Heart Failure Flashcards by Daisy Perez

Most common type of heart failure

Left sided

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HF in which the heart does not have a forceful enough contraction to eject blood

Systolic HF

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Measurement of blood leaving the left ventricle and going into circulation

Ejection Fraction (EF)

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EF normal range

50-70%

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Effects of decreasing EF

Decreased tissue perfusion, accumulation of blood initially in pulmonary vessels, fluid backs-up into pulmonary system causing crackles, dyspnea, etc.

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HF in which the left ventricular ejection fraction may still be preserved, but left ventricle stiffens and loses compliance over time causing inadequate ventricular filling

Diastolic

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Mixed/both systolic and diastolic HF with dilated ventricular wall

Combination HF

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Types of left side HF

Systolic, diastolic, combination

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Common causes of right-sided HF

Clients with L-sided HF that progresses to biventricular HF, MI in coronary arteries on R side of heart, inability of R ventricular to empty completely (causing systemic congestions and pulmonary edema)

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___ is the most common reason for hospital admission for people >65

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What race is HF more common in?

African Americans under 50

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HF etiology

Systemic HTN (increased SVR causes growth of LV —> HF), CAD (plaque —> arterial narrowing —> cardiac ischemia), MI, structural changes such as ventricular remodeling

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Right-side HF in the absence of left-side HF is associated with

Pulmonary problems such as COPD, ARDS, sleep apnea, etc.

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S/S of L-sided HF

Dyspnea (exertional, paroxysmal nocturnal), fatigue (d/t inadequate perfusion), weakness, arm heaviness, chest pain/palpitations/skipped beats/fast rate, decreased UO, weak pulses

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S/S of R-sided HF

JVD, increased abdominal girth (ascites), dependent edema, hepatomegaly, hepatojugular reflux

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What kind of HF is associated with increased systemic venous pressures and congestion?

R-sided

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Where would dependent edema be assessed in a bedridden patient?

Around the sacrum

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What is the most reliable indicator of fluid gain/loss?

Weight

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Weight gain to report

> 2 lbs in 24 hr period OR 5 lbs in a week

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Inability of both the R and L ventricles to pump effectively

Biventricular HF

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Effects of biventricular HF

Fluid build-up and venous engorgement, decreased perfusion to vital organs

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Increase in pulmonary venous pressures and engorgement of pulmonary vascular system (lungs lose compliance) caused by LV failure

Acute Decompensated Heart Failure (ADHF)

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ADHF patho

Alveoli lining cells are disrupted, fluid with RBCs moves into alveoli causing pulmonary edema

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S/S of pulmonary edema

Cyanosis, anxiety (impending doom), pallor, RR>30 w/ use of accessory muscles, wheezing, coughing, orthopnea, frothy pink sputum, tachycardia

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ADHF ABGs

low PaO2 + high PaCO2 = respiratory acidosis

Causes of ADHF

Transfusing fluids too quickly, HF with renal insufficiency

CO is insufficient to meet body’s demands

Heart Failure

HF compensatory mechanisms

SNS stimulation (initial mechanism), RAS system activation, chemical responses such as: ventricular remodeling, inflammatory response, production of BNP

Stimulation of SNS patho

Triggered by low CO —> release of epi and norepi. To increase HR, contractility, and systemic vasoconstriction

Effects of SNS compensatory mechanism on HF

Increased cardiac workload and oxygen demand; long-term SNS can worsen HF

Activation of RAAS patho

Low CO causes decreased blood flow to kidneys, activating RAAS —> angiotensin II and aldosterone retain sodium and water increasing preload and afterload

RAAS compensatory mechanism effects on HF

Long term activation can cause edema; angiotensin II contributes to ventricular remodeling

Chemical response that occurs in HF and MIs in which myocytes become hypertrophied (large, misshapen) and do not contract as well causing more problems within the heart

Ventricular remodeling

Ventricular remodeling complication

Increased risk for sudden cardiac death

Hormone released by the ventricles in response to fluid overload and HF

B-type natriuretic peptide (BNP)

BNP promotes

Vasodilation and diuresis

Compensatory mechanism characterized by thicken heart muscles

Myocardial hypertrophy

Myocardial Hypertrophy complications

Higher oxygen needs; higher risk for dysrhythmias d/t inadequate coronary circulation

Patients at risk for HF

Family hx, hx of MI, chronic HTN, diabetes, smoking, African Americans, obesity, hyperlipidemia

HF classification resources

NYHA, AHA

NYHA HF classification for patients at high risk for developing HF

Class I

NYHA HF classification for patients w/ cardiac structural abnormalities or remodeling who have NOT developed HF symptoms

