Topic 5: HF Flashcards
Cardiac Output (CO= HR x SV)
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
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 and into the peripheral blood vessels
heart failure
*Inability of the heart to maintain adequate cardiac output (CO) to meet the metabolic needs of itself & the body
*The pump is broken, the blood doesn’t move as quickly to the body (impaired oxygenation & perfusion)
what cardiovascular diseases are associated with HF
*long-standing hypertension
*coronary artery disease (CAD)
*myocardial infarction (MI)
*Metabolic syndrome
*Advance age
*Smoking
Left sided heart failure
pulmonary congestion. Decreased tissue perfusion from poor cardiac output
right sidedheart failure
Right ventricle doesn’t empty completely leading to increased volume and pressure in the venous system leading to peripheral edema
How does the nurse assess for pulmonary edema?
-Anxious, pale, cyanotic
-Cool and clammy skin
-Dyspnea
-Orthopnea
-Tachypnea
-Use of accessory muscles
-Cough with frothy, blood-tinged sputum
-Crackles and wheezes
-Tachycardia
-Hypotension or hypertension
-Abnormal S3 or S4
Chronic Heart FailureClinical Manifestations
*Fatigue
*Limitation of Activities
*Chest congestion/cough
*Edema
*Shortness of breath
Labs & Diagnostic Tests for HF
-Serum Electrolytes
-TROPONIN
- BNP
-ABG’s
-Echocardiogram
Ejection Fraction
-Chest X-Ray
-12-lead ECG
how to improve gas exchange in HF
-Apply oxygen (which device is the most appropriate?)
-Raise the head of the bed
-Sit them up in a chair
how to reduce preload in HF
*Eliminate table salt, eliminate high Na foods
*Fluid Restrictions/ 2L a day
*Diuretics
*Loop (Lasix) and bumetanide (Bumex)
*Thiazide diuretic (hydrochlorothiazide) Relieve symptoms of HF
how to reduce after load in HF
*Vasodilators (hydralazine, Isosorbide dinitrate, nitrates, nitroprusside)
*ACE Inhibitors (ex. Lisinopril, Captopril, Enalapril)
*ARBs (valsartan, losartan)
What do you assess to know the medications are working correctly?
Daily weight and I&Os
which medications increase CO and enhance contractility
Digoxin
Beta-blockers (metoprolol)
what is the most effective medication to reduce fluid volume overload
Furosemide
what labs should be checked when taking furosemide
check for potassium loss & dehydration
HCTZ and HF
*more gradual diuresis, stops sodium reabsorption, self limiting.
ACE inhibitors and HF
↓ systemic vascular resistance, lower blood pressure
Nitrates and HF
will relieve myocardial ischemia by coronary vasodilation
BBlockers and HF
stop the SNS effects on the failing heart
Positive inotropes and HF
*: increase force of heart contractions, slow the heart rate, to increase the stroke volume and cardiac output
Digoxin toxicity s/s
GI effects - anorexia, nausea, vomiting, abdominal pain; CNS effects - fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects
what should be monitored whentaking digoxin
-Monitor for signs of hypokalemia and hyperkalemia, since these can increase or decrease the effects of digoxin, respectively.
-Monitor for early signs of toxicity: anorexia, nausea and vomiting, fatigue, headache, depression, visual changes.
-Monitor for late signs of toxicity, such as dysrhythmias (e.g., bradycardia, atrioventricular block).
what is done to help decrease fatigue in HF patients
do all activities at once then let patient rest for 2 hours in between
right sided HF S/S
· Peripheral edema
· Anasarca (massive generalized body edema)
· Ascites
· Hepatomegaly
· JVD
· Weight gain
· Increased HR
· Murmurs
· Right ventricular heaves
· Fatigue
· RUQ pain
· Anorexia and GI bloating
Nausea
left sided HF s/s
· Crackles (pulmonary edema)
· Dyspnea
· Paroxysmal nocturnal dyspnea
· Orthopnea
· Nocturia
· S3 and S4 heart sounds
· Pleural effusion
· Shallow respirations up to 34-40min
· Dry, hacking cough
· Frothy, pink-tinged sputum (advanced pulmonary edema)
· Restlessness, confusion
· Increased HR
· Left ventricular heaves
· Decreased PaO2 and slight increase in PaCO2
Weakness, fatigue
management of HF
· Treatment of underlying cause
· Drug therapy
· Circulatory assist devices
· Daily weights
· Sodium and possibly fluid restricted diet
· O2 by mask or nasal cannula if indicated
· High Fowlers position
Check VS
dietary therapy for HF
· Adhere to specific sodium restriction guidelines
· Examine labels to determine sodium content (food packages and OTC meds)
· Weight yourself in the morning at the same time each day preferably in the morning under the same conditions
· Eat small, frequent meals
what weight gain should be reported to the HCP
3 lb in 2 days, or 3-5 in a week
what should a patient report to the HCP w HF
· Weight gain of 3 lb in 2 days, or 3-5 in a week
· Difficulty breathing, especially when lying flat or with activity
· Waking up breathless at night
· Frequent dry, hacking cough, especially when lying down
· Fatigue, weakness
· Swelling of ankles, feet or abdomen
· Swelling of face or difficulty breathing (angioedema; may because of ACE inhibitor)
activity program for HF
· Increase walking and other activities gradually, as long as they do not cause fatigue or dyspnea
· Consider cardiac rehabilitation
· Avoid extreme heat and cold
rest and HF
· Plan a regular daily rest and activity program
· After exertion, such as exercise and ADLs, plan a rest period
· Consider shorter working hours or schedule periods of rest during working hours
· Avoid emotional upsets
heath promotion for HF
· Get flu and pneumococcal vaccine
· Develop plan to reduce risk factors (BP control, tobacco cessation, BG/HbA1C control, weight reduction)
before taking drugs for HF what VS should the client know before taking the drug
· Count pulse rate each day before taking drugs, know the parameters to take the drug
· Take BP and know parameters and target BP
if a client is on anticoagulants, what should they look for
know s/s of internal bleeding (bleeding gums, increased bruises, bloody stool or urine)
if a patient is taking warfarin, what range should they know
INR target range
