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med/surg 2 > class 11 heart failure > Flashcards

class 11 heart failure Flashcards

1
Q

cardiac output formula:

A

heart rate x stroke volume = cardiac output

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2
Q

3 things stroke volume depends on:

A

1.preload
2.afterload
3.contractility

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3
Q

what is heart failure

A

a clincial syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to fill or eject blood

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4
Q

heart failure mortality rate

A

40-50% of patients die within 5 yr of dx
-pt tend to have frequent, long hospital stays

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5
Q

what is ejection fraction

A

-the volume of blood that the LV ejects out with each contraction
-measured in percentages

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6
Q

what is a normal ejection fraction

A

50-70% of the ventricle volume

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7
Q

ejection fraction and heart failure

A

a low EF is a hallmark of HF
-the severity of HF is frequently classified according to the patient’s symptoms
-<40%

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8
Q

heart failure classification I s&s

A

-no limitations of physical activity
-ordinary activity does not cause undue fatigue , palpatation, or dyspnea

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9
Q

heart failure classification II s&s

A

-slight limittaion of physical activity
-comfortable at rest, but ordinary physical activity causes fatigue, plapatation, or dyspnea

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10
Q

heart failure classification III s&s

A

-marked limitation of physical activity
-comfortable at rest, but less than ordinary activity causes fatigue, palpatation, or dyspnea

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11
Q

heart failure classification IV s&s

A

unable to carry out any physical activity without discomfort
-symptoms of cardiac insufficiency at rest
-if any physical activity is undertaken, discomfort is increased

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12
Q

primary risk factors for HF

A

-CAD
-hypertension
-valvular disease

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13
Q

contributing risk factors for HF

A

-diabetes
-tobacco use
-obesity
-high serum cholesterol

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14
Q

manifestations of left sided heart failure

A

-SOB, dyspnea
-pulmonary edema
-frothy cough, may be blood tinged
-congestion
-fine crackles
-impaired o2 exchange

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15
Q

manifestations of right sided heart failure

A

-peripheral pitting edema
-weight gain
-ascites
-hepatomegaly
-nausea
-SOB
-usually caused by left HF d/t inc pressure

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16
Q

clinical manifestations of chronic heart failure

A

-fatigue
-dyspnea, orthopnea, paroxysmal nocturnal dyspnea
-persistent dry cough, unrelieved with position change or OTC cough suppressants
-tachycardia
-dependent edema
-sudden weight gain of >2kg in 2 days may indicate exacerbation of HF
-nocturia
-dusky, cool, damp skin
-skiny swollen legs with dimished/absent hair growth
-restlessness, confusion, decreased memory
-chest pain (angina)
-weight changes

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17
Q

diagnostic test for HF

A

-echocardiogram
-MUGA scan
-chest x-ray
-EKG
-blood work (CBC, lytes, BUN, creatinine, TSH, BNP (key diagnosic), LFT, urinalysis)

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18
Q

use of medications for HF

A

-eliminate or reduce etiologic or contributory factors
-reduce the workload of the heart by reducing afterload and preload
-optimize all therapeutic regimens
-prevent exacerbations

19
Q

medications prescribed for HF

A

-ACE inhibitors
-angiotensin II receptor blockers
-beta-adrenergic blockers
-diuretics
-digitalis
-entresto (valstartan and sacubitril)
-selective sodium glucose cotransporter 2 inhibitor
-anticoagulants, antiarrhythmics,statins

20
Q

nursing considerations for HF

A

-medications
-low sodium diet and fluid restriction
-monitor signs of excess fluid, hypotension, exacerbation, weight gain, lung sounds
-daily weights
-exercise and activity program
-stress management
-prevention of infection
-family teaching
-diet

21
Q

what is pulmonary edema

A

-acute heart failure
-abnormal accumulation of lfuid in the interstitial spaces and alveoli of the lungs
-can lead to acute respiratory failure and death

