heart failure Flashcards
whats heart failure
Impairment in the ability of the ventricle to fill or eject blood effectively
what are some causes of heart failure
Acute myocardial infarction
Uncontrolled hypertension
Valvular dysfunction
Infection, ex: myocarditis or endocarditis
Cardiomyopathy (dilated, hypertrophic, nonobstructive)
clinical manifestations of left sided HF
SOB
Orthopnea
Crackles
Elevated PAWP, PAOP, PAP
clinical manifestations of right sided HF
Lower extremity edema
Jugular vein distention
Hepatojugular reflex
Elevated CVP
describe BNP
Secreted by the ventricles in response to excessive stretching of heart muscle cells
Increases glomerular filtration rate, decreases sodium retention, and inhibits renin and aldosterone secretion
BNP of >100 is diagnostic for HF
Marker of cardiac dysfunction and is well correlated with LV preload
Determines the severity of disease and prognosis
medications for HF
ACE-I or ARB
Nitrates
Hydralazine
Beta-blockers
Diuretics
Digoxin
Spironolactone
Statins
interventions for CHF
Cardiac Resynchronization therapy (biventricular pacing therapy)
ICD (implantable cardioverter defibrillator)
patient self-management of CHF
Adherence to drug regimen
Daily weights
Low sodium diet
Exercise
Smoking & alcohol cessation
meds for acute HF
Preload Reduction
- Diuretics
- Nitrates
Afterload Reduction
- ACE-I or ARB
- Hydralazine
- Nitroprusside
- Given IV – monitor BP!
Inotropic Support
- Dobutamine
- Dopamine
- Milrinone (Primacor)
goals of HF therapy
CO will be maximized
sx will be managed
euvolemia will be achieved
rehospitalization will be prevented
The nurse is caring for a patient in an acute exacerbation of heart failure. Which of the following medications should the nurse anticipate?
A. Metoprolol
B. 0.9% Normal saline bolus
C. Morphine
D. Dobutamine
D. Dobutamine
Rational: Acute exacerbation of heart failure warrants medications that decrease preload, decrease afterload, and improve inotropy. Dobutamine is a positive inotrope
