Heart Failure Flashcards by Dyan Jones

Complex Syndrome
Acute or chronic
Leads to drop in cardiac output CO=HRxSV
Compensatory mechanisms activated
Pulmonary edema
Cardiogenic pulmonary edema (wet lungs)

Overview of Heart Failure

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Mechanisms activated to compensate
-When heart begins to fail
*Primary compensatory mechanisms
-Frank-Starling mechanism
-Neuroendocrine responses by Renin-RAAS, and Sympathetic Nervous System
-Mycardial hypertrophy
No minimal cardiac reserve
Activity intolerance when client at rest

Pathophysiology and Etiology of HF

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Ability for heart to pump stronger. Alpha (squeeze) & stimulation of Beta, increased HR, increase work load of Heart. The increase preload by Systemic better pump until a certain point.
-Elasticity of heart gone

Frank-Starling mechanism

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Over grow heart. Suppy from coronary arteries. HT. Silent Killer. Heart is enlarged

Myocardial hypertrophy

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*Systolic vs. Diastolic Failure; during rest stage; trouble with stiff ventricles; various reasons
*Left-sided vs. Right-sided Failure
*Low output vs. high-output failure; heart working OT. If HR goes to fast doesn’t have time to fill. decreased CO
*Acute vs. Chronic Failure; pulm. embolism (acute) blockage longterm
*

Classifications of HF

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Ischemic Heart disease; heart not perfusing well. BP not high enough
Cardiomyopathies; reasons for Heart failure prob. with tissue itself. Fatty tissues (4th level)
Hypertension
Congenital, valvular heart diseases
Incidence, prevalence increase with age
African Americans more than Whites

Etiology of HF

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CAD, hypertension
Family hx
Cardiotoxic drugs
Smoking
Obesity
Alcohol abuse
Diabetes mellitus

Risk Factors for HF

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4 to 8 L

Cardiac output/min

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-Fatigue, activity intolerance
-Dizziness, syncope, dyspnea, S3
Lefty Larry; SOB
Hear crackles
Flash pulmonary edema; treat with LMNOP
skinny ankles, but lungs filled with fluid
**Paroxysmal nocturnal dyspnea

Left-sided Heart Failure

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Lasix; fluid off
Morphine; reduce anxiety. vasodilate
Nitroglycerin; vasodilate; fluid off lungs; blood to heart
Oxygen; (Really 1st)
Position; HOB High Fowler’s. Pulmonary dilators; pressure low; pressures med, increase BP if low

LMNOP; Flash pulmonary edema; Left-sided HF

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Edema in feet, legs, sacrum
Anorexia, nausea
RUQ pain
Righty Rachel; 3 lbs/5lbs in a week or above
pressure line SVC elevated. 
CVP elevated
Peripheral edema; left has to pump with fluid. increase left heart over worked. 
NOT SOB
Right side not pumping well
Fluid to Sup Venaccava Flow
Liver congestion
systemic circulation congestion. 
Put legs up!; to pee out more
Weigh everyday. Over 5 lbs call Dr!
Nocturia

Right-sided Heart Failure

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Hepatomegaly, splenomegaly
Impaired liver function
Dysrhythmias
Acute pulmonary edema
Renal insufficiency; BUN, Cr increase; if heart is not perfusing well, will affect kidneys
Pleural Effusions

Complications of HF

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Main goals of care:

Slow progression; catch early
Reduce cardiac workload

Collaboration of HF

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Class I: No abnormal symptoms with activity
Class II: Symptoms with normal activity
Class III: Marked limitation due to symptoms with less than ordinary activity
Class IV: Symptoms at rest and severe limitation in functional activity

Clinical Classifications of Heart Failure

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Below 40%

Ejection Fraction in trouble

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B-Type natriuretic peptide; heart stretched
Serum electrolytes
Urinalysis, BUN, serum Creatinine
Liver function tests
Thyroid function tests; hypothyroid does to heart-weakens the heart. assoc. with A fib
ABG’s
CXR
ECG; irreg. rhythms
Echocardiogram/EKG; soundwaves/ultrasound of heart. est. ejection fraction % of volume that pumps out.

