Unit 8 Heart Failure Flashcards
What is heart failure essentially?
Ventricular dysfunction
What is cardiac remodeling?
Changes in the size, shape, structure, and function of the heart, after injury to the heart muscle.
If a PT has an EF of < 40% what should they be on?
ACEi
African Americans use what Rx’s for HF?
What race tends to have increased incident of ACEi related cough?
- isosorbide
- hydralazine
(both dilators)
Asians
What does the heart release in HF?
What does the brain release?
ANP (released with fluid overload)
BNP (released with ventricular perfusion)
What are causes of heart failure?
CAD
Hypertension
Cardiomyopathy
Valvular Heart Disease
Arrhythmias (A-Fib)
Cardiac infections and inflammation
COPD leads to (“Cor Pulmonale” R sided HF from the lung condition)
What is Cor Pulmonale?
R sided HF from lung disease such as COPD
What are the ways to classify HF?
Right or Left
Acute or Chronic
Systolic or Diastolic
Describe LEFT sided HF.
Most common form of HF
Changes most often seen in pulmonary circulation
Can lead acute decompensation and acute pulmonary edema.
Can lead to RHF
What are signs and symptoms of LEFT sided HF?
S/S of decreased cardiac output:
- AMS
- Cool clammy skin
- Fatigue
- Weak pulses
- Chest pain
- Tachycardia
- Palpations
S/S of pulmonary congestion:
- PND/orthopnea (SOB when laying down, relieved by sitting or standing; PND is during sleep.)
- Pink frothy sputum
- Crackles and wheezes
- Cough
- CXR shows vascular congestion “batwing”
What are the causes of R sided HF?
Left sided HF
Right ventricular infarction
Pulmonary HTN
COPD
What are signs and symptoms of RHF?
HJR/JVD - Hepatic juglar reflux (pressing RUQ = juglar vein distends)
RUQ pain
Hepatomegaly
Anorexia (from back up of pressure into veins and organs)
Swelling/edema
Ascites
Polyuria at night
Describe Systolic vs. Diastolic Failure. What are the causes of each?
Systolic failure:
- HF associated w/ decreased EF
- Impaired contraction and decreased stroke volume
causes: CAD, Ischemia, cardiomyopathy, valve abnormality
Diastolic Failure:
- HF associated with normal EF
- Impaired relaxation and decreased filling (ventricles are stiff, not enough blood into ventricles)
causes:
HTN, Hypertrophic cardiomyopathy (HCM)
What are diagnostics for HF?
**Echocardiogram (EF, ventricular size and motion) BMP BNP (should be < 100 normally) CBC ABG's Cardiac injury profile Liver function tests CXR (cardiomegaly-heart is enlarged, pulmonary congestion) 12 lead EKG Cardiac Cautherization Hx and physical
What is the purpose of pulmonary catheterization?
To measure CVP (central ventricular pressure) which helps indicate R sided HF by measuring after-load of R ventricle.
The normal is 0-10.
and to measure PCWP (pulmonary capillary wedge pressure) which helps measure pre-load of the L ventricle to indicate LEFT sided heart failure
(left end diastolic pressure)
Normal range is 8-12.
What is the nursing care for the pulmonary catheter procedure? Pre-procedure. During insertion. After insertion.
Pre-procedure:
- Consent
- Teaching
During Insertion:
- Monitor the passage
- Obtain readings
After insertion:
- Secure the catheter
- Maintain position of the catheter
- Record accurate # of CVP, PCW
- Monitor for complications
During the pulmonary catheter procedure what wave lengths and pressure correspond with where the catheter is entering?
What do you do once the pulmonary catheter enters the artery wedge?
- Entering R atrium waves and pressure hovering around 5mmHg
- Entering R ventricule wave spikes to 25mmHg down to zero and back up again - repeating
- Entering pulmonary artery wave starts at 10mmHg and spikes to 25mmHg and back to 10mmHg again. repeating
- When reaching the Pulmonary Artery Wedge the waves hover around 10mmHg
Notify MD once it reacher pulmonary wedge!
What are complications of HF?
Arrhythmias
Third Spacing (especially w/ R HF, fluid everywhere)
Dyspepsia (indigestion)
Cariogenic shock
Thromboembolic events
Sudden Cardiac arrest
What are lifestyle modifications for heart failure?
**Smoking cessation
- Healthy weight
- Healthy diet: limit alcohol, limit sodium, fluid restriction in later stages
- Exercise (walking 30 min a day a few times a week)
- Control modifiable risk factors: HTN, Diabetes, Metabolic syndrome, CAD
- Anti-hypertensive, anti diabetic, statins
What is the dietary management for HF?
- Sodium restriction
- Fluid restrictions in later stages
- Weight management
What are general measures/nursing management for HF?
Oxygen
Bedrest with graded activity as tolerated
Strict I/Os
Daily weight***
Patient education
Sodium/Fluid restriction
Monitor labs/arrhythmia
Flu/pneumonia vaccination assessment on admission
What are the types of medications used in HF?
Diuretics
ACE i (pril)
ARBs (artan)
Beta Blockers (olol)
Vasodilators
Positive Inotropes
Natriuretic Peptides
Anti-Arrhythmic
Name the diuretics used in HF.
What do they do besides help excrete excess fluid?
- Thiazide (causes hypokalemia, watch K+ levels)
- Loop diurectics
- Potassium sparring diuretics (spirictolactone) can cause gynecomastia
- Aldosterone blockers
These all decrease pre-load
Any medication lower BP is a safety concern for what?
PT falls
When are beta blockers mostly used?
In PT’s with diastolic heart failure
Name the Vasodilators used in HF.
What did they do?
nitroglycerine
>effective in A.A
hydralazine (side effect: butterfly rash)
nitroprusside (only IV 24-48 hrs)
Dilates veins and arteries.
Name the Inotropes used in HF.
What do they do?
Cardiac glycoside: digoxin (monitor K+ levels, dig toxicity indications = n and V, 1st degree heart block)
Beta-adrenergic agonist: dobutamine
They increase the force of contractions.
Name the Natreuretic peptide medication used in HF.
What is it?
nesiritide [Natrecor]
- Synthetic BNP given as IV drip.
- Dilates veins and arteries.
- Increases excretion of Na+ and water, therefor cardiac output
Side effect: hypotension
What are the mechanical and surgical interventions for HF?
Mechanical:
- Bi-Pap
- IABP (intra-aortic balloon pumping)
Surgical:
- LVAD
- ICDs/Vest
- Heart transplant
What are contraindications for LVAD?
Liver or Kidney failure
Life expectancy < 3 years
For what amount of weight gain in HF would you notify the MD?
5lbs in 1 week
or
2lbs in 1 day
What are the core measures for Heart Failure?
- Written discharge instructions that include:
- Weight management
- Medications
- Symptom management (when to report)
- Activity level
- Diet
- Followup appointments - LVF assessment (echocardiogram, EF <40%)
- Smoking cessation
- ACE or ARBs prescribed for PT’s w/ LV dysfunction (document if not prescribed for some reason)
Why is important to assist the client to the bathroom when first taking an ACE inhibitor?
First dose syncope is a side effect of taking an ACEi.
Ensure PT safety by assisting to BR.
