Topic 5: HF

Question 1

Cardiac Output (CO= HR x SV)

Answer 1

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

Question 2

stroke volume

Answer 2

*Amount of blood ejected from the left ventricle during each contraction

Question 3

preload

Answer 3

*stretch of at the end of diastole and just before contraction

Question 4

afterload

Answer 4

*Resistance that the ventricles must overcome to eject blood through the valves and into the peripheral blood vessels

Question 5

heart failure

Answer 5

*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)

Question 6

what cardiovascular diseases are associated with HF

Answer 6

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

Question 7

Left sided heart failure

Answer 7

pulmonary congestion. Decreased tissue perfusion from poor cardiac output

Question 8

right sidedheart failure

Answer 8

Right ventricle doesn’t empty completely leading to increased volume and pressure in the venous system leading to peripheral edema

Question 9

How does the nurse assess for pulmonary edema?

Answer 9

-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

Question 10

Chronic Heart FailureClinical Manifestations

Answer 10

*Fatigue
*Limitation of Activities
*Chest congestion/cough
*Edema
*Shortness of breath

Question 11

Labs & Diagnostic Tests for HF

Answer 11

-Serum Electrolytes
-TROPONIN
- BNP
-ABG’s
-Echocardiogram
Ejection Fraction
-Chest X-Ray
-12-lead ECG

Question 12

how to improve gas exchange in HF

Answer 12

-Apply oxygen (which device is the most appropriate?)
-Raise the head of the bed
-Sit them up in a chair

Question 13

how to reduce preload in HF

Answer 13

*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

Question 14

how to reduce after load in HF

Answer 14

*Vasodilators (hydralazine, Isosorbide dinitrate, nitrates, nitroprusside)
*ACE Inhibitors (ex. Lisinopril, Captopril, Enalapril)
*ARBs (valsartan, losartan)

Question 15

What do you assess to know the medications are working correctly?

Answer 15

Daily weight and I&Os

Question 16

which medications increase CO and enhance contractility

Answer 16

Digoxin
Beta-blockers (metoprolol)

Question 17

what is the most effective medication to reduce fluid volume overload

Answer 17

Furosemide

Question 18

what labs should be checked when taking furosemide

Answer 18

check for potassium loss & dehydration

Question 19

HCTZ and HF

Answer 19

*more gradual diuresis, stops sodium reabsorption, self limiting.

Question 20

ACE inhibitors and HF

Answer 20

↓ systemic vascular resistance, lower blood pressure

Question 21

Nitrates and HF

Answer 21

will relieve myocardial ischemia by coronary vasodilation

Question 22

BBlockers and HF

Answer 22

stop the SNS effects on the failing heart

Question 23

Positive inotropes and HF

Answer 23

*: increase force of heart contractions, slow the heart rate, to increase the stroke volume and cardiac output

Question 24

Digoxin toxicity s/s

Answer 24

GI effects - anorexia, nausea, vomiting, abdominal pain; CNS effects - fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects

Question 25

what should be monitored whentaking digoxin

Answer 25

-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).

Question 26

what is done to help decrease fatigue in HF patients

Answer 26

do all activities at once then let patient rest for 2 hours in between

Question 27

right sided HF S/S

Answer 27

· 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

Question 28

left sided HF s/s

Answer 28

· 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

Question 29

management of HF

Answer 29

· 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

Question 30

dietary therapy for HF

Answer 30

· 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

Question 31

what weight gain should be reported to the HCP

Answer 31

3 lb in 2 days, or 3-5 in a week

Question 32

what should a patient report to the HCP w HF

Answer 32

· 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)

Question 33

activity program for HF

Answer 33

· Increase walking and other activities gradually, as long as they do not cause fatigue or dyspnea
· Consider cardiac rehabilitation
· Avoid extreme heat and cold

Question 34

rest and HF

Answer 34

· 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

Question 35

heath promotion for HF

Answer 35

· Get flu and pneumococcal vaccine
· Develop plan to reduce risk factors (BP control, tobacco cessation, BG/HbA1C control, weight reduction)

Question 36

before taking drugs for HF what VS should the client know before taking the drug

Answer 36

· Count pulse rate each day before taking drugs, know the parameters to take the drug
· Take BP and know parameters and target BP

Question 37

if a client is on anticoagulants, what should they look for

Answer 37

know s/s of internal bleeding (bleeding gums, increased bruises, bloody stool or urine)

Question 38

if a patient is taking warfarin, what range should they know

Answer 38

INR target range