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medsurg > T2: Heart Failure & Valvular disease > Flashcards

T2: Heart Failure & Valvular disease Flashcards

1
Q

3 types of heart failure:

A

-Left sided
-right sided
-high-output

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2
Q

Heart failure is often caused by _______, however, may sometimes develop after an _________

A

-hypertension
-MI

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3
Q

Most heart failure begins as _____-sided and progresses to both

A

left sided

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4
Q

left sided heart failure is subdivided into:

A

-systolic HF
-diastolic HF

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5
Q

Cause of systolic HF (2)

A

-Ejection fraction of less than 40% (normal:50-70%)
-reduces tissue perfusion and blood accumulates in the pulmonary vessels

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6
Q

Systolic HF:
inadequate tissue perfusion =

A

pulmonary or systolic congestion

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7
Q

Systolic HF:
high risk for ______; clients with less than 30% ejection fraction are considered for

A

-Sudden cardiac death
-Implantable cardioverter defibrillator (ICD)

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8
Q

In Diastolic HF, ______ pressure is needed to move the same amount of volume

A

more

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9
Q

Diastolic HF is usually seen in _________ with history of _________

A

-older adult women
-chronic hypertension

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10
Q

left-sided heart failure is caused by: (3)

A

-hypertension
-coronary artery disease
-valvular disease

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11
Q

Causes of Right-sided heart failure (3)

A

-left ventricular failure
-right ventricular MI
-pulmonary hypertension

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12
Q

In right-sided heart failure, the right ventricle ________, which ______ volume and pressure buildup in the venous system causing ________

A

-cannot completely empty
-increases
-peripheral edema

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13
Q

volume of blood the heart pumps per minute

A

cardiac output

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14
Q

cardiac output formula

A

stroke volume x heart rate

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15
Q

stroke volume formula

A

(end diastolic volume) - (end systolic volume)

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16
Q

Normal cardiac output range:

A

4-8 L/min

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17
Q

cardiac output predicts

A

oxygen delivery to cells

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18
Q

how does the body compensate for decreased cardiac output (2)

A

-sympathetic nervous system
-tissue hypoxia causes the adrenergic receptors to increase heart rate and blood pressure (vasoconstriction)

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19
Q

Low cardiac output leads to decreased __________, which leads to ______ being released, causing vasoconstriction and fluid retention, worsening _____

A

-cerebral perfusion
-vasopressin
-Hypertension

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20
Q

Neurohormones that promote vasodilation and diuresis through sodium loss in the renal tubes

A

Natriuretic peptides

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21
Q

ventricles produce and release as they stretch in response to fluid overload for HF

A

B-type natriuretic peptides (BNP)

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22
Q

Left ventricular Failure:
Assess for (4)

A

-crackles and wheezes of the lungs
-confusion in older adults due to brain hypoxia
-heart sounds such as an S3 gallop
-sleep with extra pillows at night due to orthopenia

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23
Q

Right ventricular failure:
Assess for (5)

A

-neck vein distention
-abdominal girth
(hepatomegaly,
hepatojugular reflex,
ascites)
-dependent edema

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24
Q

How to assess for fluid gain due to heart failure

A

daily weights taken at the same time each morning using the same scale

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25
Q

psychosocial considerations for heart failure patients

A

assess for anxiety and depression

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26
Q

Heart Failure diagnostic (5)

A

-electrocardiogram
-chest x-ray
-echocardiography
-radiology
-multi-gated acquisition scan (MUGA)

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27
Q

provides information about ejection fraction

A

Multi-gated acquisition scan (MUGA)

28
Q

used to differentiate dyspnea related to heart failure vs respiratory problem; monitor the need for and the effectiveness of aggressive heart failure intervention

A

Human B-type natriuretic peptides (hBNP)

29
Q

hBNP is _________ in pts with heart failure

A

elevated

30
Q

hBNP result interpretation:
<100 pg/mL

A

no heart failure

31
Q

hBNP result interpretation:
100-300 pg/mL

A

heart failure caught early

32
Q

hBNP results interpretation:
900+ pg/mL

A

severe heart failure

33
Q

Left sided heart failure findings: (3)

A

-elevated PAP
-elevated PAWP
-decreased CO

34
Q

Nutritional considerations (2)

A

-reduce sodium to ~3g daily
-Fluid restrictions

35
Q

Indications Heart Failure condition is worsening (5)

A

-weight gain of 3lbs or more
-exercise tolerance decreases in last 2-3 days
-excessive need to urinate during the night
-development of dyspnea or angina at rest or angina worsens
-increased swelling in hands, feet, or ankles

