TOPIC 5 - heart failure Flashcards
disorders of heart failure (right, left, combined)
myocardial hypertrophy
cardiomyopathy
disorders of peripheral arterial disease
peripheral arterial disease
intermittent claudication
arterial skin ulcers
disorders of peripheral venous diseases
venous thromboembolism
venous skin ulcers
meds for heart failure
diuretics, ace inhibitors, nitrates, beta blockers, positive inotropes
cardiac output
6-8 liters of blood ejected from the left ventricle per minute
stroke volume
amount of blood ejected from the left ventricle during each contraction
will increase in response to an increase in volume of blood (compensation)
preload
stretch of at the end of diastole and just before contraction
afterload
resistance that the ventricles must overcome to eject blood through the valves into the peripheral blood vessels
CO and SV in heart failure
decrease in both - progressive of the disease = thickness of heart walls increase, making it less efficient while requiring increasing metabolic requirements
systolic heart failure
heart is contracting, working, depolarizing
Altered ventricular contraction
Thin ventricular wall becomes stiff, less flexible, making it weaker
Increases the afterload (hypertension)
Can cause cardiomyopathy
Cause changes to the heart valves leading to valve disease
This is more common to the left ventricle, but can happen to both right and left ventricles
diastolic heart failure
when the heart is relaxing, filling, repolarizing
Heart wall becomes thick, decreasing the inside volume of the ventricle
Ventricles can’t relax and fill properly that in turn
Decreases stroke volume and cardiac output
Venous engorgement in the pulmonary and systemic circulation
heart failure
inability of the heart to maintain adequate CO to meet the metabolic needs of itself and body
pump broken = blood doesn’t move as quickly to the body
leads to myocardial hypertrophy and cardiomyopathy
associated diseases with heart failure
long-standing hypertension
coronary artery disease (CAD)
myocardial infarction (MI)
Metabolic syndrome
Advance age
Smoking
conditions that increase workload of ventricles
Anemia (decreased oxygen supply increases workload of heart to meet the demand)
Infection (increased oxygen demand)
Dysrhythmias (decreased CO and increased workload)
Obstructive sleep apnea
Pulmonary embolism (increased workload to pump blood into lungs)
Hypervolemia (increased preload increases workload)
left sided heart failure
causes : HTN, CAD, valvular disease of aortic or mitral valve
decreased tissue perfusion from poor cardiac output, pulmonary congestion
can be from enlarged ventricles or atria
left sided heart failure results from
inability to empty adequately during systole or fill adequately during diastole
causes of right sided heart failure
left ventricular heart failure, MI of the right ventricle, pulmonary HTN
right sided heart failure leads to …
increased volume and pressure in the venous system leading to peripheral edema
complications of heart failure
pleural effusion
fluid in the lungs
dysrhythmias
left ventricle thrombus
hepatomegaly
renal failure
skin ulcers
pulmonary edema
inhibits oxygen and carbon dioxide exchange at the alveolar capillary interface
manifestations of pulmonary edema
anxious, pale, cyanotic
cool and clammy skin
dyspnea, orthopnea, tachypnea (unable to lie flat due to SOB)
use of accessory muscles
cough with frothy, blood tinged sputum
crackles and wheezes
tachycardia
hypo or hypertension
abnormal s3 and s4
increased RR (more than 30)
chronic hear failure manifestations
fatigue, limitation of activities, chest congestion & cough, edema, shortness of breath
labs and diagnostics for heart failure
serum electrolytes (monitor K levels)
troponin
BNP (produced when the heart is in distress)
ABG’s (how well they are oxygenating)
echocardiogram
ejection fraction
chest x ray
nursing diagnosis
impaired gas exchange
decreased cardiac output
excess fluid volume
activity intolerance
medical interventions
treat underlying causes
decrease morbidity and mortality
improve cardiac output
decrease and manage symptoms
preserve organ function
how do CPAP improve heart failure
improve CO and EF by decreasing preload and afterload and BP
how to reduce preload
eliminate salty foods
fluid restrictions (2L a day)
diuretics
how to reduce afterload
vasodilators
ace inhibitors
ARBs
how to increase cardiac output
digoxin (monitor K levels)
beta blockers
once ambulating, look for a change in…
20 mm Bp
20 bpm HR
signs of activity intolerance
measure distance ambulated
education
diet, activity, lifestyle, smoking cessation, cultural and social considerations, medication management, AHA resources
