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nurse 251 > Week 6 (heart failure) > Flashcards

Week 6 (heart failure) Flashcards

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1
Q

what is heart failure?

A

involves impaired cardiac pumping or filling

-associated with longstanding hypertension, Coronary artery disease, MI, DM, cig smoking, obesity and high cholesterol

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2
Q

what is heart failure characterized by?

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

what is the pathophysiology of heart failure?

A

-any alterations in the normal mechanisms regulating cardiac output (preload, afterload, myocardial contractility, heart rate, and metabolic state), of the individual can lead to ventricular dysfunction and may result in heart failure

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4
Q

is heart failure the same as congestive heart failure?

A

yes. now calling it diastolic or systolic heart failure

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5
Q

what is cardiac output?

A

heart rate X stroke volume (amount of blood ejected from ventricles each min)

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6
Q

what is normal cardiac output?

A

5 liters per min

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7
Q

what is the most common type of HF?

A

systolic heart failure

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8
Q

what does systolic heart failure result from?

A

the inability of the heart to pump blood

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9
Q

what occurs to the heart in systolic heart failure?

A

the left ventricle loses its ability to generate enough pressure to eject blood forward through the high-pressure aorta
-hallmark of systolic heart failure in a decrease in left ventricle ejection fraction (normal ejection fraction is greater than 55%)

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10
Q

what is ejection fraction?

A

percent of totally amount of blood in the left left ventricle that is ejected during each ventricular contraction (meaure EF by doing an echo)

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11
Q

what is normal ejection fraction?

A

55-65 % (grade 1)

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12
Q

what is a grade 3 (mild) ejection fraction?

A

40 - 55%

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13
Q

what is a grade 4 (severe) ejection fraction?

A

20 % or lower

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14
Q

what is diastolic heart failure?

A
  • an impaired ability of the ventricles to fill during diastole
  • decreased ventricle filling will result in decreased stroke volume thus high filling pressure in the pulmonary system
  • predominantly affects women
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15
Q

what is diastolic heart failure often referred to as?

A

heart failure with preserved systolic function

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16
Q

what is the diagnosis of diastolic heart failure made on the presence of?

A

pulmonary congestion

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17
Q

what does diastolic heart failure usually the result of?

A

usually the result of left ventricle hypertrophy from chronic hypertension, aortic stenosis or hypertrophic cardiomyopathy

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18
Q

what are the main differences between systolic and diastolic heart failure?

A

systolic: difficulty ejecting heart out of ventricle
- less blood is pumped out of ventricles because weakened heart muscle cant squeeze the blood out as well
diastolic: decreased filling of ventricles.
- less blood fills the ventricles because the stiff heart cant relax normally

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19
Q

what is a mixed (systolic and diastolic) heart failure

A

seen in dilated cardiomyopathy
- a condition in which poor systolic function (weaking heart function) is further compromised by dilated left ventricular walls that are unable to relax

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20
Q

what is dilated cardiomyopathy?

A
  • a condition in which poor systolic function (weaking heart function) is further compromised by dilated left ventricular walls that are unable to relax
  • pts have poor ejection fraction (less thatn 35%)
  • have high pulomary pressure and biventrical failure
  • blood isnt getting ejected properly, so it back tracks into the lungs
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21
Q

what are some physiological characteristics of someone with dilated cardiomyopathy?

A
  • pt will have low BP
  • pt will have low Cardiac output
  • poor renal perfusion (if cardiac output is lower than 35%, brain takes up 35% of the 02 blood, and renal needs 25%, so this is why it causes renal failure because there in not enough 02 blood for renal system)
  • poor excersise tolerance and ventricular dysrhymias
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22
Q

what metaphor is used to explain dilated cardiomyopathy?

A

the elastic band metaphor: the more stretched out it gets, the less contractability (muscles of the heart get bigger, like a band - less contraction so cant push blood )

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23
Q

what are some compensatory mechanisms of the heart is attemp to try and maintain adequate cardiac output?

A

1) ventricular dilation (heart takes in more blood to try and get more out)
2) ventricular hypertrophy (heart tries to pump faster and stronger to get more blood out)
3) increased sympathetic nervous system stimulation (to try to get heart to work harder)
4) neurohormonal response (aldosteron system from kidneys)

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24
Q

what is dilation?

