Heart Failure Flashcards by Brina Quintanilla Reyes

These following flashcards are going to be a recap on what we had learn back last year on patho that we are expected to know for this upcoming exam that will include more heart failure things

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what does heart failure mean ?

an abnormal clinical syndrome that involves

inadequate pumping and filling of the heart that results in the inability of the heart to provide enough blood to meet the oxygen needs of the tissues

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Heart failure is characterized by decreased cardiac output, which results in what 4 things?

decreased tissue perfusion
impaired gas exchange
fluid volume imbalance
activity intolerance

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the following terms below are terms we need to know in order to help our understanding of heart failure a little better, so describe/explain each

preload
afterload
contractility
heart rate

the amount of volume of blood that sits in your left ventricle ready to be pumped out

the force your heart is needing to pump blood out the body/against something
( like hypertension )

the ability of your muscles fibers in your heart to contract

how fast your heart is beating per minute

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true or false
anything that affects your cardiac output can lead or cause heart failure and why?

true
because if you’re heart is trying to push more blood so your body can reach a normal level, it will eventually give out and go into heart failure, just like how hypertension causes hypertrophy, sooner or later your body will not be able to function too well with hypertrophy

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What tool do we use to help measure the severity of heart failure in patients?

ejection fraction

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what is ejection fraction ?

blood pumped out of ventricle
/
blood left in ventricle

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what is normal ejection fraction ?

55-65%

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what are some risk factors for heart failure ?

hypertension
diabetes
advancing age
tobacco use
obesity
high serum cholesterol
myocardial infarction

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usually when it comes to heart failure we like to put the risk factors into two categories, what are the two causes of heart failure ?

primary causes
precipitating causes

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what is a primary cause of heart failure ?
what is the criteria to be a primary cause?
explain to me why this example is a primary cause for heart failure ?

myocardial infarction ( heart attack )

conditions that directly damages the heart

the reason why heart attack are primary causes for heart failure is because of the direct tissue damage it causes on the heart before, during and after experiencing a heart attack. think of how before a heart attack your tissue slowly starts to die, then it does die and then it becomes scar tissue. it is a direct damage to the heart.

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what is an example of precipitating causes for heart failure?

what is the criteria to be a precipitating cause for heart failure ?

explain to me why the example is a precipitating cause

hypertension

conditions that increase workload of the heart

the reason why hypertension is a precipitation cause for heart failure Is because hypertension in itself is causing the heart to pump more blood out because of the intensive vasoconstriction hypertension does. it slowly progresses if left untreated and is sadly one of the main causes of heart failure because patients do not end up knowing or getting well treated for it.

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what are the 2 classifications we give to heart failure in order to diagnose, treat and expect from heart failure ?

left sided or right sided heart failure

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what is the most common heart fault?

left sided

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right sided heart failure is usually a cause from what ?

left sided, its a consequence

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most of the time we like to identify heart failure with a systolic and diastolic issue.
explain to me what is systolic issue
explain to me what diastolic issue
for heart failure ?

inability for your left ventricle to
empty/pump enough blood during systolic
fill/relax enough blood during diastolic

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can you explain to me the patho behind left sided heart failure ?
there are usually 5 steps to this

left ventricle dysfunction
blood will end up backing to the left atrium
left atrium goes into the pulmonary veins
4.pulmonary veins will cause increased pulmonary pressure and will leak into the lungs
5.causing pulmonary congestion and edema

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what do you normally heart in a patient who has pulmonary edema or congestion with left sided heart failure ?

crackles in the lungs
- remember the blood isn’t being able to go to the rest of the body so it’ll back up into the lungs and fill the lungs with fluids, sounding like crackles

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how do you think we will treat pulmonary edema or congestion for patients with left sided heart failure ?

diuretics
typically like furosemide or lasix

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what are some typical left sided heart failure symptoms you will see ? (5)

pulmonary congestion !!!
- crackles
- blood tinged sputum
extertional dyspnea
fatigue
orthopnea !!!
( when laying down its hard to breathe)
tachycardia
restlessness !!!
paroxysmal nocturnal dyspnea !!!
( random at night its hard to breathe)
elevated pulmonary capillary wedge pressure !!!

