Day III Flashcards
(93 cards)
1
Q
what is HF?
A
- HF occurs when the heart muscle is unable to pump effectively which causes inadequate cardiac output, myocardial hypertrophy, and pulmonary/systemic congestion
- Heart is unable to maintain adequate circulation to meet tissue needs
- It is the result of an acute or chronic cardiopulmonary problem, such as systemic HTN, MI, pulmonary HTN, dysrhythmias, valvular heart dz, pericarditis, or cardiomyopathy
2
Q
New York Heart Assoc’s functional classification scale for HF
A
- indicates the level of activity it takes to make the client symptomatic (client pain or shortness of breath)
- Class I: no symptoms w/ activity
- Class II: symptoms with ordinary exertion
- Class III: displays symptoms with minimal exertion
- Class IV: symptoms at rest
3
Q
American College of Cardiology and AHA staging HF
A
- A: high risk for developing HF
- B: cardiac structural abnormalities or remodeling but no heart failure symptoms
- C: current or prior symptoms of HF
- D: refractory end stage HF
4
Q
left sided heart failure
A
- results in inadequate left ventricle (cardiac) output and consequently in inadequate tissue perfusion
- Systolic heart (ventricular) failure: ejection fraction below 40%, pulmonary and systemic congestion
- Diastolic heart (ventricular) failure: inadequate relaxation or “stiffening” prevents ventricular filling
5
Q
right sided heart failure
A
- results in inadequate right ventricle output and systemic venous congestion (peripheral edema)
6
Q
health promotion and dz prevention for HF
A
- Maintain exercise routine to remain physically active
- Diet: low in sodium, fluid restrictions
- Refrain from smoking
- Follow med regimen
7
Q
what are 2 risk factors for all types of heart failure?
A
- SBP is elevated in older adults, putting them at risk for coronary artery dz and HF
- Some meds inc the risk of HF or worsen manifestations in older adult clients
8
Q
risk factors for left sided HF
A
- HTN
- Coronary artery dz, angina, MI
- Valvular dz
9
Q
risk factors for right sided HF
A
- Left sided HF
- Right ventricular MI
- Pulmonary problems (COPD, pulmonary fibrosis)
10
Q
risk factors for cardiomyopathy
A
- Coronary artery dz
- Infection or inflammation of the heart muscle
- Various cancer tx
- Prolonged alcohol use
- Heredity
11
Q
expected findings of left sided HF
A
- Dyspnea, orthopnea (SOB while laying down), nocturnal dyspnea
- Fatigue
- Displaced apical pulse (hypertrophy)
- S3 heart sound (gallop)
- Pulmonary congestion (dyspnea, cough, bibasilar crackles)
- Frothy sputum (can be blood tinged)
- Altered mental status
- Manifestations of organ failure, such as oliguria (dec in urine output)
12
Q
expected findings of right sided HF
A
- JVD
- Ascending dependent edema (legs, ankles, sacrum)
- Abdominal distention, ascites
- Fatigue, weakness
- Nausea and anorexia
- Polyuria at rest (nocturnal)
- Liver enlargement (hepatomegaly) and tenderness
- Weight gain
13
Q
what is cardiomyopathy?
what are the 4 types?
A
- Blood circulation to the lungs is impaired when the cardiac pump is compromised
- can lead to HF
- 4 types:
- dilated: most common
- hypertrophic
- Arrhythmogenic right ventricular
- Restrictive
14
Q
manifestations of cardiomyopathy
A
- Fatigue, weakness
- HF (left with dilated type & right with restrictive type)
- Dysrhythmias (heart block)
- S3 gallop
- Cardiomegaly
- Angina (hypertrophic type)
15
Q
lab test for HF
A
- Human B type Natriuretic peptides (hBNP)
- In clients who have dyspnea, elevated hBNP confirms a diagnosis of HF rather than a problem originating in the respiratory system. hBNP levels direct the aggressiveness of treatment interventions
- Less than 100: no HF
- 100-300: suggests HF is present
- >300: mild HF
- >600: moderate HF
- >900: severe HF
- In clients who have dyspnea, elevated hBNP confirms a diagnosis of HF rather than a problem originating in the respiratory system. hBNP levels direct the aggressiveness of treatment interventions
16
Q
what are the diagnostic procedures for HF?
