week 6 