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Flashcards in CHF Deck (13):
1

Heart Failure

Heart pumps blood inadequately, leading to reduced blood flow to tissue, back-up of blood in veins and lungs, and changes that may further weaken the heart
there is a problem with the contraction of the heart (systolic failure) and/or filling of the heart (diastolic failure).

Can occur at any age - mostly elders
Some cases are reversible
Most HF is a progressive, lifelong disorder managed with lifestyle changes and medications.

Failure can be in the Right Ventricle, the Left Ventricle or both.

2

ETIOLOGY OF HEART FAILURE

PRIMARY CARDIAC ORIGIN
***HTN
***CAD
MI
Valvular dysfunction
Dysrhythmias
***Cardiomyopathy
Rheumatic Heart
Congenital Heart
Pulmonary Hypertension

NON-CARDIAC ORIGIN
Diabetes
Age
Tobacco
Obesity
Increased Cholesterol
Thyroid dysfunction
ETOH
Chemo
Chronic anemia
Infectious disease
Inflammatory disorders
Sleep apnea

3

Forms

Systolic
Heart contracts less forcibly so not all blood is pumped out
More blood must remain in the veins
Most common
Causes
- CAD, myocarditis, heart valves, Conduction problems

Diastolic
Heart is stiff and does not allow for proper filling
More blood remains in the veins
Causes
- Inadequately treated HTN, advanced age, parasites, constrictive pericarditis

4

Pathophysiology of CHF

heart damage--> Ventricular overload-->Decreased ventricular Contraction--> Tachycardia, ventricular dilation, myocardial hypertrophy--> Decreased cardiac output--> Decreased Renal perfusion--> Increased sodium retention--> Increased osmotic pressure--> Increased ADH--> Increased water reabsorption--> Fluid overload edema

New York Heart Association:
Class I – Patients without physical limitations.
Class II – Patients who are comfortable at rest but become symptomatic with activity.
Class III – Patients who are comfortable at rest, but have marked limitations with any type of physical activity.
Class IV – Patients who are symptomatic with rest or activity.

American College of Cardiology & AHA
Class A – Has several risk factors but no S/S
Class B – Has heart disease but no S/S
Class C – Has heart disease and experiences S/S
Class D – Advanced heart disease requiring specialized treatment

5

Pathophysiology of CHF

Right-sided failure
- RV cannot eject sufficient amounts of blood, and blood backs up in the venous system. This results in peripheral edema, hepatomegaly, ascites, anorexia, nausea, weakness, and weight gain.

Left-sided failure
LV cannot pump blood effectively to the systemic circulation. Pulmonary venous pressures increase, resulting in pulmonary congestion with dyspnea, cough, crackles, and impaired oxygen exchange.


Chronic HF is frequently biventricular.

6

Clinical Manifestations

Right:
Tired and weak after physical activity
Tachycardia
Murmurs
Jugular distention
Fluid accumulation/weight gain
Liver enlarged/R upper quadrant pain
Anorexia, nausea, bloating

Left:
Weakness/fatigue
Alternating pulses
S3 S4 sounds
Fluid accumulation in lungs
SOB
Orthropnea
Dry cough
Feeling of suffication
Clots
Confusion/disorientation

7

Significant Subjective Data

Patient may state:
I’m having trouble breathing
My ankles and fingers are swelled up
I have to sleep with two pillows
Sometimes I have chest pain
I am always tired
Sometimes my left arm gets numb
My brain feels kind of foggy sometimes

8

Medical Management of HF

Eliminate or reduce etiologic or contributory factors.
Reduce the workload of the heart by reducing afterload and preload.
Optimize all therapeutic regimens.
Prevent exacerbations of HF.
?Pacer

Medications:
Vasodilators
Diuretics
Morphine
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor blockers
Beta-blockers
Digitalis
Anticoags
Other dysrythmics

9

Assessment

Health history
Sleep and activity
Diet
Knowledge and coping
Physical exam
- Mental status
- Lung sounds: crackles and wheezes
- Heart sounds: S3 S4
- Fluid status/signs of fluid overload
Daily weight and I&O

Assess responses to medications

10

Nursing Management

I&O
Weigh daily
Auscultate lung sounds
Determine degree of JVD
Assess dependent edema
Monitor VS
Examine skin turgor and mucous membranes
Assess for symptoms of fluid overload

Nursing Diagnosis:
Impaired Gas Exchange
Decreased cardiac Output
Excess fluid volume
Activity intolerance and fatigue
Anxiety
Powerlessness
Noncompliance

Patient Teaching:
Medications -Action, side effects and signs of toxcity
Diet: low-sodium diet (DASH/TLC)
Fluid restriction for severe
BP and O2 monitoring
Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation,
Daily weight
Exercise and activity program
Stress management
Prevention of infection
Know how and when to contact health care provider
Include family in teaching

11

Collaborative Problems/PC

Pleural Effusion
Dysrhythmias
Thromboembolism
Pericardial effusion and cardiac tamponade
Enlarged liver
Renal Failure
Cardiogenic shock

12

Pulmonary Edema

Acute event in which the LV cannot handle an overload of blood volume.
Pressure increases in the pulmonary vasculature, causing fluid to move out of the pulmonary capillaries and into the interstitial space of the lungs and alveoli.
Results in hypoxemia

Clinical manifestations:
Restlessness,
Anxiety,
Dyspnea,
Cool and clammy skin,
Cyanosis,
Weak and rapid pulse, cough,
Lung congestion (moist, noisy respirations),
Increased sputum production (sputum may be frothy and blood-tinged),
Decreased level of consciousness

Management:
Prevention
Early recognition:
- monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention
Place patient upright and dangle legs.
Minimize exertion and stress.
Oxygen
Medications
- Morphine
- Diuretic (furosemide)

13

Treating Congestive Heart Failure

UNLOAD FAST:
Upright position
Nitrates
Lasix
Oxygen
ACE inhibitors
Digoxin

Fluids (decreased)
Afterload (decreased)
Sodium Restriction
Test (Digoxin level, ABGs, Potassium Level)