A
- hemodynamic monitoring
- ultrasound
- transesophageal echocardiography (TEE)
- CXR
- ECG, cardiac enzymes, electrolytes, and ABGs: use to assess factors contributing to HF and/or the impact of HF
17
Q
explain hemodynamic monitoring to diagnose HF
A
- HF generally results in inc central venous pressure (CVP), inc pulmonary wedge pressure (PAWP), inc pulmonary artery pressure (PAP), and dec CO
- Mixed venous O2 sats (SvO2) are directly related to CO.
- Drop in SvO2 indicates worsening cardiac function
18
Q
explain ultrasound to diagnose HF
A
- 2D or 3D
- Left ventricular ejection fraction: volume of blood pumped from the left ventricle into the arteries upon each beat
- Expected reference: 55-70%
- Right ventricular ejection fraction: volume of blood pumped from the right ventricle to the lungs upon each beat
- Expected reference: 45-60%
- Left ventricular ejection fraction: volume of blood pumped from the left ventricle into the arteries upon each beat
19
Q
explain transesophageal echocardiography (TEE) to diagnose HF
A
- Uses a transducer placed on the esophagus behind the heart to obtain a detailed view of cardiac structures
- Nurse prepares client in same manner as upper endoscopy
20
Q
explain CXR to diagnose HF
A
- can reveal cardiomegaly and pleural effusions
21
Q
nursing care involved with HF
A
- Monitor daily weight and I&O
- Assess for SOB and dyspnea on exertion
- Administer O2
- Monitor V/S and hemodynamic pressures
- Put client in high Fowler’s
- Check ABGs, electrolytes, SaO2, and CXR
- Assess for signs of med toxicity
- Encourage bed rest
- Encourage energy conservation
- Maintain dietary restrictions as prescribed (restricted fluid intake, restricted sodium intake)
22
Q
what are the classes of meds used to tx HF?
A
- diuretics
- afterload reducing agents
- inotropic agents
- beta blockers
- vasodilators
- human B type natriuretic peptides
- anticoagulants
23
Q
diuretics to tx HF
A
- use to decrease preload
- Loop: furosemide, bumetanide
- Thiazide: HCTZ
- Potassium sparing diuretics: spironolactone
- Nursing considerations:
- Administer furosemide IV no faster than 20 mg/min
- Loop and thiazide diuretics can cause hypokalemia, and potassium supplementation can be required
- Client edu: teach clients taking loop or thiazide diuretics to ingest foods and drinks that are high in potassium to counter the effects of hypokalemia
24
Q
afterload reducing agents to tx HF
A
- help the heart pump more easily by altering the resistance to contraction
- Contraindicated for clients who have renal deficiency
- ACE inhibitors: enalapril, captopril
- ARBs: losartan
- CCBs: diltiazem, nifedipine
- Phosphodiesterase 3 inhibitors: milrinone
- Nursing considerations:
- ACE inhibitors: first dose hypotension, angioedema, dec sense of taste, skin rash
- Monitor for inc levels of potassium
- Client edu: ACE Inhibitors
- Teach client about dry cough
- Notify provider if rash or dec sense of taste
- Notify provider if swelling of face occurs
- Remind client that BP needs to be monitored for 2 hours after initial dose
25
intropic agents to tx HF: meds, action, nursing considerations
* digoxin, dopamine, dobutamine, milrinone
* Used to inc contractility and thereby improve cardiac output
* Nursing considerations:
* For a client taking digoxin, take apical HR for 1 min, and hold if pulse is \<60/min
* watch for n/v
* Dopamine, dobutamine, and milrinone are administered via IV.