Class I

NYHA HF classification for patients with current or prior symptoms of HF

Class II or III

NYHA HF classification for patients with refractory end-stage HF

Class IV

Complications of chronic HF

Pleural effusion, dysrhythmias and dyssychronous contractions, hepatomegaly, cardiorenal syndrome, anemia

Laboratory assessment of chronic HF

Serum electrolytes (potassium), low H&H (diluted d/t fluid retention), elevated BNP, urine dilute if diuresing but concentration if HF with renal insufficiency, respiratory acidosis (trapping of CO2). Other assessments: BUN/creatinine, magnesium

Imaging assessment for HF

CXR, echocardiography, radionuclide studies, multigated angiography study (MUGA)

Gold standard imaging assessment for HF

Echocardiography

__________ allows for direct assessment of cardiac function and volume status

Hemodynamic monitoring

Short-term mechanical circulatory support devices for HF

Intra-aortic balloon pump (IABP), Extracorporeal membrane oxygenation (ECMO)

Long-term mechanical circulatory support device for HF, often used in clients w/end-stage HF who may not be good candidates for transplant

Ventricular Assist Device (VAD)

Gold standard therapy suitable for patient in end-stage HF

Heart transplant

Heart transplant process

Candidates must undergo a comprehensive physical, diagnostic, and psychological evaluation

Antihypertensives that inhibit the RAAS system

ACE inhibitors (-pril)

Medications administered in HF to block the negative effects of SNS such as tachycardia

Beta Blockers (-olol, metoprolol, etc.)

Nursing consideration for beta blockers

Do not administer if HR<60

First line drugs for HF

ACE inhibitors, BB, ARBs

Medications that help with myocardial ischemia, commonly given if patient is intolerant to ACE inhibitors

Nitrates such as hydralazine

__________ increase cardiac contractility

Positive inotropic agents such as digoxin

Positive inotropic agents are often used in conjunction with

ACE and BB

HCN channel blocker that slows HR to effectively pump more blood; used in severe HF

Ivabradine

Examples of diuretics used in HF

Furosemide (IVP), HCTZ, spironolactone

Option for volume overload or fluid retention used in patients who do not response well to diuretics or who have major pulmonary or systemic overload; removes salt and water from patient’s blood

Ultrafiltration or aquaphoresis

Ultrafiltration or aquaphoresis consideration

Patient must be hemodynamically stable

Practice Questions: A nurse is assessing a client with L-side HF. For which clinical manifestations would the nurse assess?

Pulmonary crackles, cough that worsens at night

What kind of HF occurs with a decrease in contractility of the heart or an increase in afterload?

L-sided HF

Most of the signs associated with L-side HF will be noted in the

Respiratory system; S/S include crackles, confusion (d/t decreased oxygenation), and cough

Right ventricular HF is associated with

Pulmonary HTN, edema, and JVD

Example hypotheses for HF

Decreased gas exchange d/t ventilation/perfusion imbalance, potential for decreased perfusion d/t inadequate CO, potential for pulmonary edema d/t L-sided HF

Interventions for increasing gas exchange

Elevate HOB, supplemental O2 (starting w/ 2 L and titrate up), treat underlying problem (such as administering diuretics to decrease fluid overload)

Pharmacological interventions for increasing perfusion

Medications such as BB (carvedilol), digoxin

Intervention for preventing and managing pulmonary edema

Limit fluid intake < 2 L/day (or 2000 mL/day)

Standard of care expected of nurses for patients with HF

MAWDS

Medication, Activity, Weight, Diet, Symptoms

HF diet

Sodium restriction (2-3 g/day)

Level of acute care in the home setting

Hospital at Home

Hospital at Home requirements

1 provider visit per day, 2 RN visits per day, one can be in-person and the other can be telehealth

Benefits of Hospital at Home

Reduced risk for falls, pressure ulcers, HAIs; patient’s report better experience; hospitals save on PPE

Gold standard for HF resources

American Heart Association (HF helper app, self-check plan for HF management)

Practice Question: A nurse cares for a client with R-sided HF. The client asks “why do I need to weigh myself everyday?” How would the nurse respond?

“Weight in the best indication that you are gaining or losing fluid”

1 L of fluid = ? Lbs

2.2 lbs (1 kg)

Assessing tissue perfusion

Capillary refill, pedal and peripheral pulses

Evaluation of effectiveness of HF interventions

Adequate tissue perfusion, increased cardiac pump effectiveness, free of pulmonary edema (clear upon auscultation)

Severe attack of difficulty breathing that awakens an individual, typically within 1-2 hours of falling asleep

Paroxysmal nocturnal dyspnea

Heart Failure Flashcards

(84 cards)