Exam 3 - Hypertension & Heart Failure Flashcards
(237 cards)
1
Q
Through which veins is deoxygenated blood from the body returned to the heart ?
A
The superior and inferior vena cava
2
Q
Where does deoxygenated blood get dumped after entering the superior and inferior vena cava’s ?
A
the right atrium
3
Q
Once deoxygenated is dumped into the right atrium, where does it flow next ?
A
The Right ventricle
4
Q
From the Right ventricle, where does the deoxygenated blood get pumped to next?
A
Into the pulmonary artery and out to the lungs to circulate and become oxygenated.
5
Q
Once the deoxygenated blood in the lungs circulates and becomes oxygenated, that freshly oxygenated blood then enters from both lungs into where ?
A
Enters through the pulmonary veins into the Left atrium
6
Q
From the left atrium, the newly oxygenated blood then flows to where next ?
A
Down into the left ventricle
7
Q
From the left ventricle, the oxygenated blood gets pumped to where next ?
A
Gets pumped up and out through the aorta to the body
8
Q
Where does oxygen exchange occur ?
A
Lungs !
9
Q
What cardiac valve is located between the R atrium and R ventricle ?
A
Tricuspid valve
10
Q
What cardiac valve is the last valve before blood enters into circulation ?
A
Aortic (semilunar) valve
11
Q
What cardiac valve is located between the L atrium and L ventricle ?
A
Mitral valve
12
Q
What are two major coronary arteries of the heart ?
A
- Right coronary artery
- Left coronary artery
13
Q
Both the Right coronary artery and the left coronary artery branch off into what ?
A
Smaller descending arteries
14
Q
What is the medical term for the Heart muscle ?
A
Myocardium
15
Q
The myocardium has its own what ?
A
Blood supply/circulation
16
Q
What supplies blood/circulation to the heart itself ?
A
The coronary arteries and veins
17
Q
Blockage of what coronary artery can result in serious defects in cardiac conduction, because it supplies the bundle of hiss, AV node, etc.
A
R coronary artery
18
Q
What is Systole defined as ?
A
Contraction of the myocardium
19
Q
What is Diastole defined as ?
A
Relaxation of the myocardium
20
Q
_______________ is the amount of blood pumped by each ventricle in 1 minute ?
A
Cardiac output
21
Q
What is the equation for determining the Cardiac Output (CO) ?
A
CO = SV x HR
- Cardiac output = stroke volume x Heart rate *
22
Q
What is the Cardiac index ?
A
CO divided by body surface area
23
Q
What is a normal cardiac output for an Adult at rest ?
A
4-8 Liters per minute
- 1 IV bag = 1L *
24
Q
_____________ is the volume of blood in the ventricles at the end of diastole ?
( the amount of blood in ventricles before the next contraction)
A
Preload
25
In what types of patients do we tend to see a higher incidence of preload ?
Patients with HTN & Hypervolemia
26
What is Contractility ?
How strong the muscles contract to provide movement of that fluid (preload fluid) ?
27
____________ is the peripheral resistance against which the left ventricle must pump ?
(How hard the left ventricle has to keep pumping to maintain circulation and cardiac output)
Afterload
28
Afterload is affected by what ?
- The size of the ventricle
- The wall tension
- Arterial BP
29
A principle of hemodynamics is that blood always goes where ?
Always goes to where there is less pressure
*If theres an area of high pressure, it will find areas of low pressure to fill it and even it out
30
A patient is receiving a drug that decreases afterload. To evaluate the effect of the drug, the nurse monitors the patient's ?
Blood pressure
31
What is Blood Pressure defined as ?
The Measurement of arterial blood pressure
32
What does MAP stand for ?
Mean Arterial Pressure
33
What MAP pressure is needed to perfuse vital organs ?
MAP > 60mmHg
34
What does a MAP of < 60mmHg mean ?
Means that theres not enough blood getting to the vital organs.
