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NURS 3512 - Class 1-6 > Week 3 - Heart Failure > Flashcards

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
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2
Q

what is HF characterized by (4)

A
  • ventricular dysfunction
  • reduced exercise tolerance
  • diminished quality of life
  • shortened life expectancy
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3
Q

what are risk factors for HF (7)

A
  • MI
  • HTN
  • CAD
  • DM
  • smoking
  • obesity
  • high cholestrol
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4
Q

what are some chronic causes of HF (9)

A
  • CAD
  • HTN
  • congenital heart disease
  • pulmonary disease
  • cardiomyopathy
  • anemia
  • endocarditis
  • valve disorders
  • DM
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5
Q

what are some acute causes of HF (6)

A
  • MI
  • dysrhythmias
  • pulmonary embolus
  • thyrotoxicosis
  • HTN crisis
  • myocarditis
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6
Q

what are precipitating factors

A
  • factors that increase the workload of the ventricles
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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
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8
Q

what effect does HF have on the ventricles

A
  • get thickened (hypertrophy) ventricles

- dilation of heart chambers

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9
Q

what are 2 types of HF

A
  1. left sided

2. right sided

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10
Q

what does RSHF cause

A
  • backward blood flow into the venous circulation

= venous congestion

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11
Q

what is the primary cause of RSHF

A
  • LSHF
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12
Q

what does LSHF cause

A
  • fluid backs into the pulmonary veins

- eventually causes biventricular failure (both sides fail)

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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

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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

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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
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16
Q

why does chest pain occur in a pt with HF (2)

A
  • decreased coronafy perfusion from decreased CO

- increased myocardial work

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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
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18
Q

what are some complications of HF (5)

A
  • pleural effusion
  • dysrhythmias
  • emboli
  • hepatomegaly
  • renal failure
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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)

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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)
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21
Q

what dysrhythmia is especially common in a pt with HF

A
  • atrial fibrillation
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22
Q

where do thrombi often from during HF

A
  • in the left ventricle
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23
Q

why does left ventricular thrombus occur in HF

A
  • enlarged LV and decreased CO = blood sitting there = formation of clot
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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
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25
Q

what type of HF can specifically lead to hepatomegaly? what does hepatomegaly lead to

A
  • RSHF

= impaired liver fnxn

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26
Q

how does HF lead to renal failure

A
  • decreased CO = decreased perfusion to kidneys = renal insufficiency & failure
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27
Q

what can be used to diagnose HF (10)

A
  • history
  • physical exam
  • chest xray
  • ECG
  • lab data
  • hemodynamic assessment
  • echo
  • stress test
  • cardiac catheterization
  • measure ejection fraction
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28
Q

what is ejection fraction

A
  • how much blood the ventricles pump out w each contraction
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29
Q

HF is an ejection fraction of…

A

<40%

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30
Q

how is HF classified

A
  • functional classifications based on a pt’s tolerance of physical activity
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31
Q

how many classes of HF are there? which is best and which is worst?

A

classes 1 (best) to 4 (worst)

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32
Q

what are the goals of treatment for HF (6)

A
  • decrease intravascular volume
  • decrease venous return/preload
  • decrease afterload
  • improve gas exchange & oxygenation
  • increase CO
  • reduce anxiety
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33
Q

what treatment is done to decrease intravascular volume (2)

A
  • diuretics (ex. lasix)

- ultrafiltration

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34
Q

what is the benefit of using diuretics to decrease intravascular volume (8)

A
  • 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
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35
Q

what is ultrafiltration

A
  • filtration done thru hemodialysis or a central venous access
  • removes fluid up to 500 mL per hr
36
Q

what benefit does decreasing venous return have

A
  • reduces amt of volume returned to the LV during diastole = can contract better
37
Q

what treatment/interventions can be done to decrease venous return (5)

A
  • 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
Q

what effect does high fowlers w feet horizontal or hanging off the bed have (2)

A
  • decreases venous return by pooling blood in legs

- increases thoracic capacity = improved ventilation

39
Q

what effect does IV nitroglycerin have (4)

A
  • decreases preload thru vasodilation
  • increases coronary circulation by dilating the coronary arteries
  • slightly reduces afterload in high dses
  • increases myocardial O2 supply
40
Q

what is afterload

A
  • the resistance against which the LV must pump

= amt of work it takes for the LV to eject blood into systemic circulation

41
Q

what is the benefit of reducing afterload in treatment of HF

A
  • reduced afterload = increased CO & decreased pulmonary congestion
42
Q

what meds are used to reduce afterload (2)

A
  • morphine (vasodilator)

- IV nitroprusside (Nipride)

43
Q

what should you monitor during treatments that reduce afterload

A
  • BP, dont want too low otherwise will get decreased perfusion to heart and brain
  • -> nipride has v potent effect on vascular system
44
Q

what treatment can be done to improve gas exchange during HF (5)

A
  • IV morphine (decreases O2 demands)
  • O2
  • noninvasive ventilatory suppoirt
  • intubation
  • mechanical ventilation
45
Q

what treatment can be done to improve cardiac function

A
  • positive inotropic tx (meds that increase the strength of contraction without increasing O2 consumption)
46
Q

what treatment can be done to decrease anxiety in a pt with HF (2)