36
Q

Heart failure:
nursing actions (9)

A

-Assess O2 saturation, SOA, dyspnea on exertion
-Daily weight monitoring
-Vital signs and hemodynamic pressure monitoring
-Position client (High Fowlers)
-Monitor labs
-Assess for medication toxicity
-Monitor for fall risk
-Monitor dietary restrictions
-Emotional and educational support

37
Q

Labs nurses need to monitor for HF patients

A

-ABG
-electrolytes
-O2 saturation
-Chest x-ray

38
Q

abnormality or dysfunction of any of the hearts four valves

A

valvular disease

39
Q

Valvular heart disease is either:

A

congenital or acquired

40
Q

acquired valvular heart diseases (3)

A

-Degenerative disease
-Rheumatic disease
-Ineffective endocarditis

41
Q

damage over time from mechanical stress (hypertension most common)

A

Degenerative Valvular heart disease

42
Q

fibrotic changes occurring over time, calcification of valve cusps (mitral valve most common)

A

Rheumatic disease

43
Q

infection destroys the valve (streptococcal infections most common)

A

ineffective endocarditis

44
Q

Valvular heart disease risk factors (7)

A

-Hypertension
-Rheumatic fever
-Ineffective endocarditis
-Congenital malformations
-Marfan sundrome
-Age
-Murmurs

45
Q

Reasons why age is a risk factor for valvular heart disease (2)

A

-degenerative calcification
-papillary muscle dysfunction

46
Q

connective tissue disorder

A

Marfan Syndrome

47
Q

Narrowing of the opening of the mitral valve

A

Mitral Stenosis

48
Q

Blood flowing back from the left ventricle into the left atrium during systole

A

Mitral Regurgitation

49
Q

valve leaflets ballots back into the atrium during systole

A

Mitral valve prolapse

50
Q

Distinguishable S/S of mitral stenosis (4)

A

-Paroxysmal nocturnal dyspnea
-Hemoptysis
-Hepatomegaly
-Rubbing apical diastolic murmur

51
Q

Distinguishable S/S of Mitral Regurgitation (1)

A

-high-pitched holystolic murmur

52
Q

S/S shared between Mitral Stenosis & Regurgitation (6)

A

-fatigue
-dyspnea on exertion
-orthopnea
-atrial fibrillation
-neck vein distension
-pitting edema

53
Q

Distinguishable s/s of mitral valve prolapse (5)

A

-Atypical chest pain
-Dizziness, syncope
-Atrial tachycardia
-Ventricular tachycardia
-Systolic click

54
Q

Shared S/S between Mitral regurgitation and prolapse (1)

A

-palpations

55
Q

has two cusps or flaps and lies between the left atrium and the left ventricle of the heart

A

mitral valve

56
Q

narrowing of the orifice between the left ventricle and aorta

A

aortic stenosis

57
Q

S/S of aortic stenosis (7)

A

-Dyspnea on exertion
-Angina
-Syncope on exertion
-Fatigue
-Orthopnea
-Paroxysmal nocturnal dyspnea
-Harsh, systolic crescendo-decrescendo murmur

58
Q

Aortic valve doesn’t close all the way, leading to back flow of blood back into the left ventricle

A

aortic regurgitation

59
Q

S/S of aortic regurgitation (8)

A

-Palpitations
-Dyspnea
-Orthopnea
-Paroxysmal nocturnal dyspnea
-Fatigue
-Angina
-Sinus tachycardia
-Blowing, decrescendo diastolic murmur

60
Q

Assessment finding:
atrial dysrhythmias, systolic murmurs

A

tricuspid insufficiency

61
Q

Assessment finding:
atrial dysrhythmia, diastolic murmurs

A

tricuspid stenosis

62
Q

Assessment finding:
systolic murmurs, cyanosis

A

pulmonic stenosis

63
Q

Assessment finding:
systolic murmurs, angina

A

aortic stenosis

64
Q

Assessment finding:
diastolic murmurs, angina

A

aortic insufficiency

65
Q

If ______-sided valve damage; s/s include:
Dyspnea, fatigue, increased pulmonary artery pressure, and decreased cardiac output

A

left sided valve damage

66
Q

If _____-sided valve damage; s/s include:
dyspnea, fatigue, increased right atrial pressure, peripheral edema, jugular vein distention, and hepatomegaly

A

right sided valve damage

67
Q

_____-sided valve damage most commonly affected due to higher pressure

A

left-sided valve damage

medsurg (14 decks)

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