(Ex: Brain, Heart, Lungs, Kidneys, Liver, etc.)
* Don't want our vital organs to become ischemic *
35
What is ischemia ?
Happens when theres not enough blood flow or perfusion to vital organs
36
______ is one of the greatest risk factors for cardiovascular disease ?
Age
37
In the gerontologic population, what is the most common type of cardiovascular disease that we tend to see ?
CAD
38
What is the leading cause of death in those age 65 and older ?
Cardiovascular Disease
39
_____ alters the cardiovascular response to physical and emotional stress ?
Age
40
With the Gerontologic population, Heart valves become what ?
Thick and stiff
41
With the Gerontologic population, there is a frequent need for what ?
Pacemakers
42
Which population is less sensitive to B-andrenergic agonist drugs ?
Gerontologic population
43
What do B-andrenergic agonist drugs typically do ?
- Relax muscles of the airway
| - Widen airways and make it easier to breathe
44
In the Gerontologic population, what is a common cause of the heart valves becoming thick and stiff ?
- Lipid accumulation
| Fibrosis can occur of the valves also
45
In the Gerontologic population, There is an ____________ in SBP and a ___________ or ___________________ in DBP ?
- INCREASE in SBP
- DECREASE OR NO CHANGE in DBP
* The vessels start to loose elasticity with age *
46
Why is there a frequent need for pace makers in the Gerontologic population ?
Older individuals are more at risk for disrythmias because they just don't have those natural SA nodes firing
47
In regards to heart valves becoming thick and stiff in the gerontologic population, what happens if the heart valves aren't working properly and don't have good closure ?
Can result in the regurgitation of blood. So we see a back flow of blood if we don't have a well closed valve.
* this is when we start hearing heart murmurs
48
In regards to the "Lub-dub" sound of the heart; which sound is S1 ?
Lub
49
In regards to the "Lub-dub" sound of the heart; Which sound is S2 ?
Dub
50
Which heart sound is the closure of the tricuspid and mitral valves (beginning of systole) ?
S1
51
Which heart sound is the closure of the aortic and pulmonic valves (beginning of diastole) ?
S2
52
On an ECG, what does the P wave indicate ?
Contraction of the atria
53
On an ECG, what does the QRS spike indicate ?
Contraction of the ventricle
54
On an ECG, what does the T wave indicate ?
Repolarization of the cardiac cycle
55
What are examples of Noninvasive studies of the Cardiovascular system ?
- Blood studies
- Chest x-ray
- Electrocardiogram
- Echocardiogram
- Stress test
56
What Lab is the most sensitive for cardiac damage ?
Troponin !
57
What labs fall under "Cardiac enzymes" ?
- Troponin
- CK-MB
- hs, CRP
- BNP
- Lipids
58
What does the lab CK-MB stand for ?
Creatinine Kinase
59
What cardiac enzyme, is found primarily in heart muscles ?
CK-MB
* Not as specific as Troponin, as it can also be found in the brain, skeletal muscles, and heart*
60
What cardiac enzyme can also be found in the brain, skeletal muscle, and heart ?
CK-MB
61
What does the cardiac enzyme, CRP stand for ?
C-reactive protein
62
What cardiac enzyme (lab) indicates inflammation ?
CRP
* it can be an indicator of cardiac damage, BUT its not specific to just cardiac muscle. If theres inflammation anywhere else in the body, it can also rise
63
What does the cardiac enzyme/lab BNP stand for ?
Brain Naturetic Peptide
64
What lab should be looked at when assessing for Heart Failure ?
BNP
65
What lab should you look at if your patient is in fluid overload or HF ?
BNP
66
What Noninvasive test will give rhythm information ?
Electrocardiogram
67
What Noninvasive test gives us pictures of the heart ?
Echocardiogram
68
What Noninvasive test is the test of choice to find out what an injection fraction is for a patient ?
Echocardiogram
69
Which Noninvasive test is used to evaluate heart response to activity ?
