Week 3 - Heart Failure Flashcards
1
Q
what is heart failure
A
- abnormal clinical syndrome involving impaired cardiac pumping and/or filling & ventricular dysfunction
- heart has loss the ability to meet the body’s needs
2
Q
what is HF characterized by (4)
A
- ventricular dysfunction
- reduced exercise tolerance
- diminished quality of life
- shortened life expectancy
3
Q
what are risk factors for HF (7)
A
- MI
- HTN
- CAD
- DM
- smoking
- obesity
- high cholestrol
4
Q
what are some chronic causes of HF (9)
A
- CAD
- HTN
- congenital heart disease
- pulmonary disease
- cardiomyopathy
- anemia
- endocarditis
- valve disorders
- DM
5
Q
what are some acute causes of HF (6)
A
- MI
- dysrhythmias
- pulmonary embolus
- thyrotoxicosis
- HTN crisis
- myocarditis
6
Q
what are precipitating factors
A
- factors that increase the workload of the ventricles
7
Q
what are some precipitating factors of HF (10)
A
- anemia
- infection
- pulm. emboli
- pulm. disease
- hypothyroidism
- thyrotoxicosis
- dysrhythmias
- endo/myocarditis
- nutritional deficiencies
- hypervolemia
8
Q
what effect does HF have on the ventricles
A
- get thickened (hypertrophy) ventricles
- dilation of heart chambers
9
Q
what are 2 types of HF
A
- left sided
2. right sided
10
Q
what does RSHF cause
A
- backward blood flow into the venous circulation
= venous congestion
11
Q
what is the primary cause of RSHF
A
- LSHF
12
Q
what does LSHF cause
A
- fluid backs into the pulmonary veins
- eventually causes biventricular failure (both sides fail)
13
Q
what are symptoms of RSHF (11)
A
- peripheral edema
- weight gain
- hepatomegaly
- ascites
- jugular venous distension
- pleural effusion
- fatigue
- tachycardia
- anorexia, nausea, GI bloating
- chest pain
- dyspnea
- nocturia
- behavioral changes
peripheral S&S
14
Q
what are symptoms of LSHF (10)
A
- tachycardia
- crackles
- dyspnea
- fatigue
- cough
- pulmonary edema
- nocturia
- orthopnea
- chest pain
- behavioral changes
pulmonary S&S
15
Q
why does a pt with HF get nocturia
A
- HF = decreased CO = impaired renal perfusion and decreased urinary output during day
- at night, fluid move from the interstitial space back into vascular space = increased renal perfusion
16
Q
why does chest pain occur in a pt with HF (2)
A
- decreased coronafy perfusion from decreased CO
- increased myocardial work
17
Q
why do behavioral changes occur in a pt with HF
A
- cerebral circulation is impaired d/t decreased CO and decreased gas exchange
18
Q
what are some complications of HF (5)
A
- pleural effusion
- dysrhythmias
- emboli
- hepatomegaly
- renal failure
19
Q
why does pleural effusion occur in a pt with HF
A
- d/t increased pressure in the pleural capillaries
= fluid shifts into pleural space
(mainly w LSHF)
20
Q
how can HF lead to dysrhythmias
A
- HF = enlargement of chambers of heart = alteration in the normal electrical pathway (esp. in the atria)
21
Q
what dysrhythmia is especially common in a pt with HF
A
- atrial fibrillation
22
Q
where do thrombi often from during HF
A
- in the left ventricle
23
Q
why does left ventricular thrombus occur in HF
A
- enlarged LV and decreased CO = blood sitting there = formation of clot
24
Q
what is the concern w left ventricular thrombus in a pt with HF (3)
A
- decrease left ventricular contractility
- decrease CO
- further worsen pts perfusion
25
what type of HF can specifically lead to hepatomegaly? what does hepatomegaly lead to
- RSHF
| = impaired liver fnxn
26
how does HF lead to renal failure
- decreased CO = decreased perfusion to kidneys = renal insufficiency & failure
27
what can be used to diagnose HF (10)
- history
- physical exam
- chest xray
- ECG
- lab data
- hemodynamic assessment
- echo
- stress test
- cardiac catheterization
- measure ejection fraction
28
what is ejection fraction
- how much blood the ventricles pump out w each contraction
29
HF is an ejection fraction of...