Diagnostic Tests for Heart Failure

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Parameters
Monitoring devices
Risks assoc. with hemodynamic monitoring
Intra-arterial pressure monitoring
Venous pressure monitoring
Pulmonary artery pressure monitoring

Hemodynamic Monitoring HF

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Angiotensin-converting enzyme (ACE) inhibitors; (pril)
decrease afterload. decrease workload on heart. decrease preload. Does cause cough in patients.
Decreases Angten. II. Decreases vasoconstriction. Decreases Fluid Vol. Decreases Na and H2O

Angiotensin-converting enzyme (ACE) inhibitors

Pharm Therapy for HF

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Angiotensin II receptor blockers; (Sartans)

blocks vasoconstriction. Blocks Aldosterone. release.

Angiotensin II receptor blockers;

Pharm therapy for HF

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Beta-blockers; blocks beta1. decreases HR, decreases contractility, decreases workload on heart, vasoDilation. [Beta2 can cause vasoconstriction. bronchodilation]
careful giving to patients with pulmonary constriction issues. Diabetes lungers

Beta-blockers1

Pharm therapy for HF

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Diuretics; decrease preload. Lasix
Vasodilators
Digitalis, digoxin; pos inotropic agent. increases contractility, more Ca in heart muscle. increase power of pump. (check K levels, K low worry digtoxicity)
Antidysrhythmics; heart irritable, overloaded (irreg. rhythms)

Pharmacologic therapies cont. for HF

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Sodium-restricted diet; Na goes H2O goes
Fluid restriction; only if fluid overloaded.
Exercise intolerance; optimize ability to move.
-moderate, progressive activity program.

Nutrition and Activity for HF patients

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*Circulatory assistance;
-Intra-aortic balloon pump; temp measure balloon on stick. catheter in groin. inflats/deflats
-Left-ventricular assist device
*Cardiac transplantation; intune to complications
-Cardiac tamponade; fluid in pericardial sac. (fluid in sac);Heart hardly pumps; Chest tubes in perisac.
-Nursing care for transplant;
bleeding precautions
chest tube care
assess for cardiac tamponade
treat atrial dysrhythmias
treat hypothermia
assess and treat infections, rejection

Surgery for HF patients

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Cardiomyoplasty; stimulate muscle, helps contract.

- Ventricular reduction; piece of muscle out hopes of decreasing preload.

Other surgical procedures for HF patients

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* Hawthorn; increase healthy elasticity of arterial vessels. | * Coenzyme Q10, Mg, thiamine; mitochondrial cellular structure of heart

Complementary and Alternative Therapy of HF patients

Chronic heart failure is terminal disease. -unless cardiac transplant Advance directives Hospice; if no treatment options

End-of-life care for HF patients

* **Teach clients about coronary heart disease; education Na/fluid restriction. cessation of smoking. HT, diabetes mellitus management * *Discuss risk factors for coronary heart disease, ways to reduce * Health Hx

Nursing Process for HF

``` Health Promotion -Instruct about CAD -Reduction of risk factors -Hypertension -Diabetes management Assessment -health hx -physical examination ```

Nursing Assessment for HF

Decreased Cardiac Output Excess Fluid Volume Activity Intolerance Deficient knowledge r/t low-sodium diet

Nursing Diagnosis for HF

``` Client will: -Describe purpose of medication -Report symptoms -Maintain adequate oxygenation -Maintain adequate tissue perfusion -Meet body's nutritional needs Pt. knows how to take pulse. **look for weight gain, low pulse, etc. ```

Planning for HF

``` Monitor vitals, ox sat Monitor BNP levels Auscultate heart and breath sounds Admin supplemental oxygen Admin medications Encourage rest ```

Implementation: Maintain Cardiac Output | Heart Failure

``` Assess Respiratory status/airway Monitor I & O Record abdominal girth Measure hemodynamic parameters Restrict fluids ***Weight gain best indicator of FVE ```

Implementation: Monitor Fluid Volume | Heart Failure

Organize rest periods between activities Assist with ADL's as needed Plan progressive activities Provide written, verbal instructions about activity after discharge