* Closely monitor ECG, BP, and urine output
26
inotropic agents to tx HF: client edu
* If client self administering digoxin:
* Count pulse for 1 min before taking, and if less than 60 or greater than 100, then hold
* Take dose at same time each day
* Do not take at same time as antacids--\>separate other meds by 2 hours
* Toxicity: fatigue, muscle weakness, confusion, and loss of appetite
* Check digoxin and K levels regularly
27
beta blockers to tx HF
* carvedilol and metoprolol
* Can be used to improve the condition of the client who has sustained increased levels of sympathetic stimulation and catecholamines
* Includes clients who have chronic HF
* Nursing considerations:
* Monitor BP, pulse, activity tolerance, and orthopnea
* Check orthostatic BP readings
* Client edu:
* Instruct client to weigh daily
* Advise client to regularly check BP
28
vasodilators to tx HF
* nitroglycerin and isosorbide mononitrate
* Prevent coronary artery vasospasm and reduce preload and afterload, decreasing myocardial O2 demand
* Nursing considerations:
* Given to tx angina and help control BP
* Use cautiously with other anti HTN meds
* Can cause orthostatic hypoTN
* Client edu:
* HA is common SE
* Sit and lie down slowly
29
human B type natriuretic peptids (hBNPs) to tx HF
* nesiritide
* Used to treat acute HF by causing natriuresis (loss of Na and vasodilation)
* Administered IV
* Nursing considerations:
* Can cause hypoTN, v tach, and bradycardia
* BNP levels will inc on this med
* Monitor ECG, BP
* Client edu:
* Client may be asymptomatic with a low BP
* Remind client to sit and lie down slowly
30
anticoagulants to tx HF
* warfarin
* Use if pt has hx of thrombus formation
* Nursing considerations:
* Contraindications: active bleeding, PUD, hx of CVA, recent trauma
* Monitor PT, aPTT, INR, CBC
* Client edu:
* Teach client risk for bruising and bleeding
* Teach about getting blood monitored
31
interprofessional care to help with HF
* cardio/pulmonary services: to manage HF
* Respiratory services: for inhalers, breathing tx, suctioning
* Cardiac rehab: for client with prolonged weakness
* Nutrition: for diet with low sodium and low saturated fat food choices
32
therapeutic procedures for HF
* ventricular assist device (VAD)
* heart transplantation
33
ventricular assist device as a therapeutic procedure for HF
* mechanical pump that assists a heart that is too weak to pump blood thru the body
* Used in clients who are eligible for heart transplants or who have severe end stage HF and are not candidates for heart transplants
* Heart transplantation is the tx of choice for clients who have severe dilated cardiomyopathy
* Nursing actions:
* Prepare client with NPO status and informed consent
* Monitor post-op: V/S, SaO2, incision drainage, and pain mgmt
34
heart transplantation as a therapeutic procedure to tx HF
* option for clients who have end stage HF
* Immunosuppressant therapy is required post transplantation to prevent rejection
* Eligibility for transplant depends on life expectancy, age, psychosocial status, absence of drug and alcohol use disorders
* Nursing actions:
* Prepare client for NPO and informed consent
* Monitor post op: V/S, SaO2, incision drainage, pain mgmt
* Monitor for complications: organ transplant recipients are at risk for infection, thrombosis, and rejection
* Client edu: instruct client to:
* Take meds
* Take diuretics in early morning and early afternoon
* Maintain fluid and Na restriction
* Inc dietary intake of potassium if client is taking K losing diuretics
* Check weight daily at the same time: notify provider for weight gain of 2 lb in 24 hr or 5 lb in 1 week
* Schedule follow up
* Get vaccines for pneumonia and flu
35
what are the complications of HF?
* pulmonary edema
* cardiogenic shock
* pericardial tamponade
36
what is cardiogenic shock?
what are the expected findings?
* serious complication of pump failure that occurs commonly following an MI and injury greater than 40% of the left ventricle
* Findings:
* Tachycardia
* hypoTN
* Inadequate urinary output
* Altered LOC
* Respiratory distress (crackles, tachypnea)
* Cool, clammy skin
* Dec peripheral pulses
* Chest pain
37
nursing actions with cardiogenic shock as it occurs with HF
* Monitor breath sounds: crackles, wheezing
* Monitor heart sounds
* Administer O2, intubation and ventilation may be required
* Administer IV morphine, diuretics, and/or nitro to dec preload
* Administer vasopressors and/or positive inotropes to inc CO and maintain organ perfusion
* Provide continuous hemodynamic monitoring
38
pericardial tamponade as a complication of HF
* Can result from fluid accumulation in the pericardial sac
* Findings:
* hypoTN
* JVD
* Muffled heart sounds
* Paradoxical pulse (variance of 10 mmHg or more in SBP b/w expiration and inspiration)
* Diagnostics: hemodynamic monitoring will reveal intracardiac and pulmonary artery pressures similar and elevated
39
nursing actions for pericardial tamponade as a complication of HF
* Notify provider
* Administer IV fluids to combat hypoTN
* Obtain CXR or ECG
* Prepare for pericardiocentesis: informed consent, gather materials, administer meds
* Monitor hemodynamic pressures
* Monitor heart rhythm--changes indicate improper positioning of needle
* Monitor for reoccurrence of findings after the procedure
40
what is pulmonary edema? what are the expected findings of acute pulmonary edema?
