W9: Heart Failure

Question 1

What is Ejection Fraction (EF)?

Answer 1

the stroke volume divided by the end-diastolic volume-represents the fraction or percentage of the diastolic volume that is ejected from the heart during systole

Question 2

What does an EF of under 40% indicate?

Answer 2

A measurement under 40% may be evidence of heart failure or cardiomyopathy.

Question 3

Systolic (HFrEF)/ Diastolic (HFpEF)-Reduced vs Preserved

Answer 3

Reduced
Anyone’s who EF is low

Preserved
- Anyone’s who EF is normal

Question 4

Heart failure with preserved ejection fraction

Answer 4

Over half of patients with a clinical diagnosis of heart failure have a preserved ejection fraction (HFpEF) >50%.

Question 5

Heart failure with reduced ejection fraction

Answer 5

Previously named systolic heart failure with an ejection fraction of less than 40%.

Question 6

Precipitating Causes of Heart Failure

Answer 6

F – faulty heart valves
A – arrhythmias (afib and tachycardia)
I – myocardial Infarction/CAD
L – lineage
U – uncontrolled HTN
R – recreational drugs
E – evaders - infections

Question 7

What are pulmonary symptoms of left HF?

Answer 7

when the left ventricle fills and unable to pump out – the overflow goes into the lungs

Question 8

Left Heart Failure - DROWNING

Answer 8

D – dyspnea
R – rales
O – orthopnea
W – weakness
N – Nocturnal Paroxysmal dyspnea
I – increased heart rate – increased volume
N – nagging cough
G – gaining weight

Question 9

What is Nocturnal Paroxysmal dyspnea?

Answer 9

gasping for breath while sleeping

Question 10

What are symptoms of Right Sided Heart Failure?

Answer 10

Peripheral congestion symptoms

Question 11

Right Heart Failure - SWELLING

Answer 11

S – swelling of legs
W – weight gain
E – edema
L – large neck veins
L – Lethargic
I – irregular heart beat
N – nocturia
G – girth - ascities

Question 12

Which of the following actions is the appropriate initial response to a client coughing up
Pink frothy sputum

A. Call for help
B. Call the physician
C. Start an IV
D. Suction patient

Answer 12

A. Call for help

Question 13

What are s/s of Cardiogenic Shock?

Answer 13

S3, JVD, decrease MAP, SOB, weak pulse, pale skin, cool hands and feet, decreased urine output

Question 14

Cardiogenic Shock

Answer 14

Failure of heart to pump blood adequately

Most common cause MI; ineffective pumping caused by arrhythmias, mechanical defects, ventricular aneurysm or valve dysfunction.

Myocardial depressant factor (MDF) produces myocardial depression, ventricular dilatation, and decreased LVEF-follows other causes of severe shock or burns

Question 15

What nursing interventions for heart failure?

Answer 15

Assess for worsening symptoms
Labs – Potassium, BUN, Creatinine, Dig level, Bnp, Troponin
Fluid status - fluid restriction
Cardiac status - monitor bp and rhythm
Diet - low sodium
Edema
Response to medications - some meds can cause orthostatic HTN
Safety

Question 16

What do ACE inhibitors prevent?

Answer 16

inhibitor-prevent conversion of Angiotensin I to II –vasodilatation: newer blockers cause less cough; delays or inhibits left ventricular chamber remodeling and ventricular dilation

Question 17

Digitalis

Answer 17

positive inotropic drug and decrease in sinoatrial node activity (slow heart rate and increase diastolic filling time)

Question 18

What do diuretics promote?

Answer 18

Diuretics promote excretion of edema fluid, reduce preload and allow heart to operate at a more optimal part of the Frank Starling curve

Question 19

Describe ACE inhibitors?