Stress Test
70
What are examples of Invasive diagnostic studies for the cardiovascular system ?
- Transesophageal echocardiogram (TEE test)
- Cardiac catheterization and coronary angiography
- Electrophysiology study
71
What invasive study uses a scope to go down the throat, bypassing the lungs and ribs and ultimately gets a better picture of the heart and whats going on with it ?
Transesophageal echocardiogram (TEE)
72
What invasive cardiovascular test, requires the Pt. to be sedated ?
Transesophageal echocardiogram (TEE test)
73
what invasive cardiovascular study, involves a catheter getting inserted into the heart via a major artery (ex: femoral) to get a better look at the heart ?
Cardiac catheterization and coronary angiography
74
What invasive cardiovascular study involves a catheter(s) getting inserted into the jugular or femoral vein, and entering in on the R side of the heart, and ultimately records electrical activity within the heart ?
Electrophysiology study
75
NCLEX Question: A pt. returns to the cardiac observation area following a cardiac catheterization with coronary angiography. Which of the following assessments would require immediate action by the nurse ?
a. ) Pedal pulses are 2+ bilaterally
b. ) Apical pulse is 54bpm
c. ) MAP is 72mmHg
d. ) Chest pain rate 3/10
d. ) Chest pain rate 3/10
* May indicate a myocardial ischemia is present with partial or total occlusion of the coronary artery.
* No matter how minor the chest pain, you will always get a 12 lead EKG, administer morphine and nitroglycerin, and we would notify the health care provider immediately
76
What are 2 safety precautions we want to follow with coronary artery angiogram(s) ?
- Always want to ask our pt's. if their allergic to shellfish/iodine
- Hold Metformin for 48 hrs.
77
With patients who are on Metformin and having a coronary artery angiogram, why do you want to hold the Metformin for 48 hrs ?
Both the dye and the metformin are tough on the kidneys.
* We don't want to tax the kidneys more than we need to
78
Cardiac cath's use what type of dye ?
radio-opaque dye
79
Radio-opaque dye has a cross allergy to what ?
Shellfish/iodine
80
Persons > 50yrs with a _______ of > __________mmHg, are more at risk for CVD than diastolic ?
SBP of > 140mmHg
81
Risk for CVD, beginning at 115/75 does what with each increment of 20/10 ?
Doubles
82
Persons with a SBP of ___ to ___ or a DBP of ___ to ___ should be considered as prehypertensive & require health-promoting changes ?
SBP of 120 to 139
| DBP of 80 to 89
83
What is the Definition of Hypertension ?
```
Persistent elevation of
- SBP greater than or equal to 140mmHg
OR
- DBP greater than or equal to 90mmHg
OR
- Current use of Antihypertensive medication(s)
```
84
What is a Normal BP classified as ?
- SBP < 120 & DBP < 80mmHg
85
What is Prehypertension classified as ?
- SBP 120-139mmHg OR DBP 80-89mmHg
86
What classifies Stage 1 Hypertension ?
- SBP 140-159 OR DBP 90-99mmHg
87
What classifies Stage 2 Hypertension ?
- SBP greater than or equal to 160mmHg OR DBP greater than or equal to 100mmHg
88
What factors influence Blood Pressure ?
- Cardiac output
- Systemic Vascular Resistance
BP = Cardiac Output x Systemic Vascular Resistance
89
______________________ is the force opposing the movement of blood within the blood vessels
Systemic Vascular Resistance
90
What is Isolated systolic hypertension defined as ?
SBP > 140mmHg with DBP <90mmHg
91
Which Subtype of Blood Pressure classification is more common in older adults ?
Isolated systolic hypertension
92
What subtype of Blood Pressure classification is from sclerotic arteries that do not collapse when the cuff id fully inflated ?
Pseudohypertension
93
Primary hypertension is also known as ?
