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NURS232 > HF > Flashcards

HF Flashcards

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1
Q

HF

A

An abnormal clinical syndrome involving impaired cardiac pumping and/or filling

Heart is unable to produce an adequate cardiac output to meet metabolic needs

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2
Q

Characterizations of HF

A

Ventricular dysfunction
Reduced exercise tolerance
Diminished quality of life
Shortened life expectancy

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3
Q

Cardiac output is

A

HR x Stroke Volume

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4
Q

Main primary Risk Factors for HF

A

CAD
HTN (Vessels less elastic, heart must work harder)

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5
Q

Secondary Risk factors for HF

A

DM
Smoking
Obesity
High serum cholestoral

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6
Q

HF is caused by any interference with normal mechanisms regulating cardiac output - what are these mechanisms?

A

Preload
Afterload
Myocardial Contractility
HR

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7
Q

Preload

A

The initial stretching of cariac myocytes
What happens BEFORE contraction

Volume of blood at end of Diastole

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8
Q

Afterload

A

The resistance the left ventricle must overcome (In the aortic valve) to circulate blood

Ventircular reistance

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9
Q

Myocardial contractiliity

A

The capacity of the heart to pump effectively

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10
Q

HFrEF

A

HF with reduced dejection fraction

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11
Q

What is ejection fraction (+ what is a normal one)

A

% of total amount of blood in LV that is ejected druing each ventircular contraction; normal EF is >55% of ventricular volume

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12
Q

What causes HFrEF?

A

Myocardial ischemia, increased afterload AKA HTN, cardiomyopathy, or mechanical abnormality (Valvular disease)

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13
Q

Most common type of HF

A

HFrEF

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14
Q

Hallmark finding of HFrEF

A

Decreases in LV EF

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15
Q

Pts with an EF of ____ require specialist intervention

A

40% or less

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16
Q

HFpEF (Heart Failure with preserved ejection fraction

A

Inability of the ventricles to relax and fill during diastole
Results in decreased stroke volume and CO

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17
Q

What causes HFpEF

A

Poorly compliant ventricle - LV hypertrophy, myocardial ischemia, valvular disease (aortic or mitral), Cardial myopathy

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18
Q

Diagnosis of HFpEF is?

A

Based on presence of HF symptoms with an EF of 50% or greater

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19
Q

Compensatory mechanisms for HF

A

Increased SNS stim (increase HR, vasocontstriction) - Quick response, least effective - Effort to increase CO

Neurohormonal: Renal system is particularly senesitive to reductions in BF - activates RAA mechanisms - causes vasoconstriction and leads to aldosterone secrtion

Causes retention of salt and water - increasing preload - eventually results in systemic venous congestion and peripheral edema

ADH is secreted to retain water to increase preloadddddddddd

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20
Q

What is cardiac decompensation

A

When compensatory mehs can no longer maintain adequate CO and insufficient tissue perfusion

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21
Q

Ventricular Remodeling

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A

Hypertrophy of cardiac myocytes - large abnormal cells (Less efficient pump)

Eventually leads to vent mass, changes in ventricular shap and impared contractillity

Results in a bigger but less effective pump

22
Q

Ventricular dialation

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A

Enlargement of chambers of heart due to elevated pressure over time

Initially an adaptive mechanism to cope with increased blood volume - decreased elasticity in muscle fibers resuts in decreased CO

23
Q

Ventricular hypertrophy

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A

Increase in muscle mass and cardiac wall thickness due to overwork and straindd

24
Q

Counterregulatory mechanisms

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A

If the compensatory mechs work TOO well

Atrial Naturuetic peptide (released from atria)
Beta-type natriuretic peptide (released from ventricles)

Both released in repsonse to increased blood volume in heart, effect renal, CVS and hormones

