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NUR 405 (Med Surg II) > Heart Failure (Exam 2) > Flashcards

Heart Failure (Exam 2) Flashcards

(42 cards)

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1
Q

Blood flow through the heart

A

Superior and Inferior Vena Cave

Right atrium

Tricuspid valve

Right ventricle

Pulmonary valve

Pulmonary artery

Lungs

Pulmonary vein

Left atrium

Left ventricle

Aorta

Rest of body

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2
Q

4 things that cause heart failure

A

Issues with:

-Preload

-Afterload

-Myocardial contractility

-Heart rate

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3
Q

Preload

A

Amount of blood in the heart during diastole

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4
Q

Increase blood volume in the heart =

A

increase preload

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5
Q

Afterload

A

The amount of resistance the ventricle has to overcome to get blood out of the heart

elevated = harder for the blood to get out

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6
Q

If someone has high blood pressure then they typically have

A

Increase afterload

Which can lead to heart failure

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7
Q

Myocardial contractility

A

Someone might have a weakened myocardial contractility due to damage of myocardium from an MI

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8
Q

Ejection Fraction Equation

A

Amount of the blood ejected from the ventricle (stroke volume)

divided by

Amount of blood in the ventricle prior to ejection (end-diastolic volume)

Times

100

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9
Q

Normal Ejection Fraction

A

55-70%

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10
Q

Patients with heart failure have an ejection fraction of

A

40% or lower

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11
Q

Types of Heart Failure

A

Left sided heart failure

Right sided heart failure

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12
Q

Left-Sided Heart Failure

A

Blood backs up in left atrium / pulmonary veins

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13
Q

Left Sided Heart failure: Manifestations

A

Pulmonary congestion/edema (crackles - rhonchi - dyspnea)

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14
Q

Right sided heart failure

A

Blood backs up into the right atrium/venous circulation

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15
Q

Right Sided Heart Failure: Manifestations

A

JVD

Hepatomegaly

Ascites

Vascular congestion GI tract (loss of appetite)

Peripheral edema

Scrotal edema

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16
Q

Left Sided Heart Failure Signs and Symptoms

A

Paroxysmal Nocturnal Dyspnea (wake up from not catching breath)

Pulmonary congestion

Restlessness

Confusion

Orthopnea

Tachycardia

Exertional Dyspnea

Fatigue

Cyanosis

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17
Q

Right Sides Heart Failure Signs and Symptoms

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A

Fatigue

Increase peripheral venous pressure

Ascites

Enlarged liver and spleen

HVD

Anorexia

Swelling in hands and fingers

Dependent edema

18
Q

cor pulmonale

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A

Refers to the enlargement of the right side of heart as result of pulmonary hypertension (COPD)

Right sided failure that results from left sided failure is NOT the same as cor pulmonale

19
Q

Chronic Heart Failure

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A

Typically diagnosed in outpatient setting

Marked by periods of acutely and or slowly worsening cardiac function

Often consequence of damage caused by other cardia events or diseases

20
Q

Acute decompensated heart failure (ADHF)

Study These Flashcards
A

Typically diagnosed in inpatient setting

Worsening chronic health failure s/s requiring urgent therapy

Life threatening condition requiring acute interventions

21
Q

How does ADHF typically present?

Study These Flashcards
A

Patient comes into the hospital because they can not catch their breath (SOA)

This is due to fluid caused by cardiac overload

22
Q

How do we diagnose heart failure

Study These Flashcards
A

History and physical exam

EKG

BNP and ProBNP

CXR (cardiomegaly and pleural effusions)

Echocardiogram (including EF)

LVAD

Heart transplant

23
Q

BNP and ProBNP

Study These Flashcards
A

Help distinguish HF from other sources of dyspnea

24
Q

Most dyspneic patient with HF have BNP that is

25
Chronic Heart Failure: Collaborative Therapy
Treatment of underlying cause Oxygen therapy at 2-6L/min per NC Rest-activity periods (conserve energy) Daily weights Sodium-restricted diet
26
Chronic Heart Failure: Drug Therapy
ACE inhibitors (pril) ARBS (artan) Beta Blocker (olol) Diuretics Nitrates Cardiac glycosides (Digoxin)
27
Cardiac Glycoside for Chronic Heart Failure
Digoxin -Second line drug r/t risk for dysrhythmias (but classic drug still on the market)
28
Digoxin is a
Negative chronotropic (drug that slows down heart rate) Postive inotropic (increase contractility) Enhances cardiac output
29
What is the main concern with digoxin
Digitoxicity is concern Hypokalemia aggravates digitoxicity
30
What aggravates digitoxcitiy
Hypokalemia
31
Digoxin levels should be
0.5-2 ng/ml
32
Mineralocorticoid Receptor Antagonist
Spironolactone Potassium retaining diuretic
33
How does spironolactone help in chronic heart failure?
It supressess sodium/water retention to help with offloading of the left ventricle Associated with decrease hospitalizations and cardiac death
34
Nursing Implication when giving digoxin
Monitor serum potassium Digitalis + Hypokalemia = -Digitalis toxicity -Cardiac dysfunction -Dysrhythmias
35
S/S of digitalis toxicity
Bradycardia Headache Dizziness Confusion Nausea Visual disturbances (see halo around lights)
36
Before giving digoxin the nurse should
Take apical pulse for a full minute prior to administering Hold if pulse below 60 Monitor cardiac rhythm
37
What is the antidote for digitalis toxicity
Digoxin immune Fab (given IV) Digibind
38
Left ventricular Assist Device
LVAD Used as a bridge transplant or destination therapy BP cannot be read on these patients because machines are in continuous flow S1/S2 cannot be heard
39
If patient with LVAD becomes unresponsive
DO NOT start CPR unless you are sure the pump is completely turned off
40
ADHF: Collaborative Therapy
Treat underlying cause VS - Urine output hourly EKG and pulse oximetry (continuous) Monitor ABG results High Fowleys w/ feet horizontal or dangling at BS O2 mask of BiPap Daily weights Hemodynamic monitoring
41
ADHF Drug Therapy Goal
Decrease intravascular volume Decrease afterload Increase left ventricular function Decrease anxiety
42
Drug Therapy for ADHF
-Diuretics -Vasodilators -Morphine -Postive inotropes Decrease Intravascular Volumes Decrease Afterload Increase Left Ventricular Fucntion Decrease anxiety

NUR 405 (Med Surg II) (66 decks)

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