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Nursing 210 > Exam 4: heart failure > Flashcards

Exam 4: heart failure Flashcards

(64 cards)

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1
Q

what is heart failure?

A
  • a cardiovascular condition

- heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body’s tissues

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2
Q

how is heart failure characterized?

A
  • left ventricular dysfunction
  • reduced exercise tolerance
  • diminished quality of life
  • shortened life expectancy
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3
Q

what are the 7 risk factors of heart failure?

A
  • CAD
  • advancing age
  • HTN
  • DM
  • tobacco use
  • obesity
  • high cholesterol levels
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4
Q

what is the etiology of heart failure?

A

any interference with the normal mechanisms regulating cardiac output

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5
Q

what are the 4 mechanisms that regulate cardiac output?

A
  • preload
  • afterload
  • myocardial contractility
  • heart rate
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6
Q

what are the 9 precipitating factors of heart failure?

A
  • anemia
  • infection
  • thyrotoxicosis
  • hypothyroidism
  • arrhythmias
  • bacterial endocarditis
  • pulmonary disease
  • nutritional deficiencies
  • hypervolemia
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7
Q

what is systolic failure? what is this aka? what does this cause?

A
  • a defect in the ability of the cardiac myofibrils to shorten
  • HFeEF
  • causes a decrease in the muscles ability to contract (pump)
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8
Q

how is systolic failure characterized? who experiences this more often?

A

low forward blood volume

men

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9
Q

what are the 4 causes of systolic failure?

A
  • impaired contractile function
  • increased afterload
  • cardiomyopathy
  • mechanical abnormalities
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10
Q

how is diastolic failure characterized? what is it aka? who experiences this more often?

A
  • high filling pressures
  • venous engorgement in both pulmonary and systemic systems
  • HFpEF (heart failure with preserved ejection fraction
  • women
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11
Q

how is mixed failure characterized?

A
  • low blood pressure
  • low CO
  • poor renal perfusion
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12
Q

what are the 5 compensatory mechanism for heart failure?

A
  • SNS activation
  • neurohormonal response
  • ventricular remodeling
  • dilation/hypertrophy
  • natriuretic petides
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13
Q

how does SNS activation compensate for heart failure? when does this happen?

A
  • release of catecholamines
  • increase heart rate
  • increase myocardial contractility
  • peripheral vasoconstriction
  • first thing that happens
  • works but after awhile, the heart overworks itself and it ends up detrimental
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14
Q

how do neurohormonal responses compensate for heart failure?

A
  • RAAS
  • low CO causes a decrease in cerebral perfusion pressure, ADH is released
  • arterial vasoconstriction
  • increased contractility
  • hypertrophy
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15
Q

what effect does a pro-inflammatory cytokines release have on the heart?

A
  • depressed cardiac function

- over time, cardiac wasting, muscle myopathy, and fatigue

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16
Q

what triggers natriuretic peptides to be released? what effect do these have on the heart?

A
  • released in response to atrial volume and ventricular pressure
  • promotes venous and arterial vasodilation
  • enhances diuresis
  • blocks effects of RAAS
  • may have inflammatory effects
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17
Q

what does nitrous oxide do for the heart?

A

relaxes arterial smooth muscle, resulting in vasodilation and decreased afterload

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18
Q

what is left sided heart failure?

A

increased blood in the left atrium and pulmonary vein

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19
Q

what is right sided heart failure?

A

back flow of blood into the right atria and venous circulation

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20
Q

s/s of left sided heart failure?

A 
fatigue
paroxysmal noturnal dyspnea
orthopnea  
tachycardia
restlessness
confusion
exertional dyspnea
cyanosis
increased pulmonary capillary wedge pressure
pulmonary congestion
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21
Q

s/s of right sided heart failure?

A 
may be secondary
distended jugular veins 
anorexia 
GI distress
weight gain
dependent edema
fatigue
hepatomegaly
splenomegaly 
increased peripheral venous pressure 
ascites
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22
Q

s/s of pulmonary congestion?