Essential or idiopathic hypertension
94
Which type of Hypertension is most common (primary or secondary) ?
Primary Hypertension
95
What is Primary Hypertension defined as ?
Elevated BP WITHOUT an identified cause
96
Primary hypertension makes up _____% to ______% of all cases ?
90% to 95%
97
What are contributing factors to Primary hypertension ?
- Increase SNS activity
- Increase sodium retaining hormones and vasoconstrictors
- DM
- > ideal body weight
- Increased sodium intake
- Excessive alcohol intake
98
What is Secondary hypertension defined as ?
Elevated BP WITH a specific cause
* A lot of the time it has to do with fluid overload, where we have to much fluid running through our blood stream.
99
Secondary hypertension makes up what % of adult cases ?
5% to 10% of adult cases
100
What are contributing factors for Secondary Hypertension ?
- Coarctation of aorta
- Renal disease
- Endocrine disorders
- Neurologic disorders
- Cirrhosis
- Sleep apnea
101
Which type of Hypertension will typically go away if you treat the contributing factors ?
Secondary Hypertension !
102
What are the Overall risk factors for Primary Hypertension ?
- Age
- Alcohol
- Cigarette smoking
- DM
- Elevated serum lipids
- Excess dietary sodium
- Gender
- Family history
- Obesity
- Ethnicity
- Sedentary lifestyle
- Socioeconomic status
- Stress
103
What is referred to as the "silent killer" because patients are frequently asymptomatic until target organ disease occurs ?
Hypertension
104
Symptoms of Hypertension are often secondary to target organ disease and can include ?
- Fatigue
- Reduced activity tolerance
- Dizziness
- Palpitations
- Angina
- Dyspnea
105
Most people DO NOT have what if they are Hypertensive ?
DO NOT have symptoms
106
In regards to Hypertension complications, Target organ disease occurs most frequently In the what ?
Heart
| CAD, Left ventricular hypertrophy, HF
107
What are examples of Hypertension Complications ?
- Target Organ disease (Heart most common)
- Cerebrovascular disease (Stroke)
- Peripheral vascular disease
- Nephrosclerosis
- Retinal damage
108
Why is a Stroke a complication of Hypertension ?
If Hypertension gets so high , it can result in a hemorrhagic stroke. Essentially the pressure in the brain gets so high that the vessels in the brain actually burst
109
To avoid Retinal damage from Hypertension, what can we as nurses do ?
Recommend primary prevention, such as routine eye exams
110
What are some Diagnostic Studies we can use to diagnose Hypertension ?
- Get a good H&P
- Bilateral BP measurement
- Use appropriately sized cuff to ensure accurate readings
- Obtain at least two measurements
111
When obtaining a Pt's BP to diagnose Hypertension, Which arm should you always use for subsequent measurements ?
Always use the arm with the higher reading for subsequent measurements !
112
BP is ___________ in the Morning, and ___________ at night ?
Highest in the morning & Lowest at night
113
How should a patient be positioned to get a good BP reading ?
- Seated quietly for 5 minutes in a chair
- Feet on floor
- Arms supported at heart level
114
What do you need to diagnose Hypertension ?
Need 2 or more readings on 2 separate occasions unless target organ disease is present
115
What should you do if a Pt. has "white coat hypertension" but you need to rule out true Hypertension ?
Have the Pt. keep a log of their BP's outside of the office
116
What are labs that should be looked at if trying to diagnose Hypertension ?
- Electrolytes
- Glucose
- BUN
- Creatinine
- lipid profile
117
What Labs are especially important to monitor when trying to diagnose Hypertension ?
- BUN and Creatinine
118
Why are BUN and Creatinine important labs to monitor when trying to identify Hypertension ?
* Because the Kidneys are a Target Organ *
119
Why would the Creatinine specifically, be an important lab to look at in regards to Hypertension ?
- Would be a great indicator to see if something is going on with the kidneys !
- An increase, especially in creatinine, may indicate organ involvement !
