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NUR 102- Test 4 > Cardiovascular Disorders - Heart Failure > Flashcards

Flashcards in Cardiovascular Disorders - Heart Failure Deck (32):
1

Cardiovascular Disorders - Heart Failure (Chapter 17)

What is heart failure?

The heart's inability to function as a pump to meet the needs of the body.

2

Cardiovascular Disorders - Heart Failure (Chapter 17)

What is cardiac reserve as related to heart failure?

The heart's ability to adjust its output to meed the metabolic needs of the body. Clients with heart failure have very little cardiac reserve.

3

Cardiovascular Disorders - Heart Failure (Chapter 17)

Which side of the heart is more affected by heart failure? Why?

The left side is more affected because of its high workload and oxygen demand.

4

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are the early manifestations of left-sided heart failure?

Left-sided heart failure result from pulmonary congestion and decreased cardiac output.

Activity intolerance
Fatigue
Weakness
Dizziness and syncope
SOB
Dyspnea On Exertion (DOE)
Orthopnea
Cough
Tachycardia
Rales and wheezes (maybe heard in lung bases)

5

Cardiovascular Disorders - Heart Failure (Chapter 17)

What is orthopnea?

It is breathing difficulty while lying down. It may prompt the client to sleep propped u on two or three pillows in a recliner.

6

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are rales?

They are inspiratory crackles

7

Cardiovascular Disorders - Heart Failure (Chapter 17)

What may occur in severe left-ventricular failure?

Acute pulmonary edema.

8

Cardiovascular Disorders - Heart Failure (Chapter 17)

What is acute pulmonary edema?

It is the accumulation of fluid in the interstitial spaces and alveoli of the lung. It is considered a medical emergency. The client is "drowning" as a result of fluid in the alveolar and pulmonary spaces. It must be treated immediately.

9

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are the manifestations of acute pulmonary edema?

Acute and severe dyspnea
SOB
Anxiety
The skin is cyanotic, cool and clammy
Productive cough with pink frothy sputum (blood-tinged)
Cerebral Hypoxia (will become confused or lethargic)
Crackles (heard throughout the lung fields)

10

Cardiovascular Disorders - Heart Failure (Chapter 17)

What is the most common cause of right-sided ventricular failure? What is the pathophysiology of right-sided ventricular failure?

Left ventricular failure. Blood accumulates in the systemic venous system. Increased venous pressures lead to abdominal organ congestion and peripheral tissue edema.

11

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are the manifestations of right-sided heart failure?

Fatigue
Activity intolerance
Jugular vein distention
Peripheral edema or edema in the sacrum (reclining clients)
Anorexia, nausea
Abdominal distention, ascites
Liver, spleen enlargement, tenderness

12

Cardiovascular Disorders - Heart Failure (Chapter 17)

What is biventricular failure? What are the manifestations?

It is when both ventricles fail to function adequately. The client experiences both right- and left-sided manifestations as well as paroxysmal nocturnal dyspnea.

13

Cardiovascular Disorders - Heart Failure (Chapter 17)

What is paroxysmal nocturnal dyspnea (PND)? When does it occur?

A condition in which the client awakens at night acutely SOB. It occurs when edema fluid that has accumulated during the day is reabsorbed into the circulation at night, causing fluid overload and pulmonary congestion.

14

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are the main goals of interdisciplinary care of a client with heart failure?

The main goal is to reduce cardiac workload, improve cardiac pumping ability, and control fluid retention.

The focus is also on improving activity tolerance and decreasing mortality and mobidity.

15

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are some of the diagnostic tests used to identify heart failure and evaluate its effects?

Monitor antrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)
Serum electrolytes
Chest x-ray
Echocardiogram
Electrocardiogram

16

Cardiovascular Disorders - Heart Failure (Chapter 17)

What is atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)?

They are two hormones that are released from the heart muscle in response to changes in blood volume. The blood levels increase in heart failure, but do not change in other cardiac disorders

17

Cardiovascular Disorders - Heart Failure (Chapter 17)

What medications can the nurse expect to be order for a client with heart failure?

ACE inhibitors (Lisinopril, Captopril)
Angiotensin II receptor blockers (ARBs) (Valsartan (diovan))
Beta Blockers
Diuretics (Lasix, Hydrochlorothiazide)
Inotropics (Digoxin)
Vasodilators (Nitroglycerin)

18

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are the nursing implications for ACE inhibitors (Enalapril, Lisinopril, Captopril)?

Monitor for facial, lips, eyelid swelling itching or breathing problems
Monitor for a dry cough.
Give 1 hour before meals.
Maintain bed rest and monitor BP for 3 hours after initial dose (hypotension can develop)
Monitor K+ levels (hyperkalemia may develop)

19

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are the nursing implications for diuretics (Lasix, HydroDIURIL)?

Monitor fluid volume status (BP, weight, I&O, turgor, edema)
Administer IV slowly (no more than 20 mg/min)
Do not use with aminoglycoside antibotics (may cause ototoxicity and hearing loss)

20

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are the nursing implications for a positive inotropic agent (Digoxin)?

Assess apical pulse for 1 minute (hold and notify physician if <60 bpm)
Assess K+ levels (hypokalemia increases risk of digitalis toxicity)
Report s/s of digitalis toxicity (blurred vision, halos seen around objects, and dysrhythmias).
Avoid giving antacids or laxatives (they decrease digoxin absorption)

21

Cardiovascular Disorders - Heart Failure (Chapter 17)

What are the nursing implications for vasodilators (Nitroglycerin)?

