Unit 2: Heart Failure (HF) Flashcards
Heart Failure
progressive disease
-myocardial cell dysfunction resulting in the inability of the heart to pump enough cardiac output to meet the demands of the body
Right Sided Heart Failure
inability of the right side of the heart to effectively pump blood to the pulmonary vasculature >S/S: -jugular vein distention (JVD) -dependent edema -hepatomegaly -ascites
Left-Sided Heart Failure
dysfunction of the left ventricle >S/S: -SOB/ Dyspnea/ Orthopnea -Crackles on auscultation -Pale color, weak pulses, cool temperature in extremities -Delayed capillary refill (> 3 seconds) -Weakness & fatigue
Clinical Manifestations of Left Sided HF
the weakened contraction = poor peripheral perfusion and backflow of blood that causes fluid accumulation in the lungs (think left (L) for Lungs)
- SOB
- Dyspnea
- Orthopnea
- Fatigue
- Crackles on Auscultation
- Pale color, weak pulses, cool temp in extremities
Clinical Manifestations in Right Sided HF
the weakened contraction of the right ventricle = backflow of blood into the right atrium and venous circulation
- Jugular vein distention (JVD)
- Dependent Edema
- Hepatomegaly
- Ascites
Comparison of Stages of HF Development and New York Heart Association Functional Classes
> AHA Stages of HF Development:
A. patient w/ risk factors but no left ventricle impairment
B. asymptomatic w/ LV hypertrophy and/or impaired LV function
C. current or past symptoms of HF
D. refractory HF eligible for heart transplant, inotropic and/or mechanical support
> New York classification of functional status
I: no symptoms w/ physical activity, such as dyspnea or chest pain
II: mild symptoms w/ ordinary activities
III: marked limitation w/ physical activity but comfortable at rest
IV: severe limitation and distress w/ physical activity or at rest
AHA Stages of HF Development
A. Patient w/ risk factors but no LV impairment
B. Asymptomatic w/ LV hypertrophy and/or impaired LV function
C. Current or past symptoms of HF
D. Refractory HF eligible for heart transplant, inotropic and/or mechanical support
New York Heart Association Classification of Functional Status
I: no symptoms w/ physical activity, such as dyspnea or chest pain
II: mild symptoms w/ ordinary activities
III: marked limitation w/ physical activity but comfortable at rest
IV: severe limitation and distress w/ physical activity or at rest
Laboratory Values: Brain Natriuretic Peptide (BNP)
less than 100 pg/ml
- released from overstretched ventricular tissue
- elevated in HF
Medications for HF
-ACE (angiotensin-converting enzyme) inhibitors: (Captopril, Enalapril)
-ARBs (angiotensin receptor blockers): [Valsartan]
-ARNIs: (angiotensin receptor-neprilysin) inhibitors: (Valsartan/sacubitril combo)
-Arterial Vasodilators (hydralazine, isosorbide dinitrate, nitroprusside)
-Venous Vasodilators (isosorbide dinitrate)
-Diuretics:
>Loop (Furosemide)
>Aldosterone receptor antagonist (Spironolactone)
-Beta Blockers (Carvedilol)
-Inodilators (Milrinone, dobutamine)
-Inotropes (dopamine)
-I (f) current inhibitor: (ivabradine)
-Cardiac glycoside (Digoxin)
>all require monitoring of BP, HR, and cardiac rhythm and frequent assessments
ACE Inhibitors used for HF
angiotensin-converting enzyme inhibitors
-Captopril
-Enalapril
>afterload reduction
ARBs used for HF
angiotensin receptor blockers
-Valsartan
>afterload reduction
ARNIs used for heart failure
Valsartan/ Sacubitril combo
-afterload and preload reduction
Arterial Vasodialtors
afterload reduction
- Hydralazine
- Isosorbide dinitrate
- Nitroprusside
Venous Vasodilators
preload reduction
-isosorbide dinitrate
Diuretics
preload reduction
- loop diuretics (furosemide)
- aldosterone receptor antagonists (Spironolactone)
Beta Blockers
decreases HR and myocardial workload
-Carvedilol
Inodilators
increase contractility and reduce afterload
- Milrinone
- Dobutamine
Inotropes
increased contractility
-Dopamine
I (f) current inhibitor
myocardial workload reduction by decreasing HR
-Ivabradine
Cardiac Glycoside
enhance contractility (positive inotrope) -Digoxin
Invasive Treatments for HF
- Pacemaker
- Internal Defibrillator
- Mechanical circulatory support (LVAD)
- Heart Transplant
Complications of HF
- Pulmonary Edema
- Dysrhythmias
- Renal Failure
Pulmonary Edema
-acute complication
-accumulation of fluid in the interstitial and alveolar spaces of the lungs
-results from elevated filling pressures within the heart
>S/S:
-SOB
-low O2 sat
-pink and frothy sputum
-orthopnea
-tachycardia
-chest pain
-anxiety/fear
>Treatment:
-supplementary O2
-higher dose on IV diuretics
-depending on severity, may need respiratory support (continuous positive airway pressure [CPAP], bilevel positive airway pressure [BiPAP], or intubation w/ mechanical ventilation)
Dysrhythmias
can occur as the heart enlarges and catecholamine levels increase
Renal Failure
d/t the decrease in blood flow to the kidneys
Nursing Assessments
- Vital Signs
- Breath Sounds
- Monitoring for irregular heart rhythm or dysrythmias
- Skin color, temperature, peripheral pulses, and capillary refill time
- Dry, persistent cough
- Activity tolerance
- Urine output
- Daily weight
- Laboratory Data (BNP, BUN + Creatinine, Liver enzymes, Electrolytes)
- Depression screening
- Social Support
Nursing Actions
- Oxygen therapy
- Elevate HOB and provide fan for dyspnea
- Medication administration as ordered (ACE inhibitors, ARBs, ARNIs, Vasodilators, beta blockers, Inotropic agents)
- Fluid and Sodium restriction
Nursing Teaching
- Medication Management
- Maintain Activity as tolerated; alternate rest and activity periods
- Low-salt diet
- Daily weight at home at the same time each day, in the morning after voiding
- Cardiac rehabilitation
- S/S of worsening HF checklist (edema, SOB, fatigue, and orthopnea)