* Pulmonary edema: severe, life threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe HF
* Acute is life - threatening
* Expected findings
* Anxiety
* Tachycardia
* Acute respiratory distress
* Dyspnea at rest
* Change in level of consciousness
* An ascending fluid level within the lungs (crackles, cough productive of frothy, blood-tinged sputum)
41
nursing actions associated with pulmonary edema
* Administer prescribed medications to improve cardiac output
* Teach client about measures to improve tolerance to activity, such as alternating periods of activity with periods of rest
* Prompt response to this emergency includes the following
* Positioning the client in high-fowler’s position
* Administration of oxygen, positive airway pressure, and/ or intubation and mechanical ventilation
* IV morphine (to decrease anxiety, respiratory distress, and decrease venous return)
* IV administration of rapid-acting loop diuretics, such as furosemide
* Effective intervention should result in diuresis (carefully monitor output), reduction in respiratory distress, improved lung sounds, and adequate oxygenation
42
what is the most common cause of pulmonary edema?
* Cardiogenic factors are most common cause of pulmonary edema
* It is a complication of various heart and lung diseases
* Usually occurs from inc pulmonary vascular pressure secondary to severe cardiac dysfunction
43
noncardiac pulmonary edema
* can occur due to barbiturate or opiate overdose, inhalation of irritating gases, rapid administration of IV fluids, and after a pneumonectomy evacuation of pleural effusion
44
neurogenic pulmonary edema
* develops following a head injury
45
older adults and pulmonary edema
* Inc risk occurs related to dec cardiac output and HF
* Inc risk for fluid and electrolyte imbalances occurs when older adults receive tx with diuretics
* IV infusions must be administered at a slower rate to prevent circulatory overload
46
health promotion and disease prevention for pulmonary edema
* Maintain an exercise routine to remain physically active
* Consume diet low in Na along with fluid restrictions
* Refrain from smoking
* Follow medication regimen
47
risk factors of pulmonary edema
* acute MI
* Fluid volume overload
* HTN
* Valvular heart dz
* Postpneumonectomy
* Postevacuation of pleural effusion
* Acute respiratory failure
* Left sided HF
* High altitude exposure or deep sea diving
* Trauma sepsis
* Drug overdose
48
expected findings of pulmonary edema
* Anxiety
* Inability to sleep
* Persistent cough with pink, frothy sputum (cardinal sign)
* Tachypnea, dyspnea, and orthopnea
* Hypoxemia
* Cyanosis (later stage)
* Crackles
* Tachycardia
* Reduced urine output
* Confusion, stupor
* S3 heart sound (gallop)
* Inc pulmonary A occlusion
49
nursing care with pulmonary edema
* Monitor V/S Q15 min
* Monitor I/O
* Monitor hemodynamic status: pulmonary wedge pressures, CO
* Check ABGs, electrolytes (esp K), SaO2, CXR
* Patent airway and suctioning
* Position in high fowler’s to dec preload
* Administer O2 using high flow rebreather mask
* Restrict fluids
* Monitor hourly urine output
50
meds used for pulmonary edema
* Rapid acting diuretics: furosemide, bumetanide
* Promote fluid excretion
* Morphine: dec SNS response and anxiety, promotes mild vasodilation
* Vasodilators: nitro, sodium nitroprusside
* Dec preload and afterload
* Inotropic agents: digoxin, dobutamine
* Improve CO
* antiHTN: ACE inhibitors, beta blockers
* Dec afterload
51
client education for pulmonary edema
* Provide emotional support for client
* Teach effective breathing
* Teach client to continue to take meds even if feeling better
* Teach ADRs
* Instruct to use low sodium diet and fluid restriction
* Measure weight daily
* Notify provider if gain of more than 2 lb in 1 day or 5 lb in 1 week
* Report any swelling of feet/ankles, SOB or angina
52
pericarditis and infective endocarditis
Inflammation related to the heart is an extended inflammatory response that often leads to destruction of healthy tissue
53
health promotion and disease prevention for cardiac inflammatory disorders
* Early tx of streptococcal infections can prevent rheumatic fever
* Prophylactic tx (including Abx for clients who have cardiac defects) can prevent infective endocarditis
* Influenza and pneumonia immunizations are important for all clients in order to dec incidence of myocarditis
54
risk factors for cardiac inflammatory disorders
* Congenital heart defect/cardiac anomalies
* IV substance use
* Heart valve replacement
* Immunosuppression
* Rheumatic fever
* School age children with long streptococcus infections
* Malnutrition
* Overcrowding
* Lower socioeconomic status
55