120
What is a normal Creatinine level ?
0.6 - 1.2
121
What are some Lifestyle modifications that can be implemented for Hypertension ?
- Weight reduction
- DASH diet
- Sodium reduction
- Physical activity (at least 30min, most days of week)
- Avoidance of tobacco products
- Psychosocial risk factors
- Moderation of Alcohol consumption
122
What does DASH stand for ?
Dietary Approaches to Stop Hypertension
123
For patients with Hypertension what is the hardest change to make ?
Lifestyle modifications
- Becuause it requires change on their part, as opposed to just taking medications
124
A weight loss of 22lbs may decrease a patients BP by what (number) ?
May decrease SBP by approx 5-20mmHg
125
What is the recommended amount of Alcohol consumption for Men & Women ?
Men : no more than 2 drinks/day
| Women: no more than 1 drink/day
126
In regards to Hypertension, ALL people need what ?
- Lifestyle Modifications
| and most people also need drug therapy for control. But you STILL NEED LIFESTYLE MODIFICATIONS !
127
in regards to Drug Therapy, most patients with hypertension will require what ?
2 or more antihypertensive medications to achieve goal BP
| <140/90 or <130/80 for patients with diabetes or CKD
128
What are classifications of drugs used to treat hypertension ?
- Diuretics
- Adrenergic inhibitors
- Direct vasodilators
- ACE inhibitors
- Angiotension II receptor blockers
- Calcium channel blockers
129
How do Diuretics work to treat hypertension ?
promote sodium and water excretion
130
What drug classification used to treat hypertension, is not recommended to take at night ?
Diuretics
131
__________ drug classification used to treat hypertension, can lower K+ levels (and possibly require supplementation) ?
Diuretics
132
Adrenergic inhibitors, are also known as what ?
Beta blockers
133
With Adrenergic inhibitors, what do you need to monitor ?
BP & HR
| may need to hold, if BP or HR is low
134
What are examples of Direct Vasodilators ?
- Hydrolozine
| - Nitroglycerin
135
What is the shortened name for Angiotension-converting enzyme inhibitors ?
ACE inhibitors
136
ACE inhibitors can cause _____ retention ? so you need to monitor lab work
K+ retention
137
What drug classification are medications that end in "prils" ? (Ex: Lisinopril, Analapril, etc)
ACE inhibitors
138
When starting a new medication, and in older adults, what do you want to monitor for ?
Orthostatic Hypotension
139
What is the #1 side effect that we see from ACE inhibitors ?
A hacking cough
140
What is an example of a loop diuretic ?
Lasix
141
With loop diuretics like Lasix, what do you want to monitor ?
K+ levels
142
Many side effects of Hypertension drug therapy tens to do what ?
Many side effects diminish over time
143
What are important patient teaching points for Hypertension ?
- Its a life-long medication! NEED TO TAKE THEM EVERYDAY !
- Do not stop or adjust meds on own (abruptly stopping meds can cause withdrawl symptoms)
- Ways to decrease orthostatic hypotension (change positions slowly!)
- Do not double up on missed doses
- Side effects of meds often diminish with time
144
Whats a common cause of Orthostatic Hypotension ?
Dehydration
145
When teaching about Hypertension what should you instruct your patient to avoid ?
Avoid hot baths (vasodilates), alcohol (vasodilates), and strenuous exercise 3hrs after medication
(because you might fall into a situation where you vasodilate so much that now your Hypotensive)
146
What is a Hypertensive Crisis defined as ?
A severe increase in BP (>180/110)
147
Hypertensive Crosses often occur in patients with a history of what ?
A history of HTN who have failed to comply with medications OR pt's who have been undermedicated
148
Those with a history of HTN can tolerate an _________ BP better ?
Increased
149
What is Rebound Hypertension ?
Occurs when you abruptly stop medications or lower the dose of the drug.