A
  • its the enlargement of the chambers of the heart
  • occurs when pressure in the left ventricles is elevated over a period of time
  • the muscle fibers of the heart stretch in repsone to the volume of blood in the heart at then end of diastole (rubber band)
  • the degree of stretch is directly related to the force of contraction in systole
  • eventually the elastic elements of the muscle fibers are overstretched and can no longer contract effectively
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25
Q

what is hypertrophy?

A
  • is an increase in the muscle mass and cardiac wall thickness in response to the overwork and strain of chronic heart failure
  • occurs slowly
  • hypertrophic heart muscles have poor contracility, poor coronart arety circulation and is pronce to venticular dysrhythmias
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26
Q

is hypertrophy inherited?

A
  • is an inherited disorder

- these ppl will need heart transplants

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27
Q

what is an implanted cardioverter defibrillator?

A

its an automatic defibrillator in a persons body that detects abnormal heart rhytm / ventricile defibration and shocks that heart back into rhythm.

28
Q

what does dilation and hypertrophy result in?

A

results in ventricular remoldeling

-changes in ventricular shape cause impaired contractility (ventricules are a less effective pump)

29
Q

what is the most common form of heart failure?

A

left sided heart failure

30
Q

what does left sided heart failure result from?

A

results from left ventricular dysfunction causing blood to back up through the left atrium into the pulmonary veins
-this leads to increased pulmonary pressure causing fluid extravasation leading to pulmonary congestion and edema

31
Q

what type of sputum will someone with left heart failure have?

A

pink frothy sputum

32
Q

what lung sounds should a nurse expect to hear with someone with left sided heart failure?

A

course crackle sounds from lungs -because there is fluid (serous fluid, not blood) in lungs.
-this is why they experiance orthopnea

33
Q

what are some signs and symptoms of left sided heart failure?

A
  • paroxysmal nocturnal dysnea
  • elevated pulmonary capillary pressure
  • pulmonary congestion: cough, crackles, wheezing, blood tinged sputum, tachypnea
  • restlessness
  • confusion
  • orthopnea
  • tachycardia
  • exertional dyspnea
  • cyanosis
34
Q

what is right sided heart failure?

A

causes backwards blood flow to the right atrium into the vena cava- venous circulation

  • venous congestion in the systemic circulation results in peripheral edema, heptomegaly, and jugular venous distention (palpating jugular vein)
  • pitting edema is present
35
Q

what is the primary cause of right sided heart failure?

A

left sided heart failure

36
Q

what can cause right sided heart failure

A

cor pulmonale (right ventricular dilation and hypertrohpy by COPD)

37
Q

what is pulmonary edema?

A
  • alveoil become filled with serous fluid

- caused by acute left failure secondary to MI

38
Q

is pulmonary edema a life threatening situation?

A

yes

39
Q

what are some clinical manifestations of pulmonary edema?

A 
anxious
pale
cool/clammy skin 
severe dysnea 
accessory muscle use 
respiratory rate greater than 30 breaths per min 
piny, frothy sputum
 rapid heart rate
elevated BP and orthopnea
40
Q

what is the tx of pulmonary edema?

A

high folwers position, 02 maks, cardiac monitory, pulse oximetry

41
Q

what drug therapy can be used for pulmonary edema?

A

-morphine (slows down heart rate, takes work off heart)
-IV diuretic = drys them out (lasix gets rid of all fluid, but is not a potassium sparing diuretic, pt should get electroyes and check hypokalemia (low potassium)
-IV nitroglycerin (vasodialtes, brings down blood pressure)
-Inotropid support
goal of therapy is to decrease intravasular volume

42
Q

what is the earliest symptom of heart failure?

A

fatigue. caused bt decreased cardiac output, impaired perfusion to vital organs and decreased O2 to tissues

43
Q

what are some clinical manifestations of heart failure?

A

1) Dyspnea- caused by increased pulmonary pressure, can occur with mild exertion or at rest
2) Orthopnea- shortness of breath when laying flat tx: sleep with pillows to stay upright
3) Tachycardia: bodys first mechanism to compensate for 4) failing ventricle is to increase HR
Edema: common sign of heart failure- may occur peripherally, abdominal cavity (ascites), pulmonary, or even scrotal
5) Dysrhymias: elargement of the chambers of the heart may cause an alternation in the normal electrical pathway leading to the atria firing rapidly (atrial fibrillation)

44
Q

what does a sudden weight gane of more than 2kg in 2 days often indicate?