Answer 19

First line of treatment

Vasodilator
– decreases afterload
- Decrease the work of the heart
- Can cause hypotension: Monitor patient

Causes kidneys to secrete sodium

Decreases blood pressure

Monitor potassium
- Causes the body to retain K+, monitor levels

Nagging dry cough
- Immediate

Question 20

Describe Angioedema

Answer 20

extremely swollen tongue

Safety
This can greatly impact the airway
Watch for this when newly started ACE – can cause angioedema

Question 21

Describe Angiotensin II receptor blockers
(ARBs)

Answer 21

Used in place of ACE Inhibitors
Causes vasodilatation
Same effects as ACE inhibitors
Monitor potassium
No cough - no nagging cough

Question 22

Describe Diuretics

Answer 22

Loop or Potassium sparing
Usually used with ACE or ARB
Removes sodium and water
Helps heart pump easier
Monitor labs and vitals

***REMEMBER:
Loop – furosemide – K+ WASTING
Potassium sparing – spiro

Question 23

Describe Beta Blockers

Answer 23

Decreases workload of the heart
Decreases heart rate
Can mask hypoglycemia (S/S tachycardia)
No grapefruit juice

**Key:
If the patient is a diabetic on a beta blocker – monitor for other s/s of hypoglycemia

Question 24

Describe Anticoagulant

Answer 24

Not used in all patients
Heart failure patients in afib
History of clots – PE, DVT
Decreased EF

HF – blood pools in the LV, there is a chance that clots can form
New onset of afib – need to be on anticoagulants

Question 25

Describe Vasodilators

Answer 25

Used if patient can not take ACE or ARB
Decreases workload of heart
Decreases BP
Orthostatic hypotension

**Key:
If the patient cannot take ACE or ARBS for some reason
May put them on nitroglycerin – to aid in excreting excess fluid

Question 26

Describe Digoxin

Answer 26

Increase the ability of the heart to contract
Decreases heart rate
Toxicity – S/S ??
How do you administer?
Antidote?

**Key:
Increase the contractility of the heart
SLOWS THE HEART RATE DOWN
IMPORTANT – to perform apical pulse upon administration – apical will give the best and most accurate – hold if HR is under 60
Digoxin toxicity includes – halo sign, drowsy
Administer Dig – IVP over 5 mins and oral
What is the antidote of Dig? Digibind

Question 27

Describe Dobutamine

Answer 27

Positive inotropic
Increases cardiac output
Increases myocardial contractility
Increases ventricular ejection

**Started and takes effect immediately
Someone experiencing an acute episode may be administered dobutamine

Question 28

What is the antidote of Digoxin?

Answer 28

Digibind

Question 29

Hypertrophic Cardiomyopathy

Answer 29

Preserved type of HF
Can cause issues with the valve
The heart ventricle is not stretching as it should – stiffness affects how the heart opens and closes

Question 30

S3 - Heart Sounds

Answer 30

Produced by passive filling stage of diastole. Normally inaudible, if auscultated often represents an over loaded ventricle. Can be physiologic in children, is pathologic in adults.

Question 31

If the valve is stenotic, what will you hear?

Answer 31

If a valve is stenotic, you will hear a murmur of blood shooting through the narrow opening when the valve is open

Question 32

If the valve is regurgitant, what will you hear?

Answer 32

If a valve is regurgitant, you will hear a murmur of blood leaking back through when the valve should be closed

Question 33

Clinical Presentation
of Mitral Regurgitation or Insufficiency

Answer 33

May be asymptomatic for years
Fatigue
Dyspnea on exertion
Palpitations or Afib
May have concomitant coronary artery disease
Angina
H.F. (late) (may have S3)

Question 34

What are causes of aortic stenosis?

Answer 34

Causes: congenital, rheumatic heart disease or calcification

Question 35

What is endocarditis common in?

Answer 35

Common in IV drug abusers
Especially in the use of dirty needles

Question 36

Describe Endocarditis

Answer 36

Inflammation of the endothelium surface of the heart

Presence of a nonbacterial thrombotic lesion on a cardiac valve or endothelium

Question 37

Modified Duke Criteria for Infective Endocarditis

Answer 37

B- blood culture
E - echocardiographic evidence of endocardial involvement
T - temperature > 38C
I - immunological phenomeon
M - microbiological evidence
E - embolic phenomenon
R - risk factors: congenital heart condition or IV drug use

Question 38

Nursing Mgmt for Endocarditis

Answer 38

BLOOD CULTURES BEFORE ANTIBIOTICS

Patient education – clean needles if you are an IV drug user, going through questions regarding surgical procedure if applicable