- The body natural response is to rebound with a really high BP, which can lead a patient into a hypertensive crisis
150
What are Risk Factors that can lead to a Hypertensive Crisis ?
- Rebound Hypertension
- Drug use
- Head injury
- Preeclampsia
151
Hypertensive Urgency is defined as what ?
High BP, but NO target organ damage
152
What is Orthostatic Hypotension defined as ?
A decrease of 20mmHg in SBP (& the DBP will decrease as well) & an increase in the HR of 20bpm
153
Essentially a positive orthostatic hypotension, is characterized by what ?
A decrease in BP & increase in HR
154
Hypertensive Emergency is defined as what ?
Evidence of acute target organ damage
| hypertensive encephelopathy,(HA, N/V, seizures, coma), Cerebral hemorrhag, aortic dissection, MI, HF
155
What does a Hypertensive emergency require ?
Requires hospitalization, IV antihypertensive drugs, and ICU monitoring
156
In regards to a Hypertensive emergency, ____________ are more important to determine severity and management than the specific BP value ?
Symptoms
157
What is an aortic dissection ?
a break or split in the aorta
158
In regards to a Hypertensive emergency, anybody who is displaying the signs and symptoms will be what ?
will be the FIRST PRIORITY !
Example:
Pt. in room A: has a BP of 190/110, but is asymptomatic
Pt. in room B: has a BP of 180/110, but is having chest pain, or a really bad headache.
-----> Pt. in room B, IS THE FIRST PRIORITY !
159
Treatment for a Hypertensive Crisis, focuses on what ?
Decreasing the MAP by no more than 25% within minutes to 1 hour
- want to lower it quickly but not to quickly. Going to fast will throw off the pt's hemodynamic balance
160
In regards to Tx for a Hypertensive emergency, lowering the BP too much, may decrease what ?
May decrease cerebral, coronary, or renal perfusion and could cause a stroke, MI, or renal failure
161
_____________________ is an abnormal condition involving impaired cardiac pumping/filling ?
Heart Failure
162
In what condition is the heart unable to produce an adequate cardiac output (CO) to meet metabolic needs ?
Heart Failure
163
HF is associated with numerous types of cardiovascular disease, particularly what ?
- Long-standing Hypertension
- CAD
- MI
164
what is the most common reason for hospitalizations in adults >65 years old ?
Heart Failure
- progressive disease that has an increased risk for Re-admission
165
What is the aim of HF ?
EDUCATION !
| every pt. admitted with HF, gets a packet of information before discharge, in the hospital setting
166
What are Primary Risk Factors of HF ?
- CAD
| - HTN
167
What are contributing risk factors of HF ?
- Advanced age
- Diabetes
- Tobacco use
- Obesity
- High serum cholesterol
168
What are the 2 classifications/subgroups of HF ?
- Primary
| - Precipitating
169
What subgroup of HF is "direct" (resulting from MI< HTN, Congenital, Cardiomyopathy, Valve disorders, etc) ?
Primary HF
170
What subgroup of HF is due from "indirect measures" (anemia, infection, dysrhythmia, nutritional deficiencies, etc.) ?
Precipitating HF
171
Left sided HF has lots of _____________ issues ?
Respiratory
172
Which type of HF is the most common ? (left sided or Right sided?)
Left-sided
173
Left sided HF results from what type of conditions ?
- MI
- CAD
- HTN
174
Left-sided HF results from what (pathophys) ?
Backup of blood into the L atrium and pulmonary veins. The next site of overflow will be into the Lungs! --> resulting in Pulmonary congestion
175
What is the primary manifestation of Left-sided HF ?
Pulmonary congestion
176
Right-sided HF results from what ?
- Left-sided HF (?? don't really understand hoe??)
- Cor pulmonale
- Right ventricular MI
177
What causes Right-sided HF (pathophys) ?
Backup of blood into the right atrium and venous systemic circulation (AKA: superior and inferior vena cavas) --> resulting in swelling and edema systemically
178
What are manifestations of Right-sided HF ?