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what is the patho behind right sided heart failure ?
4 steps

1.right ventricular dysfunction
2. blood backs from the right atrium
3. right atrium into the venous circulation
4. resulting in pitting edema or edema elsewhere in the body

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what are some common clinical manifestions that are for right sided heart failure?(5)

increases peripheral venous pressure
ascites
enlarged liver and spleen !!!
( hepatomegaly and splenomegaly )
distended julgar veins !!!
weight gain !!!
dependent edema !!
anorexia/gi distress !!

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what is biventricular failure ?

both right and left sided ventricular dysfunction

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when you have heart failure, there are a couple of things your body will try to do to help compensate.
we are going to talk about kidneys.
explain to me what the body will do and the name of this mechanism?

renin-angiotensin-adolertsone-system
(RAAS)

to understand this we must understand when we aren’t perfusing well, the first organ to go out is the kidneys.
- so in heart failure we aren’t going to be perfusing well so our kidneys will stop working

our kidneys doesn’t know that our heart is the issue, but instead this of it as a low blood pressure issue, so it will try to increase our blood pressure by releasing angiotensin and adolersone

this will help increase our blood pressure by retaining that sodium and water that we can’t/won’t excrete our because of bad perfusion

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I dont think we need to know this for the test but something important to note another compensatory mechanism is the sympathetic nervous system - baroreceptors sense low arterial pressure - catecholamines are release - stimulation of b-adrenergic receptors increase heart rate and ventricular contractility heart is working harder to try to increase cardiac output

Overtime your body will do another compensatory mechanism which is the dilation of the heart - this will enlarge the heart chambers in order to help push out more blood but also will slowly be caused by the amount of pressure the body is demanding for more blood this results in the famous what term ____ eventually this mechanism becomes inadequate and actually worsens the cardiac output

hypertrophy

another beneficial compensatory mechanism the body will do will help release _____

brain natriuretic peptide !

what are the 2 reasons why bnp is being released ? like what are the 2 causes

increased in blood volume ventricular wall stretching

how does bnp help the body? helps in 2 ways

excretion of water and sodium vasodilation ( hypotension )

what is a great diagnostic tool we use to help detect heart failure in patients ?

bnp

additional important information the higher the bnp the more likely that the patient has ?

severe heart failure ( fluid retention as well )

notes additional compensatory methods nitric oxide and prostaglandin - released from vascular endothelium in response to compensatory mechanism - causes relaxation of arterial smooth muscle, resulting in vasodilation and decreased after load

something in the heart failure key points pdf that dr.brooks put up that I found to be important to help understand the information better is that the body will have compensated heart failure and decompenstated heart failure what is the difference?

compensatory mechanisms support an adequate cardiac output needed for tissue perfusion decompensated mechanisms are when the mechanism can no longer maintain adequate cardiac output and inadequate tissue perfusion results

at first these compensatory mechanisms work well to maintain cardiac output but over time, chronic stimulation of the RAAS and SNS leads to ? dont over think it

sodium and water retention inflammatory mediator activity ventricular remodeling dysrhythmias

the following flashcards are still going to be about heart failure, the only difference is that now its onto the actual powerpoint that she assigned us for this actual test

what is acute decompensated heart failure?

sudden increase in symptoms of heart failure with decrease in functional status

can you provide an example on what it means to say a sudden increase in symptoms of heart failure with decrease in functional status for the definition of acute decompensated heart failure?

patient will have shortness of breathe normally but then it will increases so much more to the point that it affects their daily living

acute decompensated heart failure requires what ?

escalation of therapy and hospitalization

what is the main cause for patients with heart failure to develop acute decompensated heart failure ?

pulmonary congestion and volume overload due to sodium and fluid accumulation - bolus of fluids really

what do you see in early acute decompenstated heart failure ? (4)

increased pulmonary venous pressure - patient has pulmonary hypertension - increase in respiratory rate - decrease in oxygenation

what do you see later on in acute decompensated heart failure ? (3)

insteritial edema - tachypnea - shortness of breath

what happens as it progress with the worsen interstitial edema in acute deompenstated heart failure ?(2)

alveolar edema - so now in the small alveoli ( lungs ) respiratory acidosis

what is one of the first things you will see in a patient who is having acute decompensated heart failure ?

