Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Advanced MedSurg > Ch 34 Heart Failure (Exam 2) > Flashcards

Ch 34 Heart Failure (Exam 2) Flashcards

(60 cards)

Start Studying
1
Q

Heart failure is a ______ disease that causes _____

A

progressive; insufficient blood supply/oxygen to tissues and organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ejection fraction?

A

amount of blood pumped by the left ventricular with each heartbeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

normal ejection fraction

A

55-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

in patients with reduced ejection fraction, expected amount

A

<45%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Etiology of heart failure

A

direct damage to the heart that causes increased peripheral resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

diagnosis for heart failure is based on? (3)

A
  • s/s
  • normal left ventricular EF
  • evidence of LV dysfunction by an ECG or cardiac catheterization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Primary risk factor of HF?

A

hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Decreased CO leads to? (5)

A
  • decreased tissue perfusion
  • impaired gas exchange
  • fluid volume imbalance
  • decreased functional ability
  • decreased LOC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CO depends on which factors? (4)

A
  • preload
  • afterload
  • myocardial contractility
  • HR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathophysiology of HF

A

result of neurohormonal compensatory mechanisms activated in response to myocardial dysfunction, leading to remodeling of myocardial structure/function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Low CO s/s (8)

A
  • dizziness
  • fatigue (d/t decreased blood flow)
  • SOB/trouble breathing
  • weak peripheral pulses
  • tachycardia (“my heart is pounding”)
  • pallor (for darker skin tones, ashen undertones)
  • dry skin, loss of elasticity
  • decreased LOC (d/t general hypoxia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is chronic HF a medical emergency?

A

not emergent, but can still lead to an emergency cardiac situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

FACES acronym for HF s/s stands for

A

F: fatigue (d/t low hemoglobin and oxygen/nutrients to cells/tissues)

A: limitation of Activities

C: chest congestion/cough

E: edema

S: shortness of breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Patho of systolic HF (HFrEF - heart failure with reduced EF)

A

inability of heart of pump effectively, causing blood to back up into the LA, causing fluid accumulation in the lungs, to pulmonary congestion (s/s: SOB, dyspnea, crackles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Systolic HF (HFrEF) is caused by

A
  • increased afterload (pressure)

- cardiomyopathy and mechanical abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Patho of diastolic HF (HFpEF - heart failure with preserved EF)

A

inability of the ventricles to RELAX and fill during diastole (stiffness does not allow ventricular filling), leading to impaired CO and pulmonary congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Main compensatory mechanisms of HF: neurohormonal renin-angiotensin-aldosterone system (RAAS) and SNS (2)

A
  • RAAS: kidneys sense decreased renal perfusion from low CO, promotes sodium and fluid retention
  • continuation of RAAS in HR leads to increased levels of ADH (water retention) and vasoconstriction, increasing BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ventricular remodeling

A

Actual change in the structure of the heart, occurs overtime in response to pressure or volume overload and/or cardiac injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ventricular Remodeling causes the ventricles to become

A

larger but less effective in pumping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ventricular dilation

A

enlargement of the chambers of the heart d/t ineffective left ventricular pumping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ventricular hypertrophy

A

increase in muscle mass and cardiac wall thickness, DECREASES STROKE VOLUME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Counterregulatory mechanisms (GOOD) of HF (4)

A

the body tries to maintain balance through: ANP, BNP, nitric oxide and prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

diagnostic test and predictor of mortality in HF is indicated by

A

high serum BNP (corresponds proportionately with fluid retention)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