<40%
30
how is HF classified
- functional classifications based on a pt's tolerance of physical activity
31
how many classes of HF are there? which is best and which is worst?
classes 1 (best) to 4 (worst)
32
what are the goals of treatment for HF (6)
- decrease intravascular volume
- decrease venous return/preload
- decrease afterload
- improve gas exchange & oxygenation
- increase CO
- reduce anxiety
33
what treatment is done to decrease intravascular volume (2)
- diuretics (ex. lasix)
| - ultrafiltration
34
what is the benefit of using diuretics to decrease intravascular volume (8)
- may be administered IV
- acts on kidneys rapidly
- decreases preload
- heart can contract more efficiently
- improved CO
- improves gas exchange
- decreases pulm vascular pressure
- improves left ventricular fnxn
35
what is ultrafiltration
- filtration done thru hemodialysis or a central venous access
- removes fluid up to 500 mL per hr
36
what benefit does decreasing venous return have
- reduces amt of volume returned to the LV during diastole = can contract better
37
what treatment/interventions can be done to decrease venous return (5)
- high fowlers position w feet horizontal or hanging off bed
- sleep w HOB elevated (recliner, pillows under head)
- IV nitroglycerin (venodilator)
- IV morphine
- diuretics
38
what effect does high fowlers w feet horizontal or hanging off the bed have (2)
- decreases venous return by pooling blood in legs
| - increases thoracic capacity = improved ventilation
39
what effect does IV nitroglycerin have (4)
- decreases preload thru vasodilation
- increases coronary circulation by dilating the coronary arteries
- slightly reduces afterload in high dses
- increases myocardial O2 supply
40
what is afterload
- the resistance against which the LV must pump
| = amt of work it takes for the LV to eject blood into systemic circulation
41
what is the benefit of reducing afterload in treatment of HF
- reduced afterload = increased CO & decreased pulmonary congestion
42
what meds are used to reduce afterload (2)
- morphine (vasodilator)
| - IV nitroprusside (Nipride)
43
what should you monitor during treatments that reduce afterload
- BP, dont want too low otherwise will get decreased perfusion to heart and brain
- -> nipride has v potent effect on vascular system
44
what treatment can be done to improve gas exchange during HF (5)
- IV morphine (decreases O2 demands)
- O2
- noninvasive ventilatory suppoirt
- intubation
- mechanical ventilation
45
what treatment can be done to improve cardiac function
- positive inotropic tx (meds that increase the strength of contraction without increasing O2 consumption)
46
what treatment can be done to decrease anxiety in a pt with HF (2)
- sedative action of morphine
| - use of a calm approach to care
47
what should you monitor in a pt whos on IV morphine
- resp. depression
48
what are some non-pharmaceutical therapies for HF (3)
- O2
- exercise
- diet
49
describe what exercise for a pt with HF should look like
- should exercise 3-5 times per week, for 30-45 min at a time
50
what type of "devices" are use in treatment of HF (5)
- pacemakers
- biventricular pacing
- cardiac resychronization therapy (CRT)
- implantable cardioverter-defibrillator (ICD)
- ventricular assist device
51
what does CRT do
- coordinates right and left ventricle thru biventricular pacing
52
what is the treatment of choice for HF
- heart transplant
53
what is the overall goal of collaborative care for a pt with HF (5)
- decrease edema
- decrease dyspnea
- increase exercise tolerance
- adhere to drug regime
- no complications
54
what discussion should you have with a pt who has HF
- goals of care
| - ACP status
55
why are diuretics used in treatment for HF
- mobilize edematous fluid
- reduce pulmonary venous pressure
- reduce preload
56
what is the first choice of diuretics for a pt with HF? what is another option?
- 1st = thiazides
| - also loop diuretics
57
what is an example of a thiazide diuretics? loop?
