T2: Heart Failure & Valvular disease Flashcards
3 types of heart failure:
-Left sided
-right sided
-high-output
Heart failure is often caused by _______, however, may sometimes develop after an _________
-hypertension
-MI
Most heart failure begins as _____-sided and progresses to both
left sided
left sided heart failure is subdivided into:
-systolic HF
-diastolic HF
Cause of systolic HF (2)
-Ejection fraction of less than 40% (normal:50-70%)
-reduces tissue perfusion and blood accumulates in the pulmonary vessels
Systolic HF:
inadequate tissue perfusion =
pulmonary or systolic congestion
Systolic HF:
high risk for ______; clients with less than 30% ejection fraction are considered for
-Sudden cardiac death
-Implantable cardioverter defibrillator (ICD)
In Diastolic HF, ______ pressure is needed to move the same amount of volume
more
Diastolic HF is usually seen in _________ with history of _________
-older adult women
-chronic hypertension
left-sided heart failure is caused by: (3)
-hypertension
-coronary artery disease
-valvular disease
Causes of Right-sided heart failure (3)
-left ventricular failure
-right ventricular MI
-pulmonary hypertension
In right-sided heart failure, the right ventricle ________, which ______ volume and pressure buildup in the venous system causing ________
-cannot completely empty
-increases
-peripheral edema
volume of blood the heart pumps per minute
cardiac output
cardiac output formula
stroke volume x heart rate
stroke volume formula
(end diastolic volume) - (end systolic volume)
Normal cardiac output range:
4-8 L/min
cardiac output predicts
oxygen delivery to cells
how does the body compensate for decreased cardiac output (2)
-sympathetic nervous system
-tissue hypoxia causes the adrenergic receptors to increase heart rate and blood pressure (vasoconstriction)
Low cardiac output leads to decreased __________, which leads to ______ being released, causing vasoconstriction and fluid retention, worsening _____
-cerebral perfusion
-vasopressin
-Hypertension
Neurohormones that promote vasodilation and diuresis through sodium loss in the renal tubes
Natriuretic peptides
ventricles produce and release as they stretch in response to fluid overload for HF
B-type natriuretic peptides (BNP)
Left ventricular Failure:
Assess for (4)
-crackles and wheezes of the lungs
-confusion in older adults due to brain hypoxia
-heart sounds such as an S3 gallop
-sleep with extra pillows at night due to orthopenia
Right ventricular failure:
Assess for (5)
-neck vein distention
-abdominal girth
(hepatomegaly,
hepatojugular reflex,
ascites)
-dependent edema
How to assess for fluid gain due to heart failure
daily weights taken at the same time each morning using the same scale
psychosocial considerations for heart failure patients
assess for anxiety and depression
Heart Failure diagnostic (5)
-electrocardiogram
-chest x-ray
-echocardiography
-radiology
-multi-gated acquisition scan (MUGA)
provides information about ejection fraction
Multi-gated acquisition scan (MUGA)
used to differentiate dyspnea related to heart failure vs respiratory problem; monitor the need for and the effectiveness of aggressive heart failure intervention
Human B-type natriuretic peptides (hBNP)
hBNP is _________ in pts with heart failure
elevated
hBNP result interpretation:
<100 pg/mL
no heart failure
hBNP result interpretation:
100-300 pg/mL
heart failure caught early
hBNP results interpretation:
900+ pg/mL
severe heart failure
Left sided heart failure findings: (3)
-elevated PAP
-elevated PAWP
-decreased CO
Nutritional considerations (2)
-reduce sodium to ~3g daily
-Fluid restrictions
Indications Heart Failure condition is worsening (5)
-weight gain of 3lbs or more
-exercise tolerance decreases in last 2-3 days
-excessive need to urinate during the night
-development of dyspnea or angina at rest or angina worsens
-increased swelling in hands, feet, or ankles
Heart failure:
nursing actions (9)
-Assess O2 saturation, SOA, dyspnea on exertion
-Daily weight monitoring
-Vital signs and hemodynamic pressure monitoring
-Position client (High Fowlers)
-Monitor labs
-Assess for medication toxicity
-Monitor for fall risk
-Monitor dietary restrictions
-Emotional and educational support
Labs nurses need to monitor for HF patients
-ABG
-electrolytes
-O2 saturation
-Chest x-ray
abnormality or dysfunction of any of the hearts four valves
valvular disease
Valvular heart disease is either:
congenital or acquired
acquired valvular heart diseases (3)
-Degenerative disease
-Rheumatic disease
-Ineffective endocarditis
damage over time from mechanical stress (hypertension most common)
Degenerative Valvular heart disease
fibrotic changes occurring over time, calcification of valve cusps (mitral valve most common)
Rheumatic disease
infection destroys the valve (streptococcal infections most common)
ineffective endocarditis
Valvular heart disease risk factors (7)
-Hypertension
-Rheumatic fever
-Ineffective endocarditis
-Congenital malformations
-Marfan sundrome
-Age
-Murmurs
Reasons why age is a risk factor for valvular heart disease (2)
-degenerative calcification
-papillary muscle dysfunction
connective tissue disorder
Marfan Syndrome
Narrowing of the opening of the mitral valve
Mitral Stenosis
Blood flowing back from the left ventricle into the left atrium during systole
Mitral Regurgitation
valve leaflets ballots back into the atrium during systole
Mitral valve prolapse
Distinguishable S/S of mitral stenosis (4)
-Paroxysmal nocturnal dyspnea
-Hemoptysis
-Hepatomegaly
-Rubbing apical diastolic murmur
Distinguishable S/S of Mitral Regurgitation (1)
-high-pitched holystolic murmur
S/S shared between Mitral Stenosis & Regurgitation (6)
-fatigue
-dyspnea on exertion
-orthopnea
-atrial fibrillation
-neck vein distension
-pitting edema
Distinguishable s/s of mitral valve prolapse (5)
-Atypical chest pain
-Dizziness, syncope
-Atrial tachycardia
-Ventricular tachycardia
-Systolic click
Shared S/S between Mitral regurgitation and prolapse (1)
-palpations
has two cusps or flaps and lies between the left atrium and the left ventricle of the heart
mitral valve
narrowing of the orifice between the left ventricle and aorta
aortic stenosis
S/S of aortic stenosis (7)
-Dyspnea on exertion
-Angina
-Syncope on exertion
-Fatigue
-Orthopnea
-Paroxysmal nocturnal dyspnea
-Harsh, systolic crescendo-decrescendo murmur
Aortic valve doesn’t close all the way, leading to back flow of blood back into the left ventricle
aortic regurgitation
S/S of aortic regurgitation (8)
-Palpitations
-Dyspnea
-Orthopnea
-Paroxysmal nocturnal dyspnea
-Fatigue
-Angina
-Sinus tachycardia
-Blowing, decrescendo diastolic murmur
Assessment finding:
atrial dysrhythmias, systolic murmurs
tricuspid insufficiency
Assessment finding:
atrial dysrhythmia, diastolic murmurs
tricuspid stenosis
Assessment finding:
systolic murmurs, cyanosis
pulmonic stenosis
Assessment finding:
systolic murmurs, angina
aortic stenosis
Assessment finding:
diastolic murmurs, angina
aortic insufficiency
If ______-sided valve damage; s/s include:
Dyspnea, fatigue, increased pulmonary artery pressure, and decreased cardiac output
left sided valve damage
If _____-sided valve damage; s/s include:
dyspnea, fatigue, increased right atrial pressure, peripheral edema, jugular vein distention, and hepatomegaly
right sided valve damage
_____-sided valve damage most commonly affected due to higher pressure
left-sided valve damage
