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NSG 430 - Critical Care > T4: Acute Heart Failure > Flashcards

T4: Acute Heart Failure Flashcards

1
Q

heart failure

A

Complex clinical syndrome resulting in insufficient blood supply/oxygen to tissues and organs

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2
Q

Ejection fraction (EF)

A

amount of blood pumped by LV with each heart beat

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3
Q

chronic heart failure clinical manifestations

A

-edema
-nocturia
-pleural effusion
-dysrhythmia-left ventricular thrombus
-hepatomegaly
-renal failure

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4
Q

HINT HINT: sudden weight gain of greater than,,,

A

3 lbs (1.4kg) in two days may indicate ADHF

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5
Q

no BP no PP

A

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

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6
Q

why is morphine given for HF

A

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 !!!!!

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7
Q

why are diuretics given for HF

A

reduce edema, pulmonary venous pressure and preload
-promote sodium and water excretion

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8
Q

why are positive inotropes given for HF

A

increase myocardial contractility

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9
Q

when giving nitro what should the client expect

A

a HA because its a vasodilator

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10
Q

BiDil

A

hydralazine/isosorbide dinitrate
-combination therapy of beta blockers and dilators

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11
Q

heart failure can be caused by

A

-primary causes: things that directly damage the heart
-precipitating causes: increase workload of ventricles

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12
Q

§Ventricular failure leads to:

A

-Low blood pressure (BP)
-Low CO
-Poor renal perfusion

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13
Q

Compensatory mechanisms of heart failure

A

-Renin-Angiotensin-Aldosterone-System (RAAS)
-Neurohormonal response - RAAS
-Neurohormonal response - SNS-catecholamines
-Ventricular remodeling (Dilation, Hypertrophy)

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14
Q

left-sided HF results from inability of LV to

A

-Empty adequately during systole
-Fill adequately during diastole

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15
Q

S/S of left sided heart failure

A

-pulmonary congestions (listen to lung sounds)
-dyspnea, tachypnea
-crackles in the lungs
-paroxysmal nocturnal dyspnea
-increase BP

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16
Q

(HFrEF) systolic failure

A

HF with reduced EF; results from an inability of the heart to pump blood effectively.

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17
Q

Ejection Fraction (EF)

A

calculation of how much blood a ventricle can eject with one contraction

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18
Q

normal ejection fraction

A

55-60%

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19
Q

Systolic HF is caused by?

A

-Impaired contractile function
-Increased afterload
-Cardiomyopathy
-Mechanical abnormalities

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20
Q

S/S of right sided heart failure

A

-dependent edema
-jugular vein distention
-abdominal distention
-weight gain
-nocturnal diuresis
-splenomegaly, hepatomegaly
-increased BP

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21
Q

Atrial natriuretic peptide (ANP) and b-type natriuretic peptide (BNP) are released in response to

A

increased blood volume in the heart do it causes diuresis, vasodilation and lowered BP

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22
Q

Nitric oxide (NO) and prostaglandin work by

A

relaxing arterial smooth muscle, resulting in vasodilation and decreased afterload

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23
Q

Compensated HF occurs when

A

compensatory mechanisms succeed in maintaining an adequate CO that is needed for tissue perfusion.

24
Q

Decompensated HF occurs when

A

these compensatory mechanisms can no longer maintain adequate CO and inadequate tissue perfusion results.

25
Q

early signs of acute decompensated heart failure

A

-increased pulmonary venous pressure
-Increase in the respiratory rate
-Decrease in Pao2

26
Q

late signs of acute decompensated heart failure

A

-interstitial edema
-tachypnea
-can lead to alveolar edema resulting in RESPIRATORY ACIDEMIA

27
Q

How do you know what the PaO2 is

A

use an oximeter

28
Q

Acute decompensated HF (ADHF) is defined as

A

*the sudden onset of signs and symptoms of HF, requiring urgent medical care.

29
Q

universal finding in ADHF is pulmonary and systemic congestion due to

A

elevated left-sided and right-sided filling pressures.

30
Q

people in ADHF are also in…

A

ARDS

31
Q

ADHF can manifest as

A

pulmonary edema

32
Q

what four groups can people in ADHF be categorized in

A

1.Dry-warm
2.Dry-cold
3.Wet-warm (most common)
4.Wet-cold

33
Q

dry-warm

A

they are perfusing and blood is flowing

34
Q

dry-cold

A

they are not perfusing

35
Q

wet-warm

A

diaphoretic and warm: they are working hard, they are warm so they are still perfusing

36
Q

wet-cold

A

they are not perfusing and fluid is leaking out of them, this is not good

37
Q

pulmonary edema clinical manifestations

A

-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

38
Q

diagnostics for acute HF

A

-echocardiogram
-ECG
-6-min walk test
-chest xray
-MUGA Scan
-BNP Levels

39
Q

BNP levels correlate positively with

A

the degree of LV failure

40
Q

MUGA scan

A

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)

41
Q

prep for stress test

A

get an IV just in case they crash

42
Q

care for ADHF

A

-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))

43
Q

why do we put a patient with dyspnea due to HF in high fowlers

A

-helps decrease venous return because of the pooling of blood in the extremities
-increases the thoracic capacity, allowing for improved breathing.

44
Q

Ultrafiltration (UF), or aquapheresis,

A

an option for the patient with volume overload.
-UF can rapidly remove intravascular fluid volume while maintaining hemodynamic stability.

45
Q

intraaortic balloon pump (IABP)

A

a device that increases coronary blood flow to the heart muscle and decreases the heart’s workload through a process called counterpulsation.

46
Q

Ventricular assist devices (VADs)

A

can be used to maintain the pumping action of a heart that cannot effectively pump.
- a mechanical pump that is surgically implanted.

47
Q

what do diuretics fo for ADHF

A

Decrease volume overload (preload)

48
Q

what do vasodilators do for ADHF

A

Reduce circulating blood volume and improve coronary artery circulation

49
Q

what does morphine do for ADHF

A

-Reduces preload and afterload
-Relieves dyspnea and anxiety

50
Q

Heart transplantation

A

*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.

51
Q

selection for a heart transplant

A

-Selection process identifies patients who would most benefit from a new heart
-Candidates must undergo physical, diagnostic, and psychologic evaluation

52
Q

Post Heart Transplant monitoring

A

-Acute rejection
-Infection
-Malignancy
-Cardiac vasculopathy
-Immunosuppressive therapy
-Endomyocardial biopsy (EMB)

53
Q

immunosuppressive drugs for heart transplant can cause

A

increased risk for infection after surgery and long term immuno suppressive therapy increases the risk for cancer

54
Q

Endomyocardial biopsy (EMB)

A

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.

55
Q

Nursing management throughout the posttransplant period focuses on

A

*promoting patient adaptation to the transplant process, monitoring cardiac function, managing lifestyle changes, and providing ongoing teaching to the patient and caregiver.

56
Q

left ventricular assist device (LVAD)

A

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.

NSG 430 - Critical Care (42 decks)

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