Week 2 Flashcards
(31 cards)
Describe cardiac reserve
when the heart is above normal situation
Describe Congestive Heart Failure
- An impairment of the pumping ability of the heart due to damage
- Increase in workload due to hypertension or a malfunctioning heart valve, or genetic predisposition
Describe Left Sided Heart Failure
- Blood backs up through the left atrium into the pulmonary veins
- Results in pulmonary congestion
What are the causes of left sided heart failure?
- Hypertension/atherosclerosis
- AMI
- Malfunction of a heart valve
- Genetic predisposition
- Cardiomyopathy
What are the clinical signs and symptoms of left sided heart failure?
- Pulmonary congestion (fine lung crackles)
- Pulmonary oedema
- Cough
- Cyanosis
- Haemoptysis
- Tachycardia
- Tachypnoea
- Skin cool and diaphoretic
- Fatigue
- Dyspnoea
- Orthopnoea
What are the treatments for heart failure?
- Medication
- Lifestyle changes
Describe right sided heart failure.
Flows back up through the right atrium to the venous circulation
- Venous and organ congestion
- Peripheral oedema (pitting ankle oedema)
- Enlarged liver and spleen
- Distention of jugular vein
What are the causes of right sided heart failure?
- Chronic hypoxaemia - pulmonary vasoconstriction and increased red blood cell production causing increased blood viscosity, both cause pulmonary hypertension
- AMI
- Malfunctioning heart valve (tricuspid)
- Genetic predisposition, diseases, toxins
List 7 signs and symptoms of right sided heart failure
- Peripheral oedema
- Ascites
- Jugular vein distention
- Increased central venous pressure
- Weakness
- Pulmonary hypertension
- Weight gain
What are the treatments for right sided heart failure?
Treatment is aimed at relieving symptoms and improving quality of life
- Correct reversible causes
- Decreasing afterload
- Reduce oedema - e.g. diuretics
- Improving oxygenation
- Improving cardiac function = medication
- Reducing anxiety
- Education
Describe pulmonary oedema
Accumulation of fluid in the alveoli
Capillary fluid moves into alveoli
- Impairs gas exchange in alveoli
- Causes lung stiffness = harder to inhale
- Extreme shortness of breath and central cyanosis
- Crackles heard on auscultation
- Frothy sputum: maybe bloodstained
How is pulmonary oedema managed?
Reduce fluid in pulmonary circulation - Diuretics - help treat fluid retention and pulmonary oedema Improve performance of left side of heart - Nitrates - reduce preload - Support respiration - Anti-arrhythmic drugs Support respiratory effort Morphine
What are the nursing interventions associated with pulmonary oedema?
- Assessment and monitoring
- Support respiratory effort
- Medication administration
- Monitor fluid balance
- Appropriate rest, assistance with general hygiene
- Diet restrictions
- Skin integrity
What are the different types of Diuretics?
- Loop
- Thiazide
- Potassium-sparing
How do diuretics work?
Increase of sodium into the urine by the kidneys. Sodium takes water with it from your blood = decreases fluid flowing through your blood vessels. Reduces pressure on artery walls
What are some nursing considerations associated with giving diuretics?
- Vital signs
- Monitor fluid balance
- Blood results - electrolyte balance & urea and creatine
- Patient weight
- Oedema and ascites
- Monitor for excessive diuresis
Describe Shock Syndrome
Shock is an altered physiological state that can affect the functioning of every cell and organ system in the body; it is a complex syndrome reflecting decreased blood flow to body tissues with resulting cellular dysfunction and eventual organ failure
Describe Hypovolaemic Shock
- Refers to loss of circulating blood volume
- Occurs when the compensatory mechanisms fail
- This results in a drop of CO2 and hypoperfusion
Causes: - Haemorrhage
- Burns
- Dehydration
Define stage 1 of hypovolaemic shock
- Initial
Body’s compensatory mechanisms are effective
No visible changes
Define stage 2 of hypovolaemic shock
2. Compensatory Body's primary goal is to maintain blood flow to heart and brain through vasoconstriction (adrenaline) and shunting to vital organs. Anaerobic metabolism occurs Signs and symptoms: - Decreased peripheral blood flow -Tachycardia - Pulse pressure narrows - Initially BP may be normal - Urine output decreases - Early signs and symptoms of shock
Define stage 3 of hypovolaemic shock
3. Progressive Compensatory mechanisms begin to fail. The prolonged vasoconstriction will also cause the vital organs to be compromised due to reduced perfusion. Systolic pressure falls. Signs and symptoms: - Tachypnoea/cardia - Weak pulse - Narrow pulse pressure - Flat neck veins - Pale/cool/clammy - Hypotension - Oliguria
Define stage 4 of hypovolaemic shock
- Refractory
At this stage, vital organs have failed and the shock can no longer be reversed
Cellular necrosis due to lack of oxygen
Multisystem organ failure
What is the nursing management related to hypovolaemic shock?
- Treat the cause
- Oxygen therapy
- Replace fluid loss
- May need inotropic drug
- Urine output
- Suppine position
Describe cardiogenic shock
Caused by failure of the heart to pump efficiently. Low cardic output results in poor perfusion
- MI - decrease efficiently to pump
- Cardiac tamponade
- Mitral regurgitation
- Congenital problems; myopathy
