TOPIC 5 - heart failure

Question 1

disorders of heart failure (right, left, combined)

Answer 1

myocardial hypertrophy
cardiomyopathy

Question 2

disorders of peripheral arterial disease

Answer 2

peripheral arterial disease
intermittent claudication
arterial skin ulcers

Question 3

disorders of peripheral venous diseases

Answer 3

venous thromboembolism
venous skin ulcers

Question 4

meds for heart failure

Answer 4

diuretics, ace inhibitors, nitrates, beta blockers, positive inotropes

Question 5

cardiac output

Answer 5

6-8 liters of blood ejected from the left ventricle per minute

Question 6

stroke volume

Answer 6

amount of blood ejected from the left ventricle during each contraction

will increase in response to an increase in volume of blood (compensation)

Question 7

preload

Answer 7

stretch of at the end of diastole and just before contraction

Question 8

afterload

Answer 8

resistance that the ventricles must overcome to eject blood through the valves into the peripheral blood vessels

Question 9

CO and SV in heart failure

Answer 9

decrease in both - progressive of the disease = thickness of heart walls increase, making it less efficient while requiring increasing metabolic requirements

Question 10

systolic heart failure

Answer 10

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

Question 11

diastolic heart failure

Answer 11

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

Question 12

heart failure

Answer 12

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

Question 13

associated diseases with heart failure

Answer 13

long-standing hypertension
coronary artery disease (CAD)
myocardial infarction (MI)
Metabolic syndrome
Advance age
Smoking

Question 14

conditions that increase workload of ventricles

Answer 14

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)

Question 15

left sided heart failure

Answer 15

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

Question 16

left sided heart failure results from

Answer 16

inability to empty adequately during systole or fill adequately during diastole

Question 17

causes of right sided heart failure

Answer 17

left ventricular heart failure, MI of the right ventricle, pulmonary HTN

Question 18

right sided heart failure leads to …

Answer 18

increased volume and pressure in the venous system leading to peripheral edema

Question 19

complications of heart failure

Answer 19

pleural effusion
fluid in the lungs
dysrhythmias
left ventricle thrombus
hepatomegaly
renal failure
skin ulcers

Question 20

pulmonary edema

Answer 20

inhibits oxygen and carbon dioxide exchange at the alveolar capillary interface

Question 21

manifestations of pulmonary edema

Answer 21

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)

Question 22

chronic hear failure manifestations

Answer 22

fatigue, limitation of activities, chest congestion & cough, edema, shortness of breath

Question 23

labs and diagnostics for heart failure

Answer 23

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

Question 24

nursing diagnosis

Answer 24

impaired gas exchange
decreased cardiac output
excess fluid volume
activity intolerance

Question 25

medical interventions

Answer 25

treat underlying causes
decrease morbidity and mortality
improve cardiac output
decrease and manage symptoms
preserve organ function

Question 26

how do CPAP improve heart failure

Answer 26

improve CO and EF by decreasing preload and afterload and BP

Question 27

how to reduce preload

Answer 27

eliminate salty foods
fluid restrictions (2L a day)
diuretics

Question 28

how to reduce afterload

Answer 28

vasodilators
ace inhibitors
ARBs

Question 29

how to increase cardiac output

Answer 29

digoxin (monitor K levels)
beta blockers

Question 30

once ambulating, look for a change in…

Answer 30

20 mm Bp
20 bpm HR
signs of activity intolerance
measure distance ambulated

Question 31

education

Answer 31

diet, activity, lifestyle, smoking cessation, cultural and social considerations, medication management, AHA resources