unit 3 HF Flashcards
SBP
Systolic pressure is the peak arterial pressure that occurs during ventricle contraction
DBP
diastolic pressure is the minimal aortic pressure just before the ventricle ejects blood during relaxation, also called filling pressure
Cardiac output
HR x SV
SVR
Force opposing blood moving within a vessel
Sustained Hypertension
140/90
Hypertension for people with diabetes
130/80
what is happening during systole and diastole in a patient with hypertension?
Putting a lot of force on the contraction, pushing really hard. The muscle gets tired and stressed out. If you cannot relax enough you will not fill up, you will end up with edema SOB ect.
Stage 1 Hypertension
140-159/90-99
Stage 2
SBP 160
DBP 100
White coat hypertension
nervous when getting BP taken goes up
why are people with hypertension out of break
O2 demands increase
What is happening to the vessels with hypertension
constrict too much or cannot relax
modifiable risks for hypertension
genetic, age, male, female and age, type 1 diabetes
Modifiable risk factors for hypertension
lack of education, diet to much to little of what, lack of exercise, stress, smoking, alcohol, obesity, hyperglycaemia, head injury
what labs should be ordered with hypertension
potassium, glucose ect.
why do a 24 hour ambulatory BP screening
to see how hypertension fluctuates throughout the day
why check the serum glucose
patients with high blood pressure are more resistant to insulin-stimulated glucose uptake than matched control groups with normal blood pressure.
Diuretics
meds that help you move extra fluid and salt out of your body (make you pee more frequently) decrease circulating blood volume
ACEI
(Angiotensin-converting enzyme inhibitor) “pril” Prevent vessel from getting tight
ACEI
(Angiotensin converting enzyme inhibitor) “pril” Prevent vessel from getting tight
ARB
(angiotensin II receptor blocker) “sartan” Prevent vessel from getting tight
CCB
(calcium channel blocker) “pine” Stimulates the heart
Things to teach hypertensive patients
-diet, exercise, weight loss, lifestyle modifications, med, 3F’s (fat, fluid, fibre)
-Good mix of cardiac and muscular exercise)
What is the dash diet
Sodium-restricted diet for people with high BP.
3300, 2300, or 1500 mg of salt daily
What foods are in the dash diet
veggies, fruit, grain, milk, meat, nuts, seeds, dry beans, oil
Potential complications for hypertension
-CAD vessels tighten and form plaque
-left ventricular hypertrophy the heart muscle get bigger
-TIA
-MI
-Embolic stroke
-PAD
-end stage organ failure, renal, eyes
Hypertensive crisis
anything 180/120 over
Incompetent valves
-Too open (regurgitation)
-Too closed (stenosis)
Stenosis
-Valve orifice is restricted
-forward blood flow is impeded
-A pressure gradient is created across open valve
-Pressure gradient differences reflect the degree of stenosis
Regurgitation
Incomplete closure of valve leaflets results in backward flow of blood
Regurgitation can be caused by
MI, Chronic rheumatic heart disease,
What is paroxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea (PND) is a sensation of shortness of breath that awakens the patient
how does regurgitation effect structure
changes the structure of the leaflets, chord tendinae, papillary muscle, left atrium, or left ventricle causes incomplete closure of the valves
Prolapse
change in structure of the leaflets, charade, tendinae, papillary muscle, left atrium, left ventricle causes the leaflets to concave during systole
Valve failure assessment
energy level, angina, SOBOE, Edema, heart murmur because of the ability to pump blood
Tests for valve failure
CXR, ECG, Trans thoracic ECHO, Trans Esophageal Echo, CARDIAC CATHETERIZATION
Medication for Valve failure
Digitalis, Vasodilators, diuretics, blockers, anticoagulants, antidysrhythmic
Things to teach with valve replacement
Symptom management, preventative antibiotics, lifestyle, medication complications
Endocarditis
Bacteria delivers the organism to the surface of the valve, adhere on the valves eventual invasion of the valvular leaflets
Cardiac output
Cardiac output (CO) is the amount of blood pumped by the heart minute and is the mechanism whereby blood flows around the body.
Ejection fraction
Ejection fraction is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction.
Ventricular remodelling
refers to changes in the heart’s size and shape that occur in response to cardiac disease or cardiac damage. When doctors talk about “remodelling,” they are usually talking about the left ventricle, though occasionally this term is applied to other cardiac chambers.
Cardiomegaly
An enlarged heart (cardiomegaly) is an increase in the size of the heart.
Ventricular dilation
Dilated cardiomyopathy (DCM) is a condition in which the left ventricle, the heart’s main pumping chamber, is enlarged (dilated).
Ventricular hypertrophy
If the heart has to work too hard to pump blood, the muscles in the walls of the left ventricle thicken. This thickening is called hypertrophy. Hypertrophy means growing (trophy) too much (hyper). Left ventricular hypertrophy (LVH) makes it harder for the heart to pump blood efficiently.
Pleural effusion
Pleural effusion is the buildup of too much fluid between the layers of your pleura around your lungs.
