Cardiac Problems Flashcards
Left-Sided Heart Failure
-formerly known as congestive heart failure
Typical causes= hypertension, coronary artery disease, valvular disease
-not all cases involve fluid accumulation
-Two types: systolic(reduced ejection power), diastolic(prevents ventricle from filling w enough blood)
Right-Sided Heart Failure
-Causes: left ventricular failure, right ventricular MI, pulmonary hypertension
-Right ventricle cannot empty completely
-Increased volume and pressure in venous system and PERIPHERAL EDEMA(extremities)
High-Output Failure
-Cardiac output remains normal or above normal (harder to detect)
-Less common form of heart failure
-Caused by increased metabolic needs or hyperkinetic conditions= septicemia, high fever, anemia, hyperthyroidism
Heart Failure Assessment: Recognize Cues
History
-history of heart conditions (ex. HTN, angina, MI, Rheumatic heart disease, valvular disorders, endocarditis, and pericarditis)
-activity tolerance (ex. symptoms when walking)
-breathing, sleeping, urinary patterns (ex. SOB, wheezing, crackers?)
-fluid volume status (ex. increase in wt? swelling?)
-knowledge of heart failure
-high BP, obesity, smoking, CAD, diabetes
Left-Sided Heart Failure Signs/Symptoms
-Dyspnea
(exertional dyspnea: less tolerance for physical activity due to SOB)
(paroxysmal nocturnal dyspnea: sudden awakening w feeling of breathlessness 2-5 hrs of falling asleep
-fatigue
-weakness
-arm heaviness
-chest pain or palpitations, skipped beats, fast rate
-small amounts of urine
-S3 gallop
-crackles, wheezing (pulmonary edema)
Right-Sided Heart Failure Signs/Symptoms
-jugular distension
-increased abdominal girth
-dependent edema
-hepatomegaly
-hepatojugular reflux
-ascites
-weight most reliable indication of fluid gain/loss (daily wt)
-swelling
-liver
Assessment: Recognize Cues
Laboratory Assessment
-SERUM ELECTROLYTES: potassium, sodium, magnesium, calcium, and chloride
-ELECTIVE BUN & CREATINE: with impaired renal function due to inadequate perfusion
-HEMOGLOBIN & HEMOCRIT: HF resulting from anemia
-URINALYSIS: proteinuria and high specific gravity
-ABGs: respiratory alkalosis, respiratory acidosis, or metabolic acidosis can occur
Imaging Assessment:
-Echocardiography: best tool to diagnose heart failure
Hemodynamic Monitoring:
-direct assessment of cardiac function & volume status
-PAP (pulmonary artery pressure)
-PAOP (pulmonary artery occlusion pressure)
-ECG (electrocardiogram)
Analysis: HF
- decreased gas exchange due to ventilation/perfusion imbalance
- potential for decreased perfusion due to inadequate cardiac output
- potential for pulmonary edema due to left-sided HF
Planning & Implementation: HF
- increased gas exchange
- increase perfusion (primary focus)
- preventing or managing pulmonary edema (decrease swelling)
Interventions: HF
-Cardiac Resynchronization Therapy (CRT)
-Gene Therapy for HF
-CardioMEMS implantable monitoring system
-CPAP (for difficulty breathing @ night)
-Ventricular Assistive Devices (VAD)
-Endoventricular Circular Patch Cardioplasty
-Heart transplant
Pulmonary Edema S/S
-crackles
-dyspnea @ rest
-disorientation or acute confusion (especially in older adults as early symptom)
-tachycardia
-hypertension or hypotension
-decreased urinary output
-cough w frothy, pink-tinged sputum
-premature ventricular contractions & other dysrhythmias
-anxiety
-restlessness
-lethargy
Planning: HF
-the pt will not develop pulmonary edema as a result of HF
-the pt will recover from pulmonary edema complications if it develops & will not develop other problems
Interventions: HF
-admission to the acute care hospital, usually the critical care unit
-if the pt systolic BP is over 100, administer sublingual nitroglycerin as prescribed every five minutes for three doses while establishing IV access
-give rapid-acting diuretic, such as furosemide or bumetanide
-if BP is adequate, IV morphine may be prescribed to reduce venous return, decrease anxiety, & reduce the work of breathing
-pt may receive other drugs such as IV NTG & drugs to treat HF, monitor vitals closely
-ultrafiltration may be used w/ severe fluid overload & renal dysfunction
Heart Failure Self-Management Health teaching (MAWDS)
M medications:
-take as prescribed & dont run out
-know the purpose & side effects of each drug
-avoid NSAIDS to prevent sodium &fluid retention
A activity:
-stay as active as possible but don’t overdo it
-know your limits
-be able to carry on a conversation while exercising
W weight:
-daily weight @ same time each day on the same scale to monitor fluid retention
D diet:
-limit daily sodium intake to 2-3g as prescribed
-limit daily fluid to 2L
S symptoms:
-note any new or worsening symptoms & notify the health care provider