Monitor BP (can cause hypotension)
Monitor cardiac rhythm

22

Cardiovascular Disorders - Heart Failure (Chapter 17)

A client develops left-sided heart failure. An appropriate nursing diagnostic is:

A. Activity intolerance
B. Ineffective Airway Clearance
C. Deficient Fluid Volume
D. Acute Pain

A. Activity intolerance

Rationale:
Left-sided heart failure affects cardiac output and the availability of the blood and oxygen to meet the body's metabolic needs. As a result, fatigue and activity intolerance are common, early manifestations of heart failure. Heart failure is not painful, nor does it usually affect airway clearance. Fluid volume often increases in heart failure due to compensatory mechanisms.

23

Cardiovascular Disorders - Heart Failure (Chapter 17)

A client develops right-sided heart failure. Which of the following symptoms would the nurse expect to find?

A. Pulmonary edema
B. Edematous legs and ankles
C. Decreased heart rate
D. Increase urinary output.

B. Edematous legs and ankles

Rationale:
The backward effects of right-sided heart failure affect the venous system and peripheral tissues. Increase pressure in the venous system causes peripheral edema. The HR increases, and urinary output may decrease. Pulmonary edema develops with left-sided failure.

24

Cardiovascular Disorders - Heart Failure (Chapter 17)

The nurse is to administer digoxin (Lanoxin) 0.25 mg PO. The client's apical pulse is 48. The appropriate nursing action is to:

A. Check the digoxin level and administer the drug if the level is less than 2 ng/mL.
B. Hold the drug and recheck the apical pulse in 1 hours.
C. Hold the drug and notify the physician.
D. Administer the drug and report the apical pulse when the physician makes rounds.

C. Hold the drug and notify the physician.

Rationale:
A slow pulse may indicate digitalis toxicity. The physician should be notified as diagnostic tests may be necessary to determine the cause of the low pulse rate.

25

Cardiovascular Disorders - Heart Failure (Chapter 17)

A client has been admitted tot he hospital in acute heart failure. Which of the following diets would the nurse expect to see ordered for this patient?

A. Low-fat, high-protein
B. High-potassium, low-protein
C. Low-sodium, high-protein
D. High protein, high-sodium

C. Low-sodium, high-protein

26

Cardiovascular Disorders - Heart Failure (Chapter 17)

Which of the following nursing diagnoses would be most appropriate for the client in congestive heart failure?

A. Activity Intolerance
B. Deficient Knowledge
C. Pain, Acute
D. Deficient Fluid Volume

A. Activity Intolerance

27

Cardiovascular Disorders - Heart Failure (Chapter 17)

The most common cause of right ventricular failure is:

A. Left ventricular failure.
B. Right atrial failure.
C. Left atrial failure.
D. Pulmonary failure.

A. Left ventricular failure.

28

Cardiovascular Disorders - Heart Failure (Chapter 17)

You are instructing a nursing student in the correct administration of a nitroglycerin patch. The most important point that should be made at this time is to:

A. wipe off the old medication before applying the new patch.
B. rotate sites.
C. wear gloves.
D. not massage into the skin

C. wear gloves.

29

Cardiovascular Disorders - Heart Failure (Chapter 17)

The drug class that increases the strength of the heart's contractions is known as:

A. calcium channel blockers
B. inotropics
C. analgesics
D. beta blockers

B. inotropics

30

Heart Failure (ATI/Med Surge-Chapter 29)

A nurse is caring for a client who has heart failure and reports increased SOB. Which of the following actions should the nurse take? (Select all that apply.)

A. Notify the provider.
B. Check the client's oxygen saturation with pulse oximeter.
C. Assist the client to a side-lying position.
D. Auscultate the client's lungs, listening for increased crackles.
E. Monitor the client for a cough or blood-tinged sputum.

A. Notify the provider.
B. Check the client's oxygen saturation with pulse oximeter.
D. Auscultate the client's lungs, listening for increased crackles.
E. Monitor the client for a cough or blood-tinged sputum.

Rationale:
The nurse should notify the provider, check the client's oxygen saturation with pulse oximeter, auscultate the client's lungs, listening for increased crackles, and monitor for cough or blood-tinged sputum. These findings may indicate the client is experiencing pulmonary edema and needs immediate attention. The client should be placed in a high-Fowler's position to decrease venous return to the heart (preload) and help relieve lung congestion.

31

Heart Failure (ATI/Med Surge-Chapter 29)

A nurse is caring for a client who has heart failure. The nurse observes that the client is SOB and confused. Which of the following findings may indicate that the client is experiencing digitalis toxicity?

A. Apical heart rate of 62/min
B. Slurred speech
C. Blurred vision
D. Serum potassium level of 4 mEq/L

C. Blurred vision

Rationale:
Apical HR of 62/min is within expected range. Slurred speech could be a sign of CVA. Potassium level of 4 mEq/L is within expected range.

32

Cardiovascular Disorders - Heart Failure (Chapter 16)

A client is to receive a morning dose of digoxin. Which finding, if present, would indicate that the medication should not be given?

A. Radial pulse of 80
B. Apical pulse of 52
C. Radial pulse of 60
D. Apical pulse of 62

B. Apical pulse of 52