T4: Acute Heart Failure Flashcards
heart failure
Complex clinical syndrome resulting in insufficient blood supply/oxygen to tissues and organs
Ejection fraction (EF)
amount of blood pumped by LV with each heart beat
chronic heart failure clinical manifestations
-edema
-nocturia
-pleural effusion
-dysrhythmia-left ventricular thrombus
-hepatomegaly
-renal failure
HINT HINT: sudden weight gain of greater than,,,
3 lbs (1.4kg) in two days may indicate ADHF
no BP no PP
if someones BP is dropping that means the mean arterial pressure is dropping so renals aren’t getting perfusion so they cannot mobilize the secretions out of the body
why is morphine given for HF
it is a vasodilator of the coronary arteries, so the heart is getting more O2 and giving more cardiac perfusion to he heart muscle itself DECREASES THE WORKLOAD OF THE HEART !!!!!
why are diuretics given for HF
reduce edema, pulmonary venous pressure and preload
-promote sodium and water excretion
why are positive inotropes given for HF
increase myocardial contractility
when giving nitro what should the client expect
a HA because its a vasodilator
BiDil
hydralazine/isosorbide dinitrate
-combination therapy of beta blockers and dilators
heart failure can be caused by
-primary causes: things that directly damage the heart
-precipitating causes: increase workload of ventricles
§Ventricular failure leads to:
-Low blood pressure (BP)
-Low CO
-Poor renal perfusion
Compensatory mechanisms of heart failure
-Renin-Angiotensin-Aldosterone-System (RAAS)
-Neurohormonal response - RAAS
-Neurohormonal response - SNS-catecholamines
-Ventricular remodeling (Dilation, Hypertrophy)
left-sided HF results from inability of LV to
-Empty adequately during systole
-Fill adequately during diastole
S/S of left sided heart failure
-pulmonary congestions (listen to lung sounds)
-dyspnea, tachypnea
-crackles in the lungs
-paroxysmal nocturnal dyspnea
-increase BP
(HFrEF) systolic failure
HF with reduced EF; results from an inability of the heart to pump blood effectively.
Ejection Fraction (EF)
calculation of how much blood a ventricle can eject with one contraction
normal ejection fraction
55-60%
Systolic HF is caused by?
-Impaired contractile function
-Increased afterload
-Cardiomyopathy
-Mechanical abnormalities
S/S of right sided heart failure
-dependent edema
-jugular vein distention
-abdominal distention
-weight gain
-nocturnal diuresis
-splenomegaly, hepatomegaly
-increased BP
Atrial natriuretic peptide (ANP) and b-type natriuretic peptide (BNP) are released in response to
increased blood volume in the heart do it causes diuresis, vasodilation and lowered BP
Nitric oxide (NO) and prostaglandin work by
relaxing arterial smooth muscle, resulting in vasodilation and decreased afterload
Compensated HF occurs when
compensatory mechanisms succeed in maintaining an adequate CO that is needed for tissue perfusion.
Decompensated HF occurs when
these compensatory mechanisms can no longer maintain adequate CO and inadequate tissue perfusion results.
early signs of acute decompensated heart failure
-increased pulmonary venous pressure
-Increase in the respiratory rate
-Decrease in Pao2
late signs of acute decompensated heart failure
-interstitial edema
-tachypnea
-can lead to alveolar edema resulting in RESPIRATORY ACIDEMIA
How do you know what the PaO2 is
use an oximeter
Acute decompensated HF (ADHF) is defined as
*the sudden onset of signs and symptoms of HF, requiring urgent medical care.
universal finding in ADHF is pulmonary and systemic congestion due to
elevated left-sided and right-sided filling pressures.
people in ADHF are also in…
ARDS
ADHF can manifest as
pulmonary edema
what four groups can people in ADHF be categorized in
1.Dry-warm
2.Dry-cold
3.Wet-warm (most common)
4.Wet-cold
dry-warm
they are perfusing and blood is flowing
dry-cold
they are not perfusing
wet-warm
diaphoretic and warm: they are working hard, they are warm so they are still perfusing
wet-cold
they are not perfusing and fluid is leaking out of them, this is not good
pulmonary edema clinical manifestations
-anxious, pale, cyanotic
-cool, clammy skin
-dyspnea, orthopnea, tachypnea
-accessory muscles
-cough, with FROTHY blood-tinged sputum
-crackles, wheezes
-tachycardia
-hypo/hypertension
-abnormal S3 S4
diagnostics for acute HF
-echocardiogram
-ECG
-6-min walk test
-chest xray
-MUGA Scan
-BNP Levels
BNP levels correlate positively with
the degree of LV failure
MUGA scan
imaging the motion of heart wall muscles and assessing the function of the heart via a multiple-gated acquisition scan, which uses radioactive chemicals
(chemically stress the heart)
prep for stress test
get an IV just in case they crash
care for ADHF
-VS, O2 saturation, urinary output
-Hemodynamic monitoring if unstable
-Supplemental oxygen
-Mechanical ventilation if unstable
-High Fowler’s position
-Circulatory assist devices for patients with deteriorating HF
(Intraaortic balloon pump (IABP), Ventricular assist devices (VADs))
why do we put a patient with dyspnea due to HF in high fowlers
-helps decrease venous return because of the pooling of blood in the extremities
-increases the thoracic capacity, allowing for improved breathing.
Ultrafiltration (UF), or aquapheresis,
an option for the patient with volume overload.
-UF can rapidly remove intravascular fluid volume while maintaining hemodynamic stability.
intraaortic balloon pump (IABP)
a device that increases coronary blood flow to the heart muscle and decreases the heart’s workload through a process called counterpulsation.
Ventricular assist devices (VADs)
can be used to maintain the pumping action of a heart that cannot effectively pump.
- a mechanical pump that is surgically implanted.
what do diuretics fo for ADHF
Decrease volume overload (preload)
what do vasodilators do for ADHF
Reduce circulating blood volume and improve coronary artery circulation
what does morphine do for ADHF
-Reduces preload and afterload
-Relieves dyspnea and anxiety
Heart transplantation
*the transfer of a healthy donor heart to a patient with a diseased heart. This surgery is used to treat a variety of terminal or end-stage heart conditions.
selection for a heart transplant
-Selection process identifies patients who would most benefit from a new heart
-Candidates must undergo physical, diagnostic, and psychologic evaluation
Post Heart Transplant monitoring
-Acute rejection
-Infection
-Malignancy
-Cardiac vasculopathy
-Immunosuppressive therapy
-Endomyocardial biopsy (EMB)
immunosuppressive drugs for heart transplant can cause
increased risk for infection after surgery and long term immuno suppressive therapy increases the risk for cancer
Endomyocardial biopsy (EMB)
obtained on a weekly basis for the first month after heart transplant , monthly for the
-a catheter is inserted into the jugular vein and moved into the right ventricle. The catheter uses a bioptome, a device with two small cups that can be closed, to remove small samples of heart muscle.
Nursing management throughout the posttransplant period focuses on
*promoting patient adaptation to the transplant process, monitoring cardiac function, managing lifestyle changes, and providing ongoing teaching to the patient and caregiver.
left ventricular assist device (LVAD)
a pump that we use for patients who have reached end-stage heart failure. We surgically implant the LVAD, a battery-operated, mechanical pump, which then helps the left ventricle (main pumping chamber of the heart) pump blood to the rest of the body.