- JVD
- Hepatomegaly (enlarged liver)
- Splenomegaly
- Vascular congestion of GI tract
- Peripheral edema
* essentially they all result in: swelling and edema systemically
179
What is a normal EF (ejection fraction) ?
55% - 60%
180
What is the Hallmark finding of Systolic failure ?
Decreased ability for the ventricles to pump. Seen in a decrease in the EF
181
What is Systolic failure caused by?
- impaired contractile function (ex: MI)
- Increased after load (ex: Hypertension)
- Cardiomyopathy
- Mechanical abnormalities (ex: valve disease)
182
__________ failure, results in an impaired ability of the ventricles to relax and fill during diastole, resulting in decreased SV (stroke volume) and CO (cardiac output)?
Diastolic failure
183
What type of failure (Systolic or Diastolic) has a NORMAL EF ?
Diastolic failure
184
Diagnosis of Diastolic failure is based on what ?
- presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, and normal EF
185
What is the Hallmark finding of Diastolic failure ?
Decreased ability of the ventricles to pump, resulting in a decrease in the EF fraction
186
Mixed Systolic and Diastolic failure is seen in disease states such as what ?
Dilated Cardiomyopathy (DCM)
187
What is Biventricular Failure ?
Both ventricles may be dilated and have poor filling and emptying capacity
188
In Systolic failure, the typical EF is what ?
Typically have an EF less than 45%
189
What type of failure (systolic, diastolic, or mixed) has poor EFs (<35%) ?
Mixed systolic and diastolic failure
190
Are dilated or Hypertrophied heart chambers a good or bad thing ?
Neither of the two are good! (bad bad bad!! DONT WANT!)
191
What is another term for Dilated heart chambers ?
Enlarged ventricles
192
What is another term for Hypertrophied Heart chambers ?
Thickened heart muscle
193
Dilated & Hypertrophied Heart Chambers leads to what ?
- poor contractility
- higher O2 needs
- poor coronary artery circulation
- RISK FOR: Ventricular Dysrhythmias
194
What lab do you look at for HF or suspected HF ?
BNP (Brain Natriuretic Peptide)
195
An elevated BPN > 100 = ?
sign of HF
196
What is the most important thing to monitor for accurate HF information ?
Weight changes !
197
Clinical Manifestations such as:
- Fatigue
- Dyspnea
- Cough
- Tachycardia
- Edema
- Nocturia
- Skin changes
- Behavioral changes
- Chest pain
- weight changes
Are associated with what disease ?
Chronic Heart Failure
198
What type of HF results when compensatory mechanisms to maintain CO can no longer keep up, and inadequate tissue perfusion results ?
Acute Decompensated Heart Failure (ADHF)
199
What is a symptom that is SPECIFIC to ADHF ?
Pink-frothy sputum
* tell tale, unique sign of Pulmonary Edema*
200
Symptoms such as:
- Breath sounds: crackles, wheezes, rhonci
- Pink-frothy sputum,
- Orthopnea
- Dyspnea, tachycardia
- Use of accessory muslces
- Cyanosis
- Tachycardia
- Restlessness, confusion, decreased memory
- Chest pain (angina)
- Anorexia, nausea
- Cool & clay skin
Are associated with what type of HF ?
Acute Decompensated Heart Failure (ADHF)
201
In regards to a Pt's position in bed, how should thy be positioned in the management of ADHF ?
High Fowlers position
* Always raise the HOB right away ! *
202
Why should pt's with ADHF have continuous ECG monitoring ?
Due to Dysrhythmias
203
What type of Noninvasive ventilatory support is used in the management of ADHF ?
BiPAP
204
What type of medications are used the Management of ADHF ?
- Morphine sulfate (decreases pulmonary congestion)
- IV lasix
- IV nitro (as vasodilator)
- IV B-andrenergic agonists (ex: dopamine, dobutamine, levophed)
205
What is the most common dysrhythmia ?