A

indicates exacerbated heart failure

make sure to weigh pt at same time everyday

45
Q

what could an atrial fibrillation promote?

A

promotes thrombus formation within the atria, which may break loose and form emboli putting pts at risk for stroke (tx, cardioversion, antidysrhythmics, and anticoagulation)

46
Q

what is preload?

A

volume of blood in ventricles at the end of diastole (end of diastlic pressure)

47
Q

what is afterload?

A

the resistence that the left ventricle muscle must overcome to circulate blood

48
Q

what are some diagnostic tools to determine heart failure?

A
  • history and physical exam
  • chest x-ray
  • ECG
  • BNP (brain natriuretic peptide - blood test)
  • echocardiogram (to determine ejection fraction)
49
Q

what is intravasular volume?

A

intravascular volume status refers to the volume of blood in a patient’s circulatory system

50
Q

how do u decrease a pts intravasular volume?

A
  • diuretics reduce venous return

- a loop diuretic (eg, furosemide, lasix) may be used to decrease volume

51
Q

what do diuretics do? how do it work?

A
  • act on the kidneys by promoting excertion of sodium and water and other electroyles
  • works by decreasing venous return to the Left ventricle, thereby reducing preload, the overfilled left ventricle may contract more efficently and improve cardiac output
52
Q

what is important to do when a pt is on a diuretic?

A

to monitor potassium levels

53
Q

what drug therapy is used for chronic heart failure?

A
  • diuretics
  • angiotensin cnverting enzyme inhibitors (ACE) - for high risk pts
  • if pts wont get better on beta blockers, or calcium channel blockers- ACE inhibators are used
  • beta blockers
  • intropic drugs
  • nitrates (for angina or heart failure, have to take it off at night)
54
Q

what foods should pts with chronic heart failure avoid?

A

foods are are high in sodium

  • salt and water must be restricted
  • 2 gram sodium diet
  • should also avoid milk, cheese, bread, cereals, canned soup, canned ceggies and processed food
55
Q

how much should a HF pt drink?

A

fluid restrictoin of 1.5 - 2 L / day

why? drinking a lot of fluid will add more volume to heart

56
Q

what is important to teach a HF pt about thier weight?

A

pts need to weigh themselves daily to monitor fluid retention.
-if a pt gains 2 Kg over 2-5 day period, need to see doctor

57
Q

is heart failure a progressive disease?

A

yes. it is progressive, life shortening, and tx plans are established with quality of life goals

58
Q

how can symptoms be managed by a pt?

A

self- managment tools (daily weights, drug regimens, excercise plans, this is important because it helps keep the pt strong. pts who cant do as much, push them as much as u can
-regular perscribed level of exercise should be maintained

59
Q

what is an example of a nursing diagnosis for activity intolerance?

A

activity intolerance realated to fatigue secondary to cardiac insufficiency and pulmonary congestion as evidenced by dyspnea, shortness of breath, weakness, increase in heart rate on excertions and pt statement “ i feel to week to do anything”

60
Q

what is a strategy to help activity intolerant pts to get them to excersise?

A

encourage energy management (eg, alternate periods of acitivity and rest)
-activity therapy - collaborate with occcupational and physical therapists to plan and monitor activity and exercise program

61
Q

what is the tx of choice for pts with end-stage heart failure?

A

heart transplant

62
Q

45% of pts with what condition with receive a heart transplant?

A

dilated cardiomyopathy

63
Q

what must pt and family undergo before receiving a heart transplant?

A

must undergo comprehensice psychological profile that includes: assessing coping skills, support systems, motivation to follow the rigorous regiment that is esstntial to a sucessful transplant

64
Q

what is the maximum ischemic time acceptable for cardiac transplant?

A

4-6 hours - often donor is side to side with the receiving pt in OR

65
Q

what is a major complication following transplant?

A

immunosuppressants can lead to infection

66
Q

what is a ventricular assist device?

A

venticular assist devices (VADS) have been created for use over months and years

  • pumps are designed to support the left ventricle
  • used while pt is waiting for a heart transplant -some pts have live at home and work while waiting with the help of this device
  • improves pts nutritional state and allows the pt to undergo transplantation in a mich improved physical condition

nurse 251 (14 decks)

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