pulmonary edema

what are some clinical manifestations the patients will present or do when they have pulmonary edema?(4)

anxious, paleness orthopnea ( laying down is very hard cause all the fluid ) paroxysmal nocturnal ( random in the middle of night sob ) crackles use of accessory muscles

pulmonary edema has a very specific cough, what is it ?

pink frothy, blood tinged sputum

dr.brooks has this slide that shows the most common clinical manifestations patients who have chronic heart failure end up having. what is the anagram to help remember these very common manifestions you have when you have chronic heart failure ? (5)

faces ! fatigue limitation of actives cough/chest congestion edema shortness of breath

I want to mention something so I dont get confused, where do we normally see pulmonary edema ? pitting edema ? left or right sided ?

left sided - pulmonary right sided - pitting

on the topic of edema, what is the biggest assessment we have to do in order to tell if the diuretic or edema is getting worse ? and how do we do it ?

weight checks same time and same clothing every day

if a patient has a sudden weight gain of ____ in the span of ___it may indicate ___

3 pounds (1.4kg) 2 days acute decompensated heart failure/ an exacerbation of chronic heart failure

dr.brooks brings up a good issue on edema. we understand that edema Is an issue with sodium and water retention because our kidneys are not getting perfused. however during the night, we know patients end up having noctuira, even though they have edema, how does this make sense?

because during the day and being active, patients are normally walking around and the fluid is fighting gravity, usually it goes down to the feet and legs however when its night time, resting time, the patients are laying down, they aren't fighting that gravity, so it will even out and reach the kidneys to be excreted

this flashcards you are going to have to identify the respected symptom that is associated with the system, so what do we expect to see with a patient who has chronic heart failure ? skin related neurological mental status sleeping cardiac renal

dusky color, mottling, shiny, swollen,decreased hair growth, brown areas on lower legs dizziness, syncope (fainting) confusion altered sleep because they can't sleep chest pain nocturia and edema

what are the 5 main complications of heart failure ? and explain how each one is affected by heart failure Think of your compensatory mechanism failing ! Pe,D, h, RF, A

pleural effusion - fluid going into the pleural cavity because of the back of blood dysrhythmias - heart is working overtime to try to get blood through and can strain it hepatomegaly - edema and enlargement of liver renal failure (cardioreneal syndrome ) - not that your kidneys dont work, its because perfusion is being focused on the heart and taken away from the kidneys anemia - from the kidneys not working, it won't create rbcs

what are some diagnostic studies we can do for patients to help diagnose heart failure? best one ?

echocardiogram ( shows the picture of the heart ) ekg, 6-mintue walk, BNP levels !!!

what does the elevated bnp tell us about your heart failure ?

the severity of the stretching your heart fibers have done in order to try to compensate

additional information TROPONION LEVELS DONT TELL HEART FAILURE THEY TELL WHAT?

heart attacks!

what some basic goals therapy to help patients with acute decompensated heart failure ?

symptom relief optimizing volume status support oxygenation avoid complications

the following are going to be interventions we are going to do for these patients of acute decompenstated heart failure what are we going to monitoring ? - basic things dont over think it

vital signs oxgenation weight urinary output

why are we going to place the patient in a high fowlers position instead of a semi fowlers?

to help with breathing because more than likely semi fowlers, if they have pulmonary edema will be very hard to breathe

if the patient with ADHF has extreme trouble trying to breathe on their own, sometimes we can place these patients on what?

BIPAP or mechanical ventilation

If a heart failure patient is receiving diuretics to aid with their edema, and the patient is not responding will the the diuretics, what is another method of treatment we can use to help try to get rid of fluid ?

ultrafiltration (aquapheresis)

what does ultrafiltration (aquaphereis) do?

think of it as a dialysis machine - it takes your blood and removes the additional fluid and goes back in helps with edema

sometimes patients who have heart failure may have a lot of damage and it takes a lot for them to pump blood in their heart, we can use 2 mechanical cardiac assisted devices, what are they ?

intra aortic ballon pump (IABP) ventricular assisted devices (VADs)

what does an intra aortic ballon pump do? what does a ventricular assisted device do ?

