.

52
Q

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

A

TRUE

53
Q

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

A

psychological issues with transplant patients

54
Q

What are common electrolyte problems associated with transplant patients?

A

Mg, K, Phosphate