Heart Failure

Question 1

definition of heart failure

Answer 1

Inadequate cardiac output and oxygen delivery, caused by the inability of the heart to pump efficiently or to fill adequately

Question 2

what is the most common medicare diagnosis and why

Answer 2

HF
age plays a role

Question 3

what is ejection fraction

Answer 3

percentage of blood in the LV that makes it out of LV with each heartbeat

Question 4

normal ejection fraction

Answer 4

60-70%

Question 5

what is preload?

Answer 5

VOLUME of blood entering the heart

Question 6

what is afterload?

Answer 6

RESISTANCE heart has to overcome to get blood out of the heart

Question 7

what is contractility

Answer 7

force from heart muscle – how hard the heart can pump

Question 8

purpose of inotropic medications

Answer 8

increase the contractility of the heart (digoxin, BB)

Question 9

what is the cardiac output

Answer 9

amount of blood volume pumped per minute

Question 10

what is stoke volume

Answer 10

amount of blood pumped out of the ventricle with each beat or contraction

Question 11

how do you calculate cardiac output

Answer 11

CO = SV x HR

Question 12

what does starling’s law say

Answer 12

-more volume = more stretched heart is the harder it can contract
-Decreased stroke volume and decreased CO begin compensatory mechanisms

Question 13

compensatory mechanisms for decreased SV and CO

Answer 13

SNS activates
RAAS activates
B-type natriuretic peptide release
Structural changes occur

Question 14

peptide released when ventricle is filled with too much fluid and stretches – tries to get body to diureis fluid

Answer 14

B-type natriuretic peptide

Question 15

possible causes of heart failure

Answer 15

Uncontrolled HTN!!!
Recreational drug use
Infections of the heart
Valvular disorders
Arrhythmias (a fib, tachycardia)
Ischemia/Infarction (MI, CAD)
Congenital defects

Question 16

causes of left sided HF

Answer 16

systemic causes

Coronary artery disease
Hypertension
Cardiomyopathy
Rheumatic heart disease

Question 17

causes of right sided HF

Answer 17

pulmonary causes

Chronic obstructive pulmonary disease (COPD)
Pulmonary embolus
Right heart failure due to pulmonary issues (termed “cor pulmonale”)
RV infarct

Question 18

classification of systolic HF

Answer 18

contraction

Majority of patients
Ventricle unable to contract and eject blood
Ejection fraction is decreased

Question 19

classification of diastolic HF

Answer 19

relaxation

Ventricle is stiff and can’t fill adequately – they cannot relax and let blood in
Usually related to long-standing hypertension or aortic stenosis

Question 20

clinical manifestations of right sided HF

Answer 20

rest of the body

Swelling, generalized edema
Weight gain
JVD
Hepatomegaly
Ascites
Irregular heat rate
Increased abdominal girth
Nocturia
Anorexia
N/V
Dependent edema
Fatigue

Question 21

clinical manifestations of left sided HF

Answer 21

back to the lungs

Dyspnea
Rales – crackles
Orthopnea
Fatigue
Cyanosis
Paroxysmal nocturnal dyspnea
Tachycardia
Nagging cough
Pulmonary edema – pink frothy sputum
S3 heart sound
Confusion/restlessness

Question 22

AHA/ACC HF stages A-D

Answer 22

A – Patient with risk factors but no left ventricular impairment
B – Asymptomatic with LV hypertrophy and/or impaired LV function
C – Current or past symptoms of heart failure
D – Refractory HF eligible for heart transplant, inotropic and/or mechanical support

Question 23

NYHA Functional Class 1-4

Answer 23

I – No symptoms with physical activity such as dyspnea or chest pain
II – Mild symptoms with ordinary activities
III – Marked limitation with physical activity but comfortable at rest
IV – Severe limitation and distress with physical activity or at rest

Question 24

normal range for BNP

Answer 24

less than 400

Question 25

Evaluates the EF and diastolic function May distinguish systolic from diastolic dysfunction

Answer 25

echocardiography

Question 26

diagnostic tests for HF

Answer 26

stress test or coronary angiography (Evaluates for active or reversible ischemia) two view chest x-ray (Evaluates chamber size and pulmonary congestion)

Question 27

why is an EKG not a useful screening tool

Answer 27

purely the pathway of electricity – not how hard the heart is pumping

Question 28

nursing assessments for pts with HF

Answer 28

Responsiveness to medications: monitor HR, BP, volume status I&O, daily weights!!! Compliance with diet and fluids Respiratory status Safety Monitor vital signs (HR, BP) S/S of decreased CO Labs: K+, BUN, creatinine, Dig levels, BNP!!!, troponins

Question 29

what should the nurse educate the pt on with HF

Answer 29

Low sodium diet Fluid restriction Daily weights Med compliance Smoking cessation Know the s/s of exacerbation Vaccinations – illness –heart stress Exercise Limit alcohol intake

Question 30

medications to treat HF

Answer 30

ACE Inhibitors (-prils) ARBs (-sartan) Diuretics Beta Blockers (-lols) Vasodilators Digoxin

Question 31

devices to treat HF

Answer 31

Pacemakers – stimulate heart to beat Biventricular pacemakers ICDs Ventricular-assist device (VAD)

Question 32

where is the fluid buildup in pulmonary edema

Answer 32

fluid in interstitial spaces and the alveoli

Question 33

fluid accumulated around pleural space

Answer 33

pulmonary effusion