Implementation: Monitor Activity | Heart Failure

Discuss rationale for sodium restrictions | Consult with dietician

Implementation: Provide Low-Sodium Diet | Heart Failure

``` Describe meds Describe symptoms to report Explains importance of daily weights Chooses appropriate low-sodium foods Modifies routine for adequate rest periods ```

Evaluation: The client

1. Documentation of discharge instructions in 6 areas: medication management, low-sodium diet, activity and exercise, signs and symptoms of worsening condition, weight monitoring, and when to contact a healthcare provider. 2. Assessment of Left ventricular function (%ejection fraction) 3. Use of an ACE-I or ARB in patients with left ventricular dysfunction. (EF less than 40%) [ventricular remodeling of the heart] 4. Smoking cessation advice and counseling.

All 6 areas have to be met. The Joint Commission on Accreditation of Healthcare organizations (JCAHO) Wont' pay if patients keep coming back. must educate patients. Poor measures

a condition in which the heart is unable to pump enough blood into circulation to meet the body's needs. -inability to pump is commonly due to the inability of the heart to fill with enough blood or the inability of the heart to pump with enough force to meet the metabolic demands. (or combo of the two)

Heart Failure

Long term effect of coronary heart disease and MI when left ventricular damage is extensive enough to impair cardiac output. -Can be acute or chronic _Usually from MI, which results from coronary heart disease & myocardial ischemia. or primary cardiac muscle disorder. -

an abnormal accumulation of fluid in the interstitial tissue and alveoli of the lung. -both cardiac and noncardiac disorders can cause pulmonary edema -medical emergency; drowning in the fluid in the alveolar and interstitial pulmonary spaces. Acute or gradual. progressing to severe respiratory distress. immediate treatment necessary.

Pulmonary Edema

the loss of effective compensation | -Cardiogenic pulmonary edema, is a sign of severe cardiac decompensation.

decompensation

Mech. pumping action of cardiac muscle propels the blood it receives to the pulmonary and systemic vascular systems for reoxygenation and delivery to the tissues

Pathophysiology HF

is the amount of blood pumped from the ventricles in 1 min. -Used to assess cardiac performance, esp. left ventricular function. ***Effective CO depends on adequate functional muscle mass and the ability of the ventricles 2 work together.

is the ability of the heart to increase CO to meet metabolic demands. *Ventricular damage decrease cardiac reserve

Cardiac Reserve

HR affects cardiac output by controlling the # of ventricular contractions per min. -influenced by the autonomic nervous system, catecholamines and thyroid hormones.

CO=HRxSV (stroke volume)

the volume of blood in the ventricles @ end diastole (just before contraction)

Preload

End-diastolic Volume depends on the amount of blood returning to the ventricles and on the distensibility or stiffness of the ventricles (compliance)

venous return

the force needed to eject blood into the circulation.

afterload

(increased systemic resistance) increases afterload, impairing stroke volume and increase myocardial wok.

HTN

is the natural ability of cardiac muscle fibers to shorten during systole. -necessary to overcome arterial pressures and eject blood during systole.

Contractility

is the % of blood in the ventricle that is ejected during systole -normal ejection is 50-70%

Ejection Fraction

1. The Frank-Starling mechanism 2.Neuroendocrine responses, including activation of the SNS and the Renin angiotensin system (RAS) 3 Myocardial hypertrophy

Failing heart-mechanisms are activated

intially stimulates aortic baroreceptors, which in turn stimulates the SNS - stimulation of SNS produces both cardiac and vascular responses; release of norepinephrine. - Norepinephrine increase HR and contractility by stimulating cardiac beta-receptors.

Decreased Cardiac Output

Norepinephrine causes arterial and venous vasoconstriction, increase venous return to the heart. * Increase venous return, increase ventricular filling and myocardial stretch, increase the force of contraction. - Overstretching the muscles fibers past their physiological limit; ineffective contraction. -the greater the stretch of cardiac muscle fibers, the greater the force of contraction. Increase contractile force leading to increase CO ~Increased myocardial oxygen demands ~limited by overstretching

1. Frank-Starling Mechanism (Failing Heart-mechanisms are activiated)

Decrease CO stimulants the SNS and Catecholamine release ~increase HR, BP & Contractility. Increase vascular resistance. Increase venous return complications. ~Increase vascular resistance. *tachycardia, with decreased filling time and decrease CO, Increase myocardial work and o2 demand.

2. Neuroendrocrine response (Failing Heart-mechanisms are activiated)

* Increase cardiac workload causes myocardial muscle to hypertrophy and ventricles to dilate. (physiology) * Increase contractile force to maintain CO (effects on body) * Increase myocardial O2 demand; cellular enlargement.(complications)

3. Ventricular hypertrophy (Failing Heart-mechanisms are activated)

Ventricle fails to contract adequately to eject a sufficient volume of blood into the arterial system. -affected by loss of myocardial cells as a result of ischemia and infarction, cardiomyopathy, or inflammation.

systolic failure

when the heart can not completely relax in diastolic, disrupting normal filling. Passive diastolic filling decrease, increase the importance of atrial contraction to preload. -decrease ventricular compliance caused by hypertropic and cellular changes and and impaired relaxation of the heart muscle.

Diastolic Failure

coronary heart disease | hypertension

Left-sided HF

restrict blood flow to lungs, acute or chronic pulmonary disease

right-sided HF

hypermetabolic states Require increase CO to maintainblood flow and O2 to the tissues. If increase blood flow cannot meet O2 demands of the tissue, compensatory mechanisms are activated to further increase CO, which in turn increases O2 demand. -

High Output Failure

Decreased CO; weakness fatigue decreased exercise tolerance

Manifestation of Systolic Failure

systolic failure

Diastolic Failure

coronary heart disease | hypertension

Left-sided HF

restrict blood flow to lungs, acute or chronic pulmonary disease

right-sided HF

frightening condition in which the client awakes @ night acutely SOB. - edema from day reabsorbs causing fluid overload and pulmonary congestion. - Severe HF may cause dyspnea @ rest and with activity signifying little or no cardiac reserve. - Both S3 and S4 maybe heard.

Paroxysmal nocturnal dyspnea

Decreased CO; weakness fatigue decreased exercise tolerance

Manifestation of Systolic Failure

