Heart Failure

Question 1

What determines Cardiac Output?

Answer 1

Cardiac Output is determined by stroke volume and heart rate.

Question 2

What determines Stroke Volume?

Answer 2

Stroke volume is determined by preload, contractility, and afterload.

Question 3

What is Preload?

Answer 3

Preload refers to how much blood can fill into the heart and how much the heart can stretch.

It is dependent on venous return.

Question 4

What is Contractility?

Answer 4

Contractility refers to how much the heart can contract.

It is dependent on ATP, Ca2+, and contractile proteins like actin and myosin.

Question 5

What is Afterload?

Answer 5

Afterload is the pressure the left ventricle must overcome in order to eject blood.

Question 6

What is Heart Failure?

Answer 6

Heart Failure is a syndrome resulting from conditions that impair the filling or pumping of the heart, leading to decreased cardiac output and inability to meet metabolic demands.

Question 7

What conditions can lead to Heart Failure?

Answer 7

Heart failure can result from many diseases such as hypertension (HTN), atherosclerosis, high cholesterol, coronary artery disease, faulty heart valves, and cardiomyopathy.

Question 8

What is Ejection Fraction?

Answer 8

Ejection Fraction is the percentage of blood ejected during systole, calculated by stroke volume divided by end diastolic volume.

It reflects contractility.

Question 9

What is Pleural Effusion?
What is it often a complication of?

Answer 9

Pleural Effusion is fluid buildup in the layers of pleura around the lungs, often a complication of left-sided heart failure.

Question 10

How does COPD cause pulmonary hypertension?

Answer 10

COPD causes poor ventilation in parts of the lung filled with mucus, leading to constriction of lung arteries to direct blood flow to healthier areas.

Question 11

What are the effects of heart failure on perfusion?

Answer 11

Heart failure results in decreased blood pressure and tissue perfusion, leading to ischemia and potential organ failure.

Question 12

What are the classifications of heart failure?

Answer 12

Heart failure can be classified as acute or chronic, right-sided or left-sided, diastolic or systolic.

Question 13

What are the clinical manifestations of heart failure?

Answer 13

Clinical manifestations include symptoms like dyspnea, crackles, jugular venous distention, and edema.

Question 14

What are the compensatory responses to decreased cardiac output?

Answer 14

Compensatory responses include sympathetic activation, hormonal changes, and myocardial remodeling.

Question 15

What is Natriuretic peptide?

Answer 15

Natriuretic peptide includes atrial and B-type natriuretic peptides, causing sodium and water loss in urine and released in response to volume overload.

Question 16

How to remember Left vs. Right sided heart failure?

Answer 16

Left-sided heart failure affects the lungs, while right-sided heart failure affects the rest of the body.

Question 17

What are the management strategies for heart failure?

Answer 17

Management includes monitoring symptoms, medications, dietary changes, and exercise.

Question 18

What lab work is important for heart failure?

Answer 18

Important lab work includes BNP, CBC, and echocardiogram to assess ejection fraction.

Question 19

What are the goals of heart failure medications?

Answer 19

The aim of heart failure medications is to increase contractility, decrease preload, decrease remodeling, and decrease afterload.

Question 20

What does HR directly affect in heart failure?

Answer 20

CO

CO stands for Cardiac Output.

Question 21

List the factors that affect SV.

Answer 21

• Preload
• Contractility
• Afterload

Question 22

What assessment symptoms indicate increased afterload?

Answer 22

Cool/clammy skin

Increased afterload can be caused by vasoconstriction.

Question 23

What are the assessment symptoms for contractility?

Answer 23

• Pulse
• S1/S2
• ECG

Question 24

What assessment symptom indicates preload issues?

Answer 24

JVD

JVD stands for Jugular Venous Distension.

Question 25

How can you differentiate between fluid in the lungs from HF and pneumonia?

Answer 25

HF fluid is bilateral; pneumonia is usually one lobe.

Question 26

What causes right-sided heart failure?

Answer 26

* Left-sided HF * COPD

Question 27

What assessment findings should focus on a client with perfusion problems?

Answer 27

* Daily weight * Vitals * Heart sounds * Cap refill * Weak pulse * CNS regulation * Abdominal edema * Lung sounds

Question 28

What clinical history is important for a client with perfusion problems?

Answer 28

* Symptoms * Functional limitations * Prior/established cardiac disease * Risk factors

Question 29

What are the risk factors associated with perfusion problems?

Answer 29

* HTN * Ischemic heart disease * CAD * Smoking * Drugs * Chemotherapy * Family history * Dyslipidemia

Question 30

What focused perfusion assessment questions should be asked for HF?

Answer 30

* Feel skin * Ask about chest pain * Palpate to rule out chest pain causes * How do you sleep at night? * New fatigue? * Functional limitations * Weight gain

Question 31

What lab work is relevant for diagnosing heart failure?

Answer 31

* BNP * CBC * Echo

Question 32

What does BNP indicate in heart failure?

Answer 32

Released from over-distended cardiac cells ## Footnote If present, it can diagnose HF.

Question 33

What role does Hgb play in heart failure assessment?

Answer 33

Used to assess anemia; can become diluted with fluid overload.

Question 34

What is the recommended sodium restriction for heart failure management?

Answer 34

2000-3000 mg per day ## Footnote This decreases RAAS activation.

Question 35

What non-pharmacological management strategies are recommended for heart failure?

Answer 35

* Diet * Exercise * Fluid restriction

Question 36

What is the fluid restriction guideline for heart failure patients?

Answer 36

2L/day TOTAL

Question 37

What does the green zone indicate for self-monitoring symptoms of HF?

Answer 37

No increased swelling, no SOB, no chest pain, no weight gain over 4lbs over 2 days, or 5 lbs in a week.

Question 38

What should be done in the yellow zone of HF self-monitoring?

Answer 38

Call the HCP for weight gain, vomiting/diarrhea 2+ days, increased SOB, increased swelling, dry cough, new light-headedness, orthopnea.

Question 39

What actions are necessary in the red zone of HF self-monitoring?

Answer 39

Go to ER for struggling to breathe, SOB that doesn’t go away, fast HR, chest pain that doesn’t go away, confusion, syncope.

Question 40

What nursing management actions are critical for heart failure?

Answer 40

* Monitor O2 * Monitor ins and outs * Monitor lung sounds * Assess new chest pain * Medication reconciliation * Lab values * Daily weight * Encourage mobility * Sodium restriction * Monitor skin integrity * Patient and family education

Question 41

What are some actual/potential problems related to heart failure?

Answer 41

* Impaired fluid and electrolytes * Impaired gastrointestinal function * Impaired nutrition/elimination * Impaired central perfusion * Confusion * Anxiety/depression * Falls risk * Impaired skin integrity * Impaired sleep * Fatigue * SOB * Dyspnea