5 complications of HF

A
  • pleural effusion
  • arrhythmias (afib is the most common, leading to blood clot rist)
  • thrombus formation
  • renal insufficiency (cardiorenal syndrome) and anemia (hepatomegaly)
  • sudden cardiac death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
HF with preserved ejection fraction (diastolic) is described as (5)
- uncontrolled hypertension is the primary cause - LV EF may be within normal limits - patho involves ventricular relaxation and filling - therapies focus on symptom control and treatment of underlying conditions
26
Acute decompensated heart failure (ADHF) is
the sudden onset of HF, causing blood to back up into the systemic and lungs **medical emergency**
27
ADHF can manifest and mask as
pulmonary edema
28
S/S of ADHF (9)
- JVD - coughing - anxiety/restlessness - crackles in the bases - SOB - pallor - cyanosis (LATE) - tachycardia - drop in SaO2
29
Common s/s of ADHF (6)
- fatigue - cough - dyspnea - tachycardia - edema - limitations on usual activities of daily living
30
Decompensation of chronic HF usually begins with?
s/s of fluid retention (weight gain, dyspnea, orthopnea)
31
As HF advances, ______ (4)
BP drops!! (indicator of cardiogenic shock), extremities become cold, decrease in peripheral pulses, and voice becomes hoarse
32
Early signs of ADHF
increased pulmonary pressure - leads to an increase in RR and a decrease in PaO2 (respiratory failure!)
33
Later signs of ADHF
interstital edema - tachypnea
34
Further progression of ADHF
alveolar edema - respiratory acidemia and ARDS
35
Some S/S of pulmonary edema that require an emergency response to ADHF (5)
- orthopnea (unable to tolerate lying flat) - abnormal S3 or S4 sounds - paroxysmal noctural dyspnea (nightmares) - nocturia (increased need to urinate at night) - sudden weight gain of >3 lbs in 2 days
36
Intervention priorities for ADHF include (5)
- admission to ICU - set HOB to 90 degrees with the legs flat if the patient is experiencing difficulty breathing (initial intervention!) - insertion of a foley cath - oxygen therapy: relieve dyspnea and fatigue - physical and emotional rest: conserve energy and decrease oxygen needs
37
Foley catheter considerations in the intervention for ADHF (3)
- normal urine output: 30 mL/hr - allows patient to void without exertion - monitor urine output and effectiveness of diuretics
38
Purpose of high-Fowler's position for intervention of ADHF
decreases PRELOAD (vol) and workload, opens airway
39
Intervention priorities for HF (3)
- decrease mortality and morbidity - minimize side effects - dietary therapy: written plan, read labels for sodium, no added salts, daily weights, smaller/more frequent meals
40
Diuretic therapy for ADHF - purpose - example - side effect - nursing consideration
- decreases volume overload (preload) - loop diuretics: furosemide (Lasix) - s/e: dysrhythmias - monitor potassium levels (potassium wasting or sparing)
41
Vasodilator therapy for ADHF - purpose - route and forms (3)
- reduces blood volume and improves coronary artery circulation, improving afterload (pressure) - IV nitroglycerin, sodium nitroprusside, nesiritide
42
Morphine for ADHF | - purpose
reduces preload and afterload, relieving dyspnea and anxiety
43
Positive inotropes | - purpose
improves cardiac contractility and stimulates CO without overloading, leading decrease HR and increase in BP
44
Lasix + digitalis - nursing consideration - s/s of digoxin toxicity (4)
- take HR before and after administration (slows HR) - if below 60 bpm, hold medication - digoxin toxicity: nausea, vomiting, ABD pain, diarrhea
45
RSHF (2)
- occurs when the right ventricle does not pump effectively, causing fluid to back into the venous system, moving fluid into peripheral tissues and organs - s/s: peripheral edema (ex: ankle swelling), ABD ascites, hepatomegaly, JVD
46
LSHF (2)
- most common form of HF from left ventricular dysfunction | - blood backs into the LA, into the pulmonary veins, causing pulmonary congestion and edema
47
End-stage HF goal and treatment
- goal: maintain comfort and reduce number of exacerbations that need hospitalization - treatment: heart transplantation
48
Heart transplant is used to treat
a variety of terminal or end-stage heart conditions
49
Early complications of heart transplantation (3)
- acute rejection - risk for sudden cardiac death - infection
50
Patient teaching for heart transplantation (5)
- avoid gardens/public places (exposure to infections) - check HR and BP - manage lifestyle changes - no hiking (strain) - no excessive activity
51
_____ is required for heart transplantation
life-time immunosuppression
52
Endomyocardial biopsies are obtained for heart transplanted patients from the right ventricle _____ for the first month, then ______ for the next 6 months, and _____ to detect rejection
- weekly for the first month - monthly for the next 6 months - yearly to detect rejection
53
Monitor post transplant (4)
- acute rejection - infection - malignancy - cardiac vasculopathy
54
Nutritional Therapy for HF (6)
- low sodium diet: DASH diet - sodium restricted to 2 g/day - foods to avoid: canned soups/tuna, prepackaged foods, preserved foods - fluid restriction (not generally required): <2 L/day - use ice chips, gum, hard candy, ice pops to quench thirst - daily weights are important (same time, same clothing)
55
Fibrinolytic Therapy is indicated for patients with
a STEMI
56
what is the goal of fibrinolytic therapy for patients with a STEMI
dissolve the thrombus in the coronary artery to reperfuse the heart muscle
57
2 examples of fibrinolytic medications
- tenecteplase | - alteplase
58
exclusion criteria/contrandications of fibrinolytic therapy (5)
- active internal bleeding (excluding menstruation) - hx of intracranial hemorrhage - current use of oral anticoagulants - major surgery < 3 weeks - recent internal bleeding (within 2-4 weeks)
59
What are major and minor bleeding complications of fibrinolytic therapy?
Major: drop in BP, increase in HR, change in LOC, blood in the urine/stool Minor: gingival or bleeding at the IV site is expected and managed by applying pressure and ice packs
60
Protocol for fibrinolytic therapy (2)
1. draw blood to obtain baseline labs | 2. start 2-3 lines for IV therapy

Advanced MedSurg (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions