Module 4 Part 4 Heart Failure

Question 1

what is preload? and what is the greatest determinant?

Answer 1

• ‘the degree to which myocardial fibers are stretched at the end of diastole…just before systole’
• greatest determinant is venous blood return to heart

Question 2

what is afterload? and what is the greatest determinant?

Answer 2

• resistance in aorta that the heart has to pump its volume against
• greatest determinant is peripheral arterial vasoconstriction

Question 3

what is contractility?

Answer 3

contractile strength of the heart pump

Question 4

what happens with the blood in R sided heart failure?

Answer 4

• back up of blood to body

- decreased blood in lungs

Question 5

what happens with the blood in L sides HF?

Answer 5

-dec. of blood to body

Question 6

mnfts of L sided HF (9)

Answer 6

• dyspnea
• elevated pulmonary capillary wedge pressure
• pulmonary congestion: cough, crackles, wheezes, tachypnea, blood-tinged sputum
• restlessness
• confusion
• orthopnea
• tachycardia
• fatigue
• cyanosis

Question 7

mnfts of R sided HF (8)

Answer 7

• fatigue
• inc. peripheral venous pressure
• ascites
• enlarged liver and spleen
• distended jugular veins
• anorexia and complaints of GI distress
• weight gain
• edema

Question 8

modifiable risk factors for HF (6)

Answer 8

• ischemic heart disease
• HTN
• diabetes
• metabolic syndrome
• hyperlipidemia
• smoking

Question 9

what are the overall goals of HF management?

Answer 9

-ELIMINATE OR REDUCE CONTRIBUTORY
FACTORS
-REDUCE WORKLOAD ON THE HEART (prelaod/afterload)
-OPTIMIZE ALL THERAPEUTIC REGIMENS
-PREVENT EXACERBATIONS OF HF

Question 10

drugs for L sided HF

Answer 10

• diuretics
• ACE inhibitors
• angiotensin 2 receptor blockers
• direct vasodilators
• beta blockers
• cardiac glycosides (digoxin)

Question 11

what do preload reducer drugs do?

Answer 11

Reduce myocardial workload by reducing the amount of volume coming back to the heart

Question 12

what is the worst thing that could happen if someone takes a preload reducer drug?

Answer 12

• inadequate cardiac output by pooling of blood in extremities
• hypotension (orthostatic)/dehydration
• electrolyte imbalance

Question 13

2 examples of preload reducer drug classifications?

Answer 13

-diuretics, vasodilators

Question 14

what do afterload reducer drugs do?

Answer 14

Reduce myocardial workload by decreasing the resistance that the heart has to pump against

Question 15

what is the worst thing that could happen if someone takes a afterload reducer drug?

Answer 15

• hypotension, hypovolemia, hyperkalemia

- aggravated heart failure

Question 16

examples of afterload reducer drug classifications?

Answer 16

ace inhibitors, angiotensin 2 blockers, diuretics

Question 17

what do contractility (& afterload) reducers drugs do?

Answer 17

• reduce myocardial workload by reducing contractile force

- reduce myocardial workload by reducing after load

Question 18

what is the worst thing that could happen if someone takes a contractility (& afterload) drug?

Answer 18

inadequate CO from reduced contractility

Question 19

examples of contractility (& afterload) drug classifications?

Answer 19

-extended release of beta blockers only*: carvedilol and metoprolol b/c of their afterload reduction properties

Question 20

what do positive inotrope drugs do?

Answer 20

increase the contractile force of the myocardium and slow HR

Question 21

what is the worst thing that could happen if someone takes a positive inotrope drug?

Answer 21

-increase myocardial workload by increasing oxygen demands, digoxin toxicity (digoxin levels!!!)

Question 22

example of a class for positive inotropes?

Answer 22

cardiac glycosides (digoxin)

Question 23

what Dx would you want for HF (8)

Answer 23

-chest xray
-echo (ejection fraction)
-ECG
-angiogram
-BNP
-CBC and renal Fx
-Na and K (electrolytes)
digoxin therapeutic levels

Question 24

what lab values would you be interested in for HF?

Answer 24

• CBC
• electrolytes
• GFR, creatinine
• digoxin level
• BNP

Question 25

what is BNP?

Answer 25

Brain Natriuetic Peptide- LAB - secreted by the ventricles in response to excessive stretching of cardiac muscle cells - WILL BE POSITIVE IF THERE'S HF

Question 26

what are the two actions of BNP?

Answer 26

- actions include: 1. dec. in systemic vascular resistance and central venous pressure 2. increase in natriuresis: the process of excretion of Na in urine via the kidneys

Question 27

whats a nutritional intervention for people with HF?

Answer 27

``` DASH diet (DIETARY APPROACHES TO STOP HTN) -reducing sodium in diet reduces fluid retention and decreases circulating BV ```

Question 28

how is fluid volume managed? (6)

Answer 28

- diuretic therapy - daily weight - fluid restrictions (ins/outs) - respiratory assessment - positional to reduce pre-load - assessing skin for breakdown

Question 29

what is nursing mngmt for activity intolerance?

Answer 29

- rest | - individualized period of daily exercise gradually increasing in duration

Question 30

what is nursing mngmt for SOB?

Answer 30

- supplemental oxygen; monitor O2 sats - for SOBOE, have pt rest, raise HOB - complete respiratory assessment

Question 31

what is nursing management for controlling anxiety?

Answer 31

- admin o2 if reqd - promote physical comfort and psychological support - relaxation techniques - screen for depression

Question 32

what is nursing management for impaired sleep?

Answer 32

- providing reqd pillows for ease of breathing | - provider chair for pt if they cannot get comfortable in bed

Question 33

what is a crystalloid fluid?

Answer 33

aqueous solution of mineral salts and other small, water-soluble molecules

Question 34

why would you administer crystalloids?

Answer 34

they contain electrolytes so they increase circulatory volume without altering chemical balances in the vascular spaces

Question 35

what are the negative side effects of crystalloids?

Answer 35

electrolyte balance, coagulation, liver and kidney function

Question 36

what is a colloid fluid?

Answer 36

-homogeneous noncrystalline substance consisting of large molecules dispersed through a second substance

Question 37

why would you administer colloids?

Answer 37

restores the intravascular volume with minimal risk of tissue edema in comparison with crystalloid solutions alone

Question 38

what are the negative side effects of colloids?

Answer 38

Intravascular volume overload, dilutional coagulopathy, extravascular extravasation across leaky capillary membranes, and anaphylactoid reactions

Question 39

what is heart failure?

Answer 39

the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients

Question 40

in the past, what was heart failure often referred to as? and why?

Answer 40

often referred to as congestive heart failure because many patients experience pulmonary or peripheral congestion

Question 41

what is HF characterized by?

Answer 41

characterized by S+S of fluid overload or of inadequate tissue perfusion

Question 42

what occurs with left sided HF (pulmonary congestion)?

Answer 42

when the left ventricle cannot effectively pump blood out of ventricle into the aorta and systemic circulation

Question 43

what occurs with R sided HF?

Answer 43

there is congestion in the peripheral tissues and the viscera predominates