A fib
206
__________ promotes thrombus/embolus formation, increasing the risk for stroke ?
A fib
207
What is pleural effusion ?
Fluid building up in the plural cavity
208
What does pleural effusion do & cause ?
What does it do: Puts pressure on the lungs
| What does it cause: causes chest pain, etc.
209
HF can lead to severe _________________ ?
Hepatomegaly (especially with RV failure)
- Fibrosis and cirrhosis can develop over time
210
What are complications of HF ?
- Pleural effusion
- A fib
- High risk for fatal dysrhythmias
- Can lead to sever heaptomegaly
- Renal insufficiency or failure
211
In regards to HF complications, what are examples of fatal dysrhythmias ?
- Sudden cardiac death
| - ventricular tachycardia
212
What is the main treatment goals for Chronic HF ?
- Treat the underlying cause and contributing factors
- Maximize CO
- Provide treatment to alleviate symptoms
- Preserve target organ damage (heart, liver, brain, kidneys, etc.)
- O2 administration
- Physical and emotional stress
213
What is the primary drug of choice for blocking the RAAS system ?
ACE inhibitors ("pails")
214
In regards to HF, What class of drugs are used for patients who can't tolerate ACE inhibitors ?
Angiotensin II receptor blockers (ARBs)
215
________ - Cause vasodilation by acting directly on the smooth muscle of the vessel wall ?
Nitrates
216
What class of drugs, block the negative effects of the SNS on the failing heart ?
Adrenergic blockers ("lols")
217
What vitals MUST you monitor with Beta Blockers ?
BP & HR
218
What is a normal potassium (K+) range ?
3.5 - 5
219
What is a normal sodium (Na+) range ?
135 - 145
220
What do Thiazide diuretics and loop diuretics do ?
Decreases fluid build up, venous return, and preload
221
With Thiazide diuretics and loop diuretics what do you want to monitor for (lab) ?
Monitor for K+ depletion
222
What is another name for the drug Digitalis ?
Digoxin
223
What Medication, increases the force of contraction and decreases the conduction speed within the heart to slow the HR, allowing for more complete emptying of the ventricles ?
Digitalis (Digoxin)
224
With the drug Digoxin, what VS MUST you monitor ?
HR !
225
With the drug Digoxin, what do you need to monitor for ?
Digoxin toxicity !
226
With the drug Digoxin, you need routine _______ ?
Labs
227
What are S/S of Digoxin toxicity ?
- N/V
- "yellow vision"
- blurred vision
- dysrhythmias
- fatigue
- drowsiness
- HA
228
What is the most common cause of Digoxin toxicity ?
Hypokalemia from potassium-depleting diuretics
229
What is an important teaching point regarding medication use for HF ?
* Medications will be lifelong ! & they need to be taken everyday !
230
In regards to Medication patient teaching for HF, what should pt in regards to taking the pulse rate ?
Take for a full minute
231
What kind of diet is recommended for patients with HF ?
```
DASH diet (Dietary approaches to stop hypertension)
&
Reduce sodium intake
```
232
What is the most clear indication of how well HF is being managed ?
Daily Weights !
- same time & same clothing each day
233
With HF, what weight changes should be reported to the HCP ?
- A weight gain of 3lbs over 2 days
OR
- A weight gain of 3 to 5lbs over a week
234
Why is it important to teach about Sodium restrictions to patients with HF ?
Helps to control fluid overload
235
For pt's with HF, what Is Sodium usually restricted to per day ?
2.5g
| such as a cardiac diet
236
What is the primary complication of Cardiac Transplantation ? and what is it followed by ?
- Primary complication = Infection
| - Followed by = Acute rejection, in the first year after transplantation
237
With cardiac transplantation, what are the major causes of death after the first year?
- Malignancy (especially Lymphoma)
&
- Coronary artery vasculopathy
