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Flashcards in Day III Deck (93)
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1

what is HF?

  • 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

New York Heart Assoc’s functional classification scale for HF

  • 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

American College of Cardiology and AHA staging HF

  • 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

left sided heart failure

  • 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

right sided heart failure

  • results in inadequate right ventricle output and systemic venous congestion (peripheral edema)

6

health promotion and dz prevention for HF

  • Maintain exercise routine to remain physically active
  • Diet: low in sodium, fluid restrictions
  • Refrain from smoking
  • Follow med regimen

7

what are 2 risk factors for all types of heart failure?

  • 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

risk factors for left sided HF

  • HTN
  • Coronary artery dz, angina, MI
  • Valvular dz

9

risk factors for right sided HF

  • Left sided HF
  • Right ventricular MI
  • Pulmonary problems (COPD, pulmonary fibrosis)

10

risk factors for cardiomyopathy

 

  • Coronary artery dz
  • Infection or inflammation of the heart muscle
  • Various cancer tx
  • Prolonged alcohol use
  • Heredity

11

expected findings of left sided HF

  • 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

expected findings of right sided HF

  • 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

what is cardiomyopathy?

what are the 4 types?

  • 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

manifestations of cardiomyopathy

  • Fatigue, weakness
  • HF (left with dilated type & right with restrictive type)
  • Dysrhythmias (heart block)
  • S3 gallop
  • Cardiomegaly
  • Angina (hypertrophic type)

15

lab test for HF

  • 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

16

what are the diagnostic procedures for HF?

  • 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

explain hemodynamic monitoring to diagnose HF

  • 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

explain ultrasound to diagnose HF

  • 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%

19

explain transesophageal echocardiography (TEE) to diagnose HF

  • 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

explain CXR to diagnose HF

  • can reveal cardiomegaly and pleural effusions

21

nursing care involved with HF

  • 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

what are the classes of meds used to tx HF?

  • diuretics
  • afterload reducing agents
  • inotropic agents
  • beta blockers
  • vasodilators
  • human B type natriuretic peptides
  • anticoagulants

23

diuretics to tx HF

  • 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

afterload reducing agents to tx HF

  • 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