A
  • sedative action of morphine

- use of a calm approach to care

47
Q

what should you monitor in a pt whos on IV morphine

A
  • resp. depression
48
Q

what are some non-pharmaceutical therapies for HF (3)

A
  • O2
  • exercise
  • diet
49
Q

describe what exercise for a pt with HF should look like

A
  • should exercise 3-5 times per week, for 30-45 min at a time
50
Q

what type of “devices” are use in treatment of HF (5)

A
  • pacemakers
  • biventricular pacing
  • cardiac resychronization therapy (CRT)
  • implantable cardioverter-defibrillator (ICD)
  • ventricular assist device
51
Q

what does CRT do

A
  • coordinates right and left ventricle thru biventricular pacing
52
Q

what is the treatment of choice for HF

A
  • heart transplant
53
Q

what is the overall goal of collaborative care for a pt with HF (5)

A
  • decrease edema
  • decrease dyspnea
  • increase exercise tolerance
  • adhere to drug regime
  • no complications
54
Q

what discussion should you have with a pt who has HF

A
  • goals of care

- ACP status

55
Q

why are diuretics used in treatment for HF

A
  • mobilize edematous fluid
  • reduce pulmonary venous pressure
  • reduce preload
56
Q

what is the first choice of diuretics for a pt with HF? what is another option?

A
  • 1st = thiazides

- also loop diuretics

57
Q

what is an example of a thiazide diuretics? loop?

A
  • thiazide = hydrochlorothiazide

- loop = lasix

58
Q

what should monitor for with a pt on diuretics (5)

A
  • potassium
  • bp
  • fluid intake and output
  • sodium
  • dehydration
59
Q

what are different types of meds used for treatment of HF

A
  • diuretics
  • ACE-inhibitors
  • ARBs
  • beta blockers
60
Q

what is the first line of therapy in treatment of HF

A
  • ACE-inhibitors
61
Q

what are 2 examples of ACE-I

A
  • ramipril

- enalapril

62
Q

what do ACE-I do

A
  • block conversion of angiotensin 1 to 2 = dilate blood vessels
63
Q

why are ACE-I used in treatment of HF

A
  • increase CO thru decreasing systemic vascular resistance (= decreased afterload)
64
Q

what are some s/e associated w ACE-I

A
  • typically well tolerated
  • angioedema
  • persistent cough
  • hypotension
65
Q

if a pt cannot tolerate ACE-I d/t angioedema and cough, what do they use next?

A
  • ARBs
66
Q

what are ARBs? what do they do?

A
  • angiotensin 2 receptor blocker

- same effect as ACE-I, just block something else

67
Q

what is 1 example of an ARB

A
  • losartan
68
Q

why are beta blockers used in treatment for HF

A
  • block the negative effects of the SNS on the failing heart
    = decrease HR = ventricles can fill and contract better
69
Q

what are some side effects of beta blockers (5)

A
  • edema
  • hypotension
  • fatigue
  • asthma exacerbations
  • bradycardia
70
Q

what is an example of a beta blockers used for HF

A
  • metoprolol
71
Q

what class of meds are used if the pt is transferred to the ICU

A
  • inotropes
72
Q

what are inotropes

A
  • meds that improve cardiac contractility
73
Q

what is important to monitor in a pt on inotropes? why?

A
  • continuous telemetry monitoring bc they can be v irritating to heart = increased risk of arrhythmias
74
Q

what is important to teach pts with HF (8)

A
  • 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
Q

what kind of a diet should a pt with HF be on

A
  • sodium restriction (2g if mild, 1g if severe)

- fluid restriction (1.5-2L/day)

76
Q

what should you teach a pt with HF regarding exercise

A
  • plan active & rest periods
  • exercise improves symptoms of HF
  • slowly increase exercise periods to improve exercise tolerance
77
Q

what should you teach a pt with HF regarding meds

A
  • 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
Q

what should you teach a pt with HF regarding S&S

A
  • how to recognize symptoms of decompensation & report them early
79
Q

when should a pt report weight gain to a HCP

A
  • if gain 2kg in 2-5 days
80
Q

a nursing diagnosis r/t heart failure is impaired gas exchange. what resp monitoring can be done for this (4)

A
  • monitor pulse ox
  • monitor RR, rhythm, depth, effort of resp
  • auscultate breath sounds
  • monitor for restlessness, anxiety, and work of breathing
81
Q

a nursing diagnosis r/t heart failure is impaired gas exchange. describe O2 therapy for this (4)

A
  • 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
Q

a nursing diagnosis r/t heart failure is impaired gas exchange. what positioning can help w this

A

position to alleviate dyspnea:

- semi fowlers

83
Q

a nursing diagnosis r/t heart failure is decreased cardiac output. what nursing interventions can be done for this (7)

A
  • 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
Q

a nursing diagnosis r/t HF is excess fluid volume. what are nursing interventions for this (7)

A
  • 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
Q

a nursing diagnosis r/t HF is activity intolerance. what nursing interventions r/t energy mngmt can be done for this (4)

A
  • 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
Q

what activity therapy can be done for activity intolerance r/t HF (2)

A
  • collab w occupational therapist, physio to plan and monitor activity plan
  • determine pts commitment to increasing freq or range of activities

NURS 3512 - Class 1-6 (47 decks)

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