pericarditis and the expected findings
* inflammation of pericardium
* Commonly follows respiratory infection
* Can be due to a MI
* Findings:
* Chest pressure/pain aggravated by breathing (mainly inspiration), coughing, swallowing
* Pericardial friction rub auscultated at left lower sternal border
* SOB
* Relief of pain when sitting/leaning forward
56
infective endocarditis and the expected findings
* infection of endocardium due to staphylococci, streptococci, fungi, or other infectious organisms
* Most common in clients who have structural cardiac malformations, cardiac devices (pacemaker), prosthetic heart valves, IV substance use disorder
* Invasive procedures, like dental procedures, body piercing, and tattooing, can cause bacteremia, which can lead to infective endocarditis in at risk clients
* findings:
* Fever
* Flu like manifestations
* Murmur
* Petechiae (on the trunk and mucous membranes)
* Positive blood cultures
* Splinter hemorrhages (red streaks under the nail beds)
57
lab tests for cardiac inflammatory disorders
* Blood cultures: to detect a bacterial infection
* High WBC: bacterial infection
* Cardiac enzymes: pericarditis
* Elevated ESR and CRP: inflammation of the body
* Throat culture: to detect a streptococcal infection, which can lead to rheumatic fever
58
diagnostics for cardiac inflammatory disorders
* ECG: can detect heart block, which is associated with rheumatic fever or demonstrate ST segment elevation in almost all leads in the case of pericarditis
* Echocardiography: can reveal inflamed heart layers or pericardial effusion
59
nursing actions for cardiac inflammatory disorders
* Auscultate heart sounds: listen for murmur or friction rub
* Review ABGs, SaO2, and CXR
* Administer O2
* Monitor V/S: watch for fever
* Monitor ECG
* Monitor for cardiac tamponade and HF
* Obtain throat cultures to identify bacteria to be tx w/ abx
* Administer abx and antipyretics
* Assess pain and administer pain meds
* Encourage bed rest
60
what are the 4 types of meds used for cardiac inflammatory disorders?
* penicillin
* ibuprofen
* prednisone
* amphotericin B
61
penicillin to tx cardiac inflammatory disorders
* abx to tx infection
* Monitor for skin rash, hives, electrolyte and kidney levels
* Instruct clients to report skin rash or hives
* Med can cause GI distress
62
ibuprofen to tx cardiac inflammatory disorders
* NSAID for fever and inflammation
* Do not use if client has PUD
* Watch for signs of GI distress
* Monitor platelets and liver & kidney function levels
* Take with food
* Avoid alcohol
63
prednisone to tx cardiac inflammatory disorders
* glucocorticoid to tx inflammation
* Use in low doses
* Monitor BP, electrolytes, blood sugar
* May have impaired wound healing
* Take with food
* Do not d/c abruptly
* Report unexpected weight gain
64
amphotericin B to tx cardiac inflammatory disorders
* antifungal given to tx fungal infection
* Monitor liver and kidney fcn
* May cause GI distress
65
therapeutic procedures to treat pericarditis
* pericardiocentesis is the insertion of a needle into the pericardium to aspirate pericardial fluid
* Can be done in ED
* Nursing:
* Send fluid to lab for culture and sensitivity
* Monitor for recurrence of cardiac tamponade
66
therapeutic procedures to tx infective endocarditis
* valve debridement, draining abscess, and repairing congenital shunts
* Nursing: monitor for bleeding, infection, alteration in CO
67
client edu for cardiac inflammatory disorders
* Encourage client to rest
* Wash hands to prevent infection
* Avoid crowded areas
* Good oral hygiene
* Make sure client can administer IV abx
* Smoking cessation
* Prophylactic abx use before invasive dental procedures
* Care after discharge:
* Home health serves may be needed if client had surgery or needs IV abx
* Pharmaceutical services can supply IV supplies
68
complication of cardiac inflammatory disorder and the manifestations it yields
* Cardiac tamponade: can result from fluid accumulation in the pericardial sac
* Manifestations:
* Dyspnea
* Dizziness
* Report of tightness in the chest
* Increasing restlessness
* Pulsus paradoxus (dec of 10 mmHg or more in SBP during inspiration)
* Tachycardia
* Muffled heart sounds
* JVD
* Hemodynamic monitoring reveals intracardiac and pulmonary artery pressures similar and elevated
69
nursing actions for cardiac tamponade (as a complication of cardiac inflammatory disorders)
* Notify provider
* Administer IV fluids to combat hypoTN
* Obtain CXR or echocardiogram to confirm dx
* Prepare client for pericardiocentesis
* Monitor hemodynamic pressures
* Monitor heart rhythm as changes indicate improper needle placement
70
what is cardiac valve disease?
