Heart Failure Notes Flashcards

Question

Nitric Oxide (NO) and Prostaglandin

Answer 1

Relax arterial smooth muscle, vasodilation and decreased afterload.

Answer 2

Compensatory mechanism can maintain adequate CO

Answer 3

Compensatory mechanisms can NOT maintain CO and inadequate tissue perfusion occurs.

Answer 4

Fatigue - when doing daily activities and is an early symptom of Chronic HF Dyspnea - most common manifestation of chronic HF Orthopnea PND- paroxysmal nocturnal dyspnea Cough - chronic and nonproductive that’s worse in recumbent position Tachycardia - early sign of HF Palpitations - Atrial Fibrillation is the most common dysrhythmia associated with HF, Edema - most common sign of HF Decreased urine output Nocturia Mottling skin- blue or gray skin color Coolness or clammy to touch Dizziness, lightheadedness and Syncope Sleep apnea Insomnia Chest Pain or Angina Weight changes- due to fluid retention Cardiac cachexia with muscle wasting and fat loss.

Answer 5

``` High Fowler's position with dyspnes Assess v/s, pulse ox, q4hrs Record I&O, daily weights Treat underlying cause Supplemental O2 Drug therapy Circulatory Assist Device Daily weights Sodium and Fluid restricted diet ```

Answer 6

Continual ECG and O2 saturation monitoring, v/s, urine output q1hr Hemodynamic monitoring- arterial BP, pulmonary artery pressure Continuous CO and Pulmonary Artery Wedge Pressure (PAWP) Supplemental O2 Ultrafiltration Mechanical Cardiac Assist Device Intraaortic Balloon Pump (IABP) Treat underlying cause

Answer 7

Treatment for patients with volume overload and regular diuretics isn't working anymore.

Answer 8

Used temporarily for patients with worsening HF in ICU unit

Answer 9

Increases coronary blood flow to heart muscles and decrease workload through counterpulsation.

Answer 10

``` Treat underlying cause Supplemental O2 with ongoing pulse ox Drug therapy Circulatory Assist Device Daily weights Sodium and Fluid restricted diet Severe HF- bed rest. Mild to Moderate - ambulatory with restricted activity Structured exercise program like cardiac rehabilitation Dietitician Consult PT and OT Consult Home Health Nursing Palliative or End-of-life Care ```

Answer 11

Weak positive inotrope Reduces SNS effects and suppress renin section Serum levels should be <0.9ng/mL Monitor renal function and serum potassium levels.

Answer 12

Diuretics First line for volume overload Decrease sodium reabsorption to enhance sodium and water loss. Decrease fluid in preload to promote efficient LV pumping Reduces edema, pulmonary venous pressure, and preload Evaluate by increased urine output, decrease symptoms and fluid weight loss. Monitor serum potassium and serum levels A/e Hypokalemia, ototoxicity, allergic reaction to sulfa-type drugs Diuretic resistance can occur in chronic HF. Chronic HF pts should start with lowest dose.

Answer 13

ACE inhibitor First line for chronic HF Block RAAS system, reduces afterload and SVR Monitor s/e Symptomatic hypotension, intractable cough, hyperkalemia, angioedema, and renal insufficiency. Monitor renal function and serum potassium levels Monitor for first-dose hypotension Skipping doses or discontinuing can result in rebound HTN.

Answer 14

``` Vasodilator Used for short term treatment and after IV diuretic treatment fails Reduces PAWP and dyspnea A/e: Hypotension Monitor BP ```

Answer 15

Opioid Dilates pulmonary and systemic blood vessels, reduces preload and afterload Given in small IV boluses for dyspnea Can cause respiratory depression

Answer 16

Positive inotrope Short term treatment for ADHF Dilates renal blood vessel and enhances urine output. Evaluate CO, BP, urine output and reduced filling pressures. Monitor IV site due to tissue necrosis and sloughing High doses produce ventricular dysrhythmia

Answer 17

Beta-blocker Decreases negative effects of SNS and increase LVEF Caution with pts with volume overload Start with low dose and increase dose every 2 weeks as tolerated S/e: Worsening HF symptoms, hypotension, fatigue, and bradycardia

Answer 18

Nitrate Vasodilator Dilate blood vessels and relaxes veins to reduce heart’s workload Treats chest pain and symptoms of HF Do NOT smoke because it decreases nitroglycerine effects.

Answer 19

Fixed combination of vasodilator Improve LVEF and exercise tolerance Effective in African Americans with systolic HF (HFrEF) after receiving optimal doses of other medications. Do NOT use phosphodiesterase inhibitors (sildenafil (Viagra)). S/e: Hypotension and headache

Answer 20

Do not add salt or seasonings containing sodium when preparing foods. Do not use salt at the table 1 tsp of salt equals 2.3 g sodium Avoid high sodium foods Canned soups, processed meats, cheese, frozen meals Limit milk products to 2 cups daily Degree of sodium restriction depends on severity of HF and effectiveness of Diuretic therapy Fluid restrictions for stage D HF pts with persistent fluid retention despite sodium restriction. Monitor fluid status, weigh the same time daily

Answer 21

All foods high in sodium (over 400 mg per serving) should be avoided.

Answer 22

Include pt and caregiver in overall care plan. Effective home health care Teach pts signs of drug toxicity and self-care such as monitoring BP and HR Tailor exercise programs based on pt's interest and teach them to rest in between.

Answer 23

End-stage HR Severe, decompensated, inoperable, valvular heart disease Recurrent, life-threatening dysrhythmias that are not responsive to interventions and defibrillator Heart abnormalities that limit normal function and greater or equal to 50% mortality risk within 2 years.

Answer 24

Chronologic age over 70 years of physiologic age over 65 Illness that limits survival to less than 5 years Advance cerebral or peripheral vascular disease not amenable to correction Active infection Severe pulmonary disease that pt will be dependent on ventilator after transplant

Answer 25

Monitor sodium and adhere to diet Weigh daily at the same time Eat small frequent meals Look at food and drug labels for sodium

Answer 26

Encourage cardiac rehab program Increase walking and other activities gradually Rest in between activities Avoid extreme heat and cold

Answer 27

Take each medication as prescribed Count HR and BP before taking certain medications Know signs and symptoms of orthostatic hypotension and internal bleeding Know INR and targeted warfarin range

Answer 28

``` Know signs and symptoms of worsening HF Notify HCP immediately when: Weight gain < or = to 3lbs Difficulty breathing, especially when lying flat Waking up breathless at night Frequent, dry, hacking cough Fatigue and weakness Swelling of ankles, feet, abd and face Dizziness or fainting Nausea with abd swelling, pain and tenderness ```

Answer 29

Obtain annual vaccines such as flu Reduce RF Implement regular rest periods in between activity