balloon that is inserted into the aorta and is blown up to match the timing of when the heart is pumping blood in order to restore and aid with cardiac function its an implanted motor machine that pretty much is pumping the heart adequately for the patient - its continuous

what are the medications/drug therapy we are going to be doing for patients who have acute decompensated heart failure ? (7)

ace inhibitors/arbs beta blockers vasodilators positive inotropic agents morphine diuretics inhibitor of cardiac sinus node

how is diuretics going to help patients who have acute decompensated heart failure ? give an example of the medication name ? what 2 things we are monitoring ?

decrease volume overload (preload) - reducing edema furosemide hypokalemia & ringing in hearing

how are vasodilators going to help patients who have acute decompensated heart failure ? give medication name ? side effects?

reduce circulating blood volume and improve coronary artery circulation - hypotensive effects, relaxing nitroglycerin hypotension

how is morphine going to help a patient who has acute decompensated heart failure ? monitor for what?

reduce the amount of blood that is needed to fill the left ventricle reduce the amount of force for blood to leave the left ventricle pain respiratory depression

how does positive inotropes help patients with acute decompenstatred heart failure ? what is the down side ? example of medications ?

increase contractility can cause dysrhythmias and increase cardiac oxygen demand dopamine, digoxin

how does beta blockers help patients with acute decompenstated heart failure ? watch out for ?

decreased after load and preventing ventricular remodeling hypotension

what do you need to watch out for when giving a patient an ace/arb and aldosterone antagonist ?

hyperkalemia

why do you think we give patients oxygen therapy when they have chronic heart failure ?

because it helps relieve the fatigue of their shortness of breathe and overall relieve the dyspnea that comes with heart failure

why do we tell patients they need to monitor their physical and exercise ?

because moving can take a lot of energy and oxygen so we tell them to rest

we tell patients after any conditions or leaving the hospital with heart failure to go to a cardio rehab, why ?

it helps build structure in their lives and aid with any issues with breathing and condition

what is an inhibitor of cardiac sinus node medication and what does it do?

ivabradine (corlanor) lowers your heart beat and decrease your oxygen demand

it is fairly common for patients who have heart failure to experience dysrthymias, however we like to avoid that by giving them what 2 things ?

ICD implantable cardioverter-defib bioventricular pacing resynchronization therapy ( CRT )

what type of diet are patients with heart failure going to be on?

low sodium diet dash diet is always a good method too - fresh fruits and vegs - cutting down on salt intake

another nutritional thing that Is not too common in patients in that we may need to do a fluid restriction for end stage heart failure what is the restriction number ? what are a common symptom ? how do we aid? when do we normally give most of their fluids and are tryin to prevent ?

less than 2L of fluids dry mouth ice chips, gum, hard candy, ice pops 2/3s during the morning and afternoon 1/3 during dinner time - prevent them from moving so much and needing to pee during the night

the following flashcards are on the next video of heart failure, I believe this is more so what we do for the patient and tell the patient.

the first thing we are going to ask a patient is what for heart failure ? dont over think it nursing assessment based

past health history - any cardiac history - any medications they are on ? any of the following symptoms of changes that have recently occurred baseline, any symptoms, change of diet, ankle swelling, nausea/vomiting weight gain, increase urintating at night, constipation, dyspnea, palpitations change in the number of pillows, insomnia, waking up difficulty breathing, chest pain, abdominal discomfort objective - edema, palpitations, crackles, pink frothy sputum

what type of electrolytes/labs are we mainly looking at for heart failure ? (2)

potassium - heart/cardiac function sodium - retention/fluid volume

the best way to test renal function ?

urinary output!

chronic heart failure overall goals - decrease In symptoms - decrease in peripheral edema - increase in exercise toleranance - adherence of the treatment plan - no complications related to heart failure

why do we want to promote health for patents who have heart failure ?

communication with patients and family to educate on how to prevent worsening of heart failure and those who dont have it, how to prevent it

it is recommended that any patient who has heart failure to get what 2 vaccinations?

flu and pneumonia vaccines yearly

its important to understand the heart failure is a ______, so we must educate to patients and family

progressive disease

since heart failure is a progressive disease, the patient must understand that overall time, its only going to get worse, however, the nurse must educate to the patient on how to ?