* Valve dz affects the efficiency of the heart as a pump and reduces stroke volume
* Overtime, the heart may remodel (hypertrophy) and HF may occur
* w/ age, fibrotic thickening occurs in the mitral and aortic valves
* The aorta is stiffer in older adults which inc SBP and stress on mitral valve
71
health promotion and dz prevention for valvular heart disease
* Prevent and tx bacterial infections
* Diet low in sodium and restrict fluids to prevent HF
* Control chronic DM, HTN, hypercholesterolemia
* Encourage inc activity and exercise to boost LDL
72
how can valvular disease be classified?
* Stenosis: narrowed opening and impedes blood moving forward
* insufficiency/improper closure: some blood flows backward
* Regurgitation
73
congenital vs. acquired valvular heart disease
* Congenital: can affect all 4 valves and cause either stenosis or insufficiency
* Acquired: 3 types:
* Degenerative dz: due to damage over time from mechanical stress, atherosclerosis, and HTN
* Most common in developed countries
* Rheumatic dz: gradual fibrotic changes, calcification of valve cusps
* Most common in developing countries
* Infective endocarditis: infectious organisms destroy the valve
* Streptococcal infections are a common cause
74
risk factors for valvular heart disease
* HTN
* Rheumatic fever: mitral stenosis and insufficiency
* Infective endocarditis
* Congenital malformations
* Marfan syndrome
* Older adults: causes are usually degenerative calcification and atherosclerosis, papillary muscle dysfunction, infective endocarditis
75
expected findings with valvular heart disease
* Clients who have valvular heart dz are often asymptomatic until late in dz
* Murmur: heard w/ turbulent blood flow
* Location of murmur and timing helps determine valve involved
* Left sided valve damage causes: inc pulmonary A pressure, left ventricular hypertrophy, & dec CO which cause orthopnea, paroxysmal nocturnal dyspnea (PND), and fatigue
76
findings associated with mitral stenosis
* apical diastolic murmur
* dyspnea on exertion
* orthopnea
* atrial fibrillation
* palpitations
* fatigue
* JVD
* pitting edema
* hemoptysis
* dry cough
* repeated respiratory infections
* PND
* hepatomegaly
77
findings associated with mitral insufficiency
* systolic murmur at the apex
* S3 sounds
* fatigue and weakness
* atrial fibrillation
* dyspnea on exertion
* orthopnea
* atypical chest pain
* palpitations
* JVD
* pitting edema
* crackles in lungs
* possible diminished lung sounds
* PND
* hepatomegaly
78
findings associated with aortic stenosis
* systolic murmur
* dyspnea on exertion
* S4 sounds
* angina
* syncope
* fatigue
* orthopnea
* PND
* narrowed pulse pressure
79
findings associated with aortic insufficiency
* diastolic murmur
* sinus tachycardia
* exertional dyspnea
* orthopnea
* palpitations
* fatigue
* nocturnal angina with diaphoresis
* widened pulse pressure
* bounding arterial pulse on palpation (Corrigan's pulse)
* elevated systolic and diminised diastolic pressures
* PND
80
diagnostic procedures with valvular heart disease
* CXR: shows chamber enlargement and pulmonary congestion
* 12 lead ECG: chamber hypertrophy
* Echocardiogram: shows chamber size, hypertrophy, specific valve dysfunction, ejection function, and amount of regurgitant flow
* Transesophageal echocardiography (TEE)
* Exercise tolerance testing/stress echocardiography: used to assess impact of the valve problem on cardiac functioning during stress
* Radionuclide studies: determine ejection fraction during activity and rest
* Angiography: used to evaluate the coronary arteries and degree of atherosclerosis
* Cardiac cath may be used as a diagnostic tool in valvular dz
81
nursing care with valvular heart disease
* Monitor current weight and note any changes
* Assess heart rhythm: can be irregular, bradycardic; assess for murmur
* Administer O2 and meds
* Hemodynamic monitoring, fluid and Na restrictions
82
what are the classes of meds used to tx valvular heart disease?