``` SOB tachypnea respiratory crackles in left ventricle distended neck vein liver enlargement anorexia and nausea (if right ventricle is affected) ```

Manifestation of Diastolic Failure

Fatigue and activity intolerance | Dizziness and syncope from decrease CO

Manifestation of Left-sided Failure

Causes dyspnea, SOB & cough May develop orthopnea difficulty breathing when supine cyanosis; impaired gas exchange maybe noted crackles (rales) and wheezes @ bases -S3 gallop maybe present (reflects hearts attempt to fill an already distended ventricle).

Pulmonary congestion

Edema develops feet and legs (scrum if client is bed-ridden) Congestion of gastrointestinal tract vessels causes anorexia and nausea. Right upper quadrant pain. (liver engorgement) -Neck Veins distend & become viable (even when upright) b/c increase venous pressure -Decrease in CO cause increase in Na & H2O causing weight gain; further increase pressure in capillaries. Resulting in edema. Nocturia; voiding 2 or more times a night. develops when edema reabsorbs while supine

Manifestation of Right-Sided Failure

``` tachypnea paroxysmal nocturnal dyspnea labored respirations cough productive of frothy, pink sputum dyspnea crackles, wheezes orthopnea ```

Manifestations of Pulmonary Edema; respiratory

``` tachycardia cool, clammy skin hypotension hypoxemaia, severe can cause confusion/lethargy cyanosis ventricular gallop ```

Cardiovascular

restlessness feeling of impending doom anxiety

neurological

Levels have been shown to positively correlate with pressures in the left ventricle and the pulmonary vascular system.

BNP

study of forces involved in blood circulation -assess cardiovascular function in the client who is critically ill or unstable. goals; evaluate cardiac and circulatory function and the response to intervention.

hemodynamics

desirable 70 to 90 mmHg perfusion severely jeopardized at MAP's @ 50 or below, Greater than 105 mmHg indicates hypertension or vasoconstriction.

Mean arterial pressure (MAP)

Labs needed to evaluate renal function

BUN, CR, urinalysis

compression of the heart

Cardiac tamponade

Heart Failure Flashcards

(79 cards)