22
Q

pulmonary edema manifestations

A

-restlessness, poor sleep
-anxiety
-dyspnea
-cool and moist skin
-cyanosis
-weak and rapid pulse
-cough
-lung congestion (moist, nosy resp)
-inc sputum production (frothy, blood-tinged)
-decreased LOC

23
Q

pulmonary edema assessment

A

resp assessment
-vital signs (>88% o2 may be a normal order)
-cardiac monitor

24
Q

pulmonary edema diagnostics

A

-ABGs, lytes, BUN, creatinine
-CXR
-medicatiosn (codiene/antitussives for cough)

25
Q

pulmonary edema management

A

-directed toward reducing volume overload, improving ventricular function, decreasing afterload, and increasing respiratory exchange
-o2
-morphine (dec RR, inc comfort)
-diuretics
-IV infusions
-prevent/early recognition
-sitting upright & dangle legs
-minimize exertion and stress

26
Q

what is peripheral vascular disease

A

includes disorder of arterial, venous and lymphatic system
-caused primarily by athersclerosis
-acute ot chronic
-superficial femoral and popliteal arteries most common

27
Q

causes for peripheral venous disease

A

-bad valves
-blood cant get back from extremities so it pools

28
Q

causes for peripheral arterial disease

A

-blood isnt GETTING to the extremities
-inc cholesterol
-inflammation/IV drug use
-diabetes
-HTN

29
Q

what is coronary athersclerosis

A

abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
- progressive blockages and narrowing of the coronary vessels reduce blood flow to the myocardium
-most common cause of cardiovascular disease in canada

30
Q

clinical manifestations of peripheral arterial disease

A

-cool
-dependent rubor, pale on elevation
-hairlessness of extremity
-dec peripheral pulses
-tissue atrophy
-delayed wound healing
-gangrene
-intermittent claudication
-rest pain
-“arterial steal” aka pins n needles
-thick toenails

31
Q

clinical manifestations of peripheral venous disease

A

-warm
-thick skin
-brown “splotchy tan” colour from pooling in extremities
-scaly skin

32
Q

medical management of peripheral vascular disease

A

-control co-morbid disease
-smoking cessation (vasoconstriction)
-prevent injury
-exercise
-diet
-promote arterial blood flow

33
Q

increased risk for peripheral venous disease

A

immobility
birth control
pregnancy
age

34
Q

nursing interventions for peripheral vascular disease

A

-neurovascular assessments
-promote arterial blood flow (dangle legs) and venous (elevate legs)
-prevent vasoconstriction (dec cold & stress)
-education
-pain management
-injury prevention
-risk for cellulitis

35
Q

surgical intervention for peripheral vascular disease

A

-not everyone is a candidate
-endovascular: angioplasty, atherectomy, and stent, laser angioplasty
-arterial bypass
-amputation

36
Q

what is a balloon angioplasty

A

balloon inserted into vessel to widen it where the narrowing is

37
Q

what is laser angioplasty

A

laser destroys the plaque narrowing the vessel

38
Q

what is a stent

A

piece inserted into vessel to hold it open

39
Q

what is atherectomy

A

blade or laser removes plaque from vessel walls

40
Q

nursing management for peripheral vascular disease

A

-maintaining circulation
-monitoring and managing complications
-promoting independence and management

41
Q

what are arterial ulcers

A

-skin breakdown in areas of an ischemic foot or leg
-painful
-usually: medial/lateral metatarsal heads and tips of toes
-sharp edge (usually round); pale base surrounded by atrophic tissue
-poor healing if any
-most require revascularization or grafting

42
Q

management of venous stasis ulcers

A

-leg elevation
-wound care
-moist dressings
-support stockings (dec pooling & inc blood return)
-ambulation
-antibiotics (if infected or cellulitis)
-debridement
-Unna boot

43
Q

characteristics of venous stasis ulcers

A

painful and red
-irregular border
-drainage and discharge common
-shallow
-commonly over bony prominiences

med/surg 2 (17 decks)

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