- thiazide = hydrochlorothiazide
| - loop = lasix
58
what should monitor for with a pt on diuretics (5)
- potassium
- bp
- fluid intake and output
- sodium
- dehydration
59
what are different types of meds used for treatment of HF
- diuretics
- ACE-inhibitors
- ARBs
- beta blockers
60
what is the first line of therapy in treatment of HF
- ACE-inhibitors
61
what are 2 examples of ACE-I
- ramipril
| - enalapril
62
what do ACE-I do
- block conversion of angiotensin 1 to 2 = dilate blood vessels
63
why are ACE-I used in treatment of HF
- increase CO thru decreasing systemic vascular resistance (= decreased afterload)
64
what are some s/e associated w ACE-I
- typically well tolerated
- angioedema
- persistent cough
- hypotension
65
if a pt cannot tolerate ACE-I d/t angioedema and cough, what do they use next?
- ARBs
66
what are ARBs? what do they do?
- angiotensin 2 receptor blocker
| - same effect as ACE-I, just block something else
67
what is 1 example of an ARB
- losartan
68
why are beta blockers used in treatment for HF
- block the negative effects of the SNS on the failing heart
= decrease HR = ventricles can fill and contract better
69
what are some side effects of beta blockers (5)
- edema
- hypotension
- fatigue
- asthma exacerbations
- bradycardia
70
what is an example of a beta blockers used for HF
- metoprolol
71
what class of meds are used if the pt is transferred to the ICU
- inotropes
72
what are inotropes
- meds that improve cardiac contractility
73
what is important to monitor in a pt on inotropes? why?
- continuous telemetry monitoring bc they can be v irritating to heart = increased risk of arrhythmias
74
what is important to teach pts with HF (8)
- meds
- diet
- activity
- lifestyle (how will they live?
- S&S to watch for
- home O2
- daily weights
- orthostatic hypotension (rise slowly from laying, etc.)
75
what kind of a diet should a pt with HF be on
- sodium restriction (2g if mild, 1g if severe)
| - fluid restriction (1.5-2L/day)
76
what should you teach a pt with HF regarding exercise
- plan active & rest periods
- exercise improves symptoms of HF
- slowly increase exercise periods to improve exercise tolerance
77
what should you teach a pt with HF regarding meds
- they will have to be taken for the rest of their lives
| - stress that meds must be taken even if they arent experiencing symptoms
78
what should you teach a pt with HF regarding S&S
- how to recognize symptoms of decompensation & report them early
79
when should a pt report weight gain to a HCP
- if gain 2kg in 2-5 days
80
a nursing diagnosis r/t heart failure is impaired gas exchange. what resp monitoring can be done for this (4)
- monitor pulse ox
- monitor RR, rhythm, depth, effort of resp
- auscultate breath sounds
- monitor for restlessness, anxiety, and work of breathing
81
a nursing diagnosis r/t heart failure is impaired gas exchange. describe O2 therapy for this (4)
- admin supplemental O2 or other noninvasive ventilator support
- monitor O2 litre flow rate & placement of O2 delivery device
- change O2 delivery device from mask to nasal prongs during meals as tolerates
- monitor effectiveness of O2 therapy
82
a nursing diagnosis r/t heart failure is impaired gas exchange. what positioning can help w this
position to alleviate dyspnea:
| - semi fowlers
83
a nursing diagnosis r/t heart failure is decreased cardiac output. what nursing interventions can be done for this (7)
- perform comprehensive assessment of peripheral circulation
- note S&S of decreased cardiac output
- monitor fluid balance
- monitor cardiac rhythm
- monitor resp status for symptoms of HF
- instruct pt and caregivers abt activity restriction and progression
- establish supportive relationship w pt and caregivers
- inform pt abt purpose and benefits of prescrubed activity & exercise
84
a nursing diagnosis r/t HF is excess fluid volume. what are nursing interventions for this (7)
- admin prescribed med to reduce preload (diuretics, nitro, morphine)
- monitor for therapeutic effect of meds
- monitor K+ lvls
- weigh pt daily and monitor trends
- monitor I&O
- monitor resp pattern for signs of pulm edema
- monitor for adventitious heart and lung sounds
85
a nursing diagnosis r/t HF is activity intolerance. what nursing interventions r/t energy mngmt can be done for this (4)
- encourage alternate rest & activity periods
- provide calming diversionary activities for relaxation
- monitor pts O2 response to self care activities
- teach pt & caregiver techniques for self care to minimize O2 consumption
86
what activity therapy can be done for activity intolerance r/t HF (2)
- collab w occupational therapist, physio to plan and monitor activity plan
- determine pts commitment to increasing freq or range of activities