25
Types of HF
Left sided (Most common) Right sided HF
26
Left sided HF
Back up of blood into LA and pulm veins manifested as (acute) Pulmonary edema (flash) Resp symptoms 3rd Heart sound Decreased output
27
Right sided HF
Causes backward blood flow to the RA and venous circulation Peripheral edema (halmark), enlargement of spleen, liver, JVD
28
Acute decompensated HF (ADHF)
Comp mechs fail Manifests as PE, often Life threatneing (Flash PE) Often happens secondary to MI
29
Symptoms of ADHF
Acutely short of breath Altered LOC Anxiety Clammy and cold skin Increased HR + RR Severe Dyspnea (Tripodding/ acc muscles) Wheezing/coughing with frothing/blood tinged sputum (Crackles) Changes in BP
30
Anasarca
Full body Edema
31
Why would Left sided HF result in nocturia
While sleeping, the Heart doesn't work as ard, therefore, blood flow is restored to kidneys
32
Management of Acute DHF
Decrease intravascular volume - Diretics Decreasing venous return (Preload) - Position (High fowlers, feet dangle) Decreasing Afterload - (Balancing BP) Improving gas exchange and Oxygenation - High flow Oxygen (IV lasix ONLY if BP is high enough) - Positive Airway Pressure mask forces fluid out of lungs into vascular space (improving Oxygenation) Improving Cardiac Function (ICU, HACU) - Inotropes etc. Reducing anxiety (morphine/hydromorphone - reducing sensation of breathlessness)
33
Care of Chronic HF
O2 administration (specifically with exertion) - shooting for 92 + SPO2 Self Management + teaching (monitoring, daily wt, sleep positioning) Regular Exercise
34
Supportive device for Chronic HF
Cardiac resynchronization therapy Implantable Cardioverter-Defibrillator (PM) Mechanical Circulatory Support Mechanical Circulatory Support
35
Dysrythmias associated with which part of heart are most deadly?
Ventricle
36
Therpeutic objective of medication therapy
Identify type of HF and causes Correction of NA and H2O retention and volume overload Reduction of cardiac workload Improve myocardial contractility Control of precipitating and complicating factors
37
Common meds for HF
Directics - Loop diretic Lasix etc. Thyaside diurectics - Reduce intravascular volume in order to reduce preload ACE inhibs: Ramabpril or analapril - Vasodialt 9BP, decreased afterload, CO Some pts can't tolerate angioedema or cough and are put on ARBs instead Beta-Adrenergic Blockers - Reduces cardiac oxygen demand by decreasing HR and BP Neprilsyn Inhibs - Combines ARB with Neprilsyn inhibitor (new drug) Inotropic Drugs - Management of ADHF - improve cardiac contractililty for increased CO, and afterload For pts with HFrEF Nitrates: Reduces afterload by dilating peripheral BV Increases myocardial O2 supply by dialting coronary BC First line med in management of chest pain - In acute PE with adequate BP Digitalis: i.e. Digoxin. Small thereapeutic window - Increases CO (decrease HR, increas V filling and contractility) - Monitor Apical rate (should be>60BPM)
38
Who are inotropics given to
Pts who are hemodynamically unstable, those with HFrEF unless it's end of life
39
Nutritional therapy for outpts with HF invovles
Diet education - Na restriction -Fluid restriction (1.5-2L) Wt management Report gains of 2 kg/24hr or 2.5 kg a week
40
Nursing Diagnoses for HF
Inadequat CO Reduced gas exchange
41
Excess fluid volume management
Use of Diuretics Monitor wt Monitor for HypoK Limit Na intake (+I&O)
42
Digitalis toxicityu
Bradycardia, tachycardia; irregular pulse/arrhythmia GI: anorexia, nausea, vomiting, diarrhea, abdominal pain Neuro: headache, drowsiness, confusion, insomnia, muscle weakness, double vision, blurred vision, visual halos Patients have regular serum digoxin levels taken to make sure they are in the therapeutic range.
43
Successful HF mgmt. depends on these principles:
HF is progressive; QoL is paramount Pt self-mgmt. needs to be emphasized Na+ and H2O need to be restricted Regular exercise should be maintained Use of supports is essential to success of tx plan Med adherence is important (education)
44
How is a persons EF determined?
Echocardiogram
45
Why does every HF pt need a Saline lock
Iv access in case anything needs to be done quickly
46
When do you withold a beta blocker?
For HR less than 50 or symptomatic HOTN
47
Two most common reasons for HF
Chronic HTN CAD (MIs are a significant cause bc they can cause part of the muscle to die )
48
ADHF occurs when?
Often caused by MI, sepsis, an acute event
49
Paraoxym nocturnal dyspnea
Waking up suffocating in the morning because of fluid flowing back to lungs
50
What is a concerning amount of wt gain in HF pts
2kg in a day or 2.5 kg in one week
51

NURS232 (27 decks)

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