A 
cough
crackles
wheezing
bloody sputum
tachypnea
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23
Q

s/s pf acute decompensated HF?

A 
fatigue
dyspnea
tachycardia
edema
nocturia
skin changes
behavior changes
chest pains 
weight changes
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24
Q

how many classes of persons with HF are there?

A

4

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25
at diagnosis of heart failure, the pt knows that they have what percent chance of being alive in 5 years?
50%
26
what is HF preferred over CHF?
not everyone has congestion
27
which two risk factors of heart failure are the best indicators?
CAD | age
28
what is cardiac output?
CO=SVxHR
29
what is preload?
volume of blood
30
what is afterload?
pressure against the pumping blood
31
what is the eject fraction (EF)?
% of blood in the ventricle ejected with every heart beat
32
what is a normal EF?
55-60%
33
what is HFrEF?
heart failure with reduced ejection fraction | systolic failure
34
what is the hallmark of systolic failure?
decreased left ventricular ejection fraction
35
who is at highest risk for diastolic failure?
women | diabetics
36
what is the biggest risk factor for diastolic failure?
hypertension
37
what is the EF of mixed heart failure?
< 35%
38
what are the positive compensatory mechanisms?
natriuretic peptides | nitrous oxide release
39
what kind of a problem is HF?
a neurohormonal problem
40
does impaired gas exchange and decreased O2 indicate left or right sided heart failure?
left sided
41
how should the nurse auscultate for crackles?
on each lobe 3 on right, 2 on left start in the front
42
which clinical manifestations indicate HF? a. orthopnea b. dyspnea c. paroxysmal nocturnal dyspnea d. crackles/rales
a, b, c, d
43
what is orthopnea? as a nurse, what question may you ask a pt?
difficulty breathing when laying down | ask pt how many pillows they sleep with at night
44
what is the earliest symptom of chronic heart failure? what often comes with it?
fatigue | dyspnea
45
how many times does one with nocturia urinate during the night?
6-8 times
46
what skin changes come from heart failure?
dusty skin absent pulses brown discoloration
47
what causes behavior changes r/t heart failure? c/m of these behavior changes?
hypoxemia | confusion, decreased memory, anxiety, depression
48
what does a heart failure pt's weight change at the end of life?
pt may lose a lot of weight right before death
49
what is class 1 HF?
no limitation of physical activity | ordinary physical activity doesn't cause symptoms of HF
50
what is class 2 HF?
slight limitation of physical activity | comfortable at rest, but ordinary activity results in symptoms of HF
51
what is class 3 HF?
marked limitation of physical activity | comfortable at rest, but less than ordinary activity causes symptoms of HF
52
what is class 4 HF?
unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest
53
what are the 6 diagnostic studies used for HF?
``` physical exam chest x-ray ECG BNP echocardiogram cardiac catheterization ```
54
which 2 diagnostic tests are most helpful for HF? which is the best?
BNP (best) | echocardiogram
55
what does an x-ray show us that is helpful for x-ray?
fluid in lungs | size of heart
56
what number for BNP is diagnostic of HF?
over 100
57
what race has a higher incidence of HF, develop HF at a younger age, and experience higher mortality rates related to HF?
African Americans
58
what race may experience more ACE inhibitor related angioedema
African Americans
59
what medication is approved only for treatment of HF in African Americans?
Isosorbide dinitrate/hydralazine
60
what race has a high risk (15-50%) for ACE inhibitor related cough
Asians
61
what is the most common cause of right sided HF
left sided HF
62
5 complications of heart failure
``` pleural effusion dysrhythmias left ventricular thrombus hepatomegaly renal failure ```
63
what is a normal pulmonary artery wedge pressure (PAWP)
8-12 mmHg
64
how high can someone with ADHF's PAWP level be
as high as 30 mmHg

Nursing 210 (12 decks)

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