Week 5- Heart Failure Flashcards
1
Q
What is congestive heart failure?
A
- Occurs when the heart is unable to pump suffcient blood to meet the metabolic needs of the body
- As a result, blood backs up into either the pulmonary circuit, systemic circuit, or both
- Usually occurs secondary to another condition
- May present as an acute episode, but is chronic
2
Q
What causes left sided heart failure?
A
- Left ventricle is most commonly damaged during an MI
- Chronic HTN- long term effects of having to pump against the increased after load
3
Q
Left Sided Heart Failure
A
- In both cases, the right side of the heart continues to pump normally and deliver normal amounts of blood to the pulmonary circulation
- The left side of the heart is unable to pump the blood from the pulmonary vessels’
- As a result, blood backs up behind the left ventricle and the pressure in the left atrium and pulmonary veins increases
- As the pulmonary veins become engorged with blood, serum is forced out of the pulmonary capillaries and into the alveoli
- Acute cardiogenic pulmonary edema
- Resp symptom but is a cardiac issue
4
Q
What will the pt present with if they have Left sided failure?
A
- Pt. present with SOB, especially when lying supine
- Never lie pt supine (can make a stable patient go into cardiac arrest, can only breathe sitting up) NEVER LAY SUPINE
- Increased fluid in the vessels leaks into the interstitial spaces causing narrowing of the bronchioles= wheezing
- Air passing through the fluid filled alveoli= crackles
- Pt will present with tachypnea, cheyene- stokes respirations
- Pt may cough up the edema fluid in the form of foamy, blood tinged sputum
5
Q
S/S of the LHF
A
- Restlessness (impending doom)
- Agitation
- Confusion
- Severe SOB
- Tachypnea
- Abnormality high or low BP
- Crackles and possibly wheezes
- Frothy, pink sputum
6
Q
What is the management for LHF?
A
Aimed at:
- improving oxygenation
- Decreasing workload on the heart
- Reducing the preload so that the LV is less overburdened
- Vitals, cardiac monitor, SPO2, ETCO2 (35-45 mmHg)
- O2
- IV
12 Lead ECG - Position pt. upright unless BP or LOA precludes it (legs dangling if possible b/c keeps the fluid down and decreases the workload on the heart)
- Nitro- SL. 0.4-0.8mg, depending on BP
- Effects vasodilation
- Reduction in cardiac workload and improved cardiac output (lowers BP, making heart not have to work as hard)
7
Q
With wheezes, why should bronchodilators be avoided?
A
- B/c they caused increased tachycardia and this will increase the workload and worsen CHF
- If you give a pt with left side heart failure ventolin this is a bronchodilator and will open the bronchioles causing more fluid to move in causing them to drown
8
Q
What is CPAP used for?
A
- Lungs have a decreased ability to keep the alveoli open due to the fluid
9
Q
How does CPAP work?
A
- CPAP works to hold the alveoli open through the respiratory cycle so that O2 and CO2 can diffuse normality
- Mask can be removed for medication administration
- CPAP causes an increase in intrathoracic pressure- may cause a slight decrease in BP (need to have a slightly higher BP)
10
Q
When should you stop CPAP?
A
If the respiratory status is very poor, oxygen saturations levels are dropping ETCO2 is increasing or LOA is decreasing, stop CPAP and begin to ventilate via BVM
- Consider advanced airways if needed
11
Q
Paroxysmal Nocturnal Dyspnea
A
- Severe attacks of SOB and coughing that typically happen at night
- Usually wakes the person from sleep
- Often occurs with LHF where the cause is chronic
- Often occurs with LHF where the cause is chronic overload as opposed to MI
- These pt’s will often complain of 1-2 weeks of SOB at night
12
Q
Right Sided Heart Failure
A
- Most commonly occurs as a result of LHF
- As blood backs up from the left side of the heart and into the lungs, the right side has to work harder to pump blood into the engorged pulmonary arteries
- Eventually, the right side is unable to keep up to the increased workload, and it too fails
- Can result in pulmonary embolism or pulmonary HTN
13
Q
Pulmonary HTN
A
- Chronic increased resistance of blood through the lungs- backing blood into the right ventricles= increased workload= failure
- Pulmonary embolism- forward blood flow through the pulmonary system is blocked by a clot= increased workload on RV= failure
14
Q
S/S of right sided heart failure
A
- Presence or absence or pulmonary edema will assist you in determining if the RHF is secondary to LHF
- If pulmonary edema is present= secondary to LHF
- If non= lung or right sided heart problems
- When the right side of the heart fails- pressure backs up behind the right ventricle and increases pressure in the systemic veins causing them to become engorged
- Distention to external jugular veins
- Over time, serum is forced out of the veins into the surrounding tissues creating edma
15
Q
What is the management of RHF?
A
- RHF, by itself is seldom life threatening
- Usually develops gradually, over weeks (likewise it requires days to reverse)
- Prehospital treatment- make the pt. comfortable
- Monitor
- If pt. presents with signs of LHF as well, treat accordingly