* diuretics
* afterload reducing agent
* inotropic agents
* anticoagulants
83
diuretics used to tx valvular heart dz
* used to tx HF by removing excessive ECF
* Nursing:
* Administer furosemide IV slow over 1-2 min
* Loop and thiazide diuretics can cause hypokalemia, and potassium supplement might be required
* Client edu:
* If taking loop/thiazide diuretics: ingest foods and drinks high in K (dried fruits, nuts, spinach, citrus fruits, bananas, potatoes
84
afterload reducing agents to tx valvular heart disease
* help the heart pump more easily by altering the resistance to contraction
* ACE inhibitors: enalapril, captopril, lisinopril
* ARBs: losartan, valsartan
* Beta blockers: metoprolol, carvedilol
* CCB: felodipine, nifedipine, amlodipine
* Vasodilators: hydralazine
* Nursing considerations: monitor clients taking ACE Inhibitors for first dose hypoTN
85
inotropic agents to tx valvular heart dz
* digoxin
* Used to inc contractility and thereby improve CO
* Client edu:
* If administering digoxin:
* Count pulse for 1 min before taking and hold dose if outside of 60-100 bpm
* Take at same time everyday
* Do not take at same time as antacids--\>separate by at least 2 hours
* Toxicity: fatigue, muscle weakness, confusion, visual changes, loss of appetite
86
anticoagulants to tx valvular heart dz
* used for clients with mechanical valve replacement, a fib, or severe left ventricle dysfunction
87
post surgery care for valvular heart dz
* post surgery care is similar to coronary artery bypass surgery--\>care for sternal incision, activity limited for 6 weeks, report fever
88
therapeutic procedures to tx valvular heart dz
* percutaneous balloon valvuloplasty
* valve replacement
* miscellaneous surgical mgmt
89
percutaneous balloon valvuloplasty to tx valvular heart dz
* can open aortic or mitral valve affected by stenosis
* Catheter is inserted thru the femoral artery and advanced to the heart
* Balloon is inflated at the stenotic lesion to open the fused commissures and improve leaflet mobility
90
valve replacement to tx valvular heart dz
* replacement of heart valves with mechanical xenograft (from other species), allografts (from cadavers), or autografts (formed from client’s pulmonic valve and a portion of the pulmonary A
* Can use open heart approach or minimally invasive surgery
* Requires lifelong anticoagulant therapy
* Tissue valves need to be replaced every 7-10 years
91
surgical management of valvular heart disease
* Other surgeries include chordae tendinae reconstruction, commissurotomy (relieve stenosis on leaflets), annuloplasty ring insertion (correct dilation of valve annulus by narrowing the opening), and leaflet repair
* Surgery is done when manifestations interfere with daily activities
92
client education for valvular heart disease
* Prophylactic Abx before invasive dental or respiratory procedure
* Weigh daily ad notify provider of 3 lb gain in 1 day or 5 lb gain in 1 week
* Plan rest periods in with activity
* Follow prescribed exercise program
* Avoid caffeine and alcohol
* Open wounds should be cleaned carefully and Abx ointment used
* Report fever immediately
* Petechial rash or SOB should be reported to HCP
* Avoid OTCs with alcohol, ephedrine, epinephrine which may cause dysrhythmias
* Teach S/S of HF
93
complications of valvular heart disease
* Heart Failure: inability of heart to maintain adequate circulation to meet tissue needs for O2 and nutrients
* Ineffective valves result in HF
* Nursing actions: monitor client’s HF class to gauge for surgical intervention