Thrombus
A thrombus is a healthy response to injury intended to stop and prevent further bleeding,
Hepatomegaly
An enlarged liver is a sign of an underlying problem, such as liver disease, congestive heart failure or cancer.
A regular LVEF is
55%
Why does EF drop with heart failure
the heart’s lower left chamber (left ventricle) doesn’t pump blood out to the body as well as it should. It’s sometimes called systolic heart failure.
How to calculate the ejection fraction
Amount of blood pumped out of the ventricle divided by total amount of blood in the ventricle
coronary artery disease
blockages in your coronary arteries that limit blood flow to your heart muscle which weakens or damages the heart muscles and impairs the muscles ability to pump
Cardiomyopathy
a disease of the heart muscle. The muscle is weakened which affects its ability to pump properly
How does high blood pressure effect heart failure
The heart has to work extra hard to pump against increased pressure which weakens the muscle
Aortic stenosis
Opening of aortic valve is narrowed imparting blood flow, the heart works harder to pump blood through the narrowed valve, weakening the muscles
Mitral Regurgitation
Increases blood volume stretched and weakens heart muscles
Arrhythmia
Irregular heart beat, irregular rhythm reduces the pumping effectiveness of the heart
Primary Heart failure
Causes are the primary condition or disease process leading to the development of HF.
Preciptants of heart failure
Precipitants are triggers or contributing factors for decompensation in patients with established chronic heart disease.
Systolic heart failure
reduced EF
Risk factors for HF
CAD, Hypertension, diabetes, MI, any type of heart disease
Left Heart failure
most common
-blood backs up into pulmonary veins
-Fluid backs up in alveoli LUNGS
-Pulmonary congestion, edema, review under complications
-Usually start with left and then develop right
-Goes to lungs
Left heart failure symptoms
Pulmonary conjestion, Dyspnea, cough, crackles, O2 Sat, Fatigue, Mentation changes, Paroxysmal nocturnal, Duspnea
Right ventricle Heart failure
Systemic congestion, edema, lower extremity edema, ascites, weight gain, liver enlargement, JVD, Anorexia/nausea
Symptoms of Right sided heart failure
chest discomfort, breathlessness, palpitations, and body swelling.
How does the heart compensate when in heart failure
Atria enlarges, The heart walls thicken (the muscles). It remodels.
Dilation of the heart
Muscle fibres stretch in response to the extra volume of blood still in the heart at the end of diastole, adaptive, short term fix
Hypertrophy
Increase in muscle mass and cardiac wall thickening in response to chronic dilation, resulting in poor contractility, higher O2 needs, poor coronary artery circulation, risk for ventricular dysrhythmias
Sympathetic Nervous system compensation
Increase HR, Increase contractility, Increase cardiac output, Vasoconstriction, Increase workload and volume on the heart
class 1 HF
No limitations of physical activity, ordinary physical activity foes not cause fatigue, dyspnea, palpations, or angina
Class 2
Slight limitation of physcical activity no symptoms at rest. Ordinary physical activity results in fatigue, dyspnea, palpations or angina
Class 3
Marked limitation of physical activity. Usually comfortable at rest. Ordinary physical activity causes fatigue, dyspnea, palpations, or agina
Class 4
Inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of angina may be present even at rest. If an physical activity is undertaken, discomfort is increased
Pulmonary edema
Pulmonary edema is a condition caused by too much fluid in the lungs. This fluid collects in the many air sacs in the lungs, making it difficult to breathe. In most cases, heart problems cause pulmonary edema. But fluid can collect in the lungs for other reasons.
Complications in Pulmonary Edema
Sudden increased RR, anxious pale/cyanotic, tell them not to panic
Assessment for pulmonary edema
cough with frothy, blood tinged sputum, Breath sounds: crackles wheeze, rhonchi, tachycardia, hypotension or hypertension, orthopnea, dyspnea, tachypnea, cyanosis, cool and clammy skin
Nursing intervention for Pulmonary Edema
DO not wait for an order, safe the patient, put on oxygen, drop left, put arms up (tripod position)
AAT
uses a sample of blood or a cheek swab to diagnose a condition called alpha-1 antitrypsin deficiency (AAT deficiency). Made by the liver
Furosemide
diuretics
Enapril
used alone or in combination with other medications to treat high blood pressure.
What does a chest x ray tell you
look at the structures and organs in your chest .It can help your healthcare provider see how well your lungs and heart are working.
What does an ECHO tell you
The test can help a health care provider diagnose heart conditions. An echocardiogram uses sound waves to create pictures of the heart. This common test can show blood flow through the heart and heart valves. Your health care provider can use the pictures from the test to find heart disease and other heart conditions.
Lab tests to complete with Heart failure
BNP, Lytes, ABG, CXR, ECG, ECHO
Abnormal test results with HF
High NA, Low K, Low urea, High BNP
What does a HF patent need
O2, Rest, Cath, positioning (fowlers), IV access, meds