slow down the progression and importance on the adherence to treatment regime

chronic heart failure NOTES most of this is re-emphaizing nursing intervention - monitor respiratory status - administers oxygen therapy -semi fowlers position - monitor hemodynamic status - daily weights -intput and oxygen -administer prescribed drugs - monitor edema - alternate rest with activity - provide diversionary activities - monitor response to activity - collaborate with OT/PT to help with energy - reduce anxiety - evaluate support system - patient teaching

dr.brooks mentioned how patients with heart failure tend to be readmitted again because it is progression, so its important to ? dont over think it

teach the patient how to avoid readmission and slow down the disease

when should the patient call the doctor ? (6)

edema gets worse dyspnea gets worse weight gains shortness of breathe worse chest pain activity intolerance

digoxin is the most important medication to tell the patients about drug toxicity levels. it does not take a lot for it to go from therautpic to toxic. so what signs of toxicity will we tell patients to watch out for ?

nausea/vomitting halo lights ( vision disturbances )

digoxin is also one of those medications that must be taken at a certain what ? and why is that? and if patients are going to be prescribed this medication, what do we tell them to do before hand ?

heart rate above 60 because it will lower your heart rate how to take pules for a full minute

its very important to tell patients when they are on medications like diuretics and ace/arbs/aldosteronie medications to watch for potassium levels. which one hypokalemia which one hyperkalmiea

diuretics is hypokalemia ace/arbs/aldosterone hyperkalemia

on the topic of hypokalemia for diuretics and hyperkalemia for ace and arbs and aldosterone, we want to encourage a good diet that follows which ever they are losing so lets say they are on a diuretic, what type of foods should we encourage? lets say they are on an ace/arbs and aldosterone, what foods should we discourage ?

bananas, orange juice,cantalope, sweet potatoes no potassium food/ limit

Dr.brooks doesn't want us to worry too much on like stages of heart failure STAGE 1 - no symptoms STAGE 4 - severe symptoms STAGE A - alright functioning STAGE D - bad functioning the more you progress in the stages the more likely they need what?

more treatment they need to be back on track or have a somewhat normal life

patients who have heart failure usually end up having how long ___year survival rate? its very sad, but sometimes we have to talk about advanced directives, hf therapies, palliative care and hospice

notes chronic heart failure evaluation expected outcomes - maintain adequate gas exchange - maintain adequate blood pumped - reduction of edema - realistic program of activities

heart transplant is the ___standard for suitable for some patients in end stage heart failure

gold

heart transplant stable patients go home unstable patients stay in the hospital

posttransplantation monitoring - rejection - infection - immunosuppressive therapy - risk for cancer

why do we do endomycocardial biopsy ? how often do we do it?

to help tell if the patient new heart is doing well and signs of rejection weekly first month monthly for the next 6 months every year after that

notes nursing care focuses on - promoting patient adaptation to the transplant process - monitoring cardiac function - detecting subtle signs of symptoms of complications - managing lifestyles - providing ongoing teaching

A patient with a history of chronic heart failure is hospitalized with severe dyspnea and a dry, hacking cough. Assessment findings include pitting edema in both ankles, BP 170/100 mm Hg, pulse 92 beats/min, and respirations 28 breaths/min. Which explanation, if made by the nurse, is most accurate? A. “The assessment indicates that venous return to the heart is impaired, causing a decrease in cardiac output.” B. “The manifestations indicate impaired emptying of both the right and left ventricles, with decreased forward blood flow.” C. “The myocardium is not receiving enough blood supply through the coronary arteries to meet its oxygen demand.” D. “The patient’s right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation.”

B. “The manifestations indicate impaired emptying of both the right and left ventricles, with decreased forward blood flow.” Reason It talks about both side on edema so both sides of the ventricles are failing

A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient’s response to these drugs? A. Observe skin turgor. B. Auscultate lung sounds. C. Measure blood pressure. D. Review intake and output.

B. Auscultate lung sounds. Reason because we are thing to get rid of the pulmonary edema

The home care nurse visits a patient with chronic heart failure who is taking digoxin (Lanoxin) and furosemide (Lasix). The patient reports nausea and vomiting. Which action is most appropriate for the nurse to take? A. Perform a dipstick urine test for protein. B. Notify the health care provider immediately. C. Have the patient eat foods high in potassium. D. Ask the patient to record a weight every morning.

B. Notify the health care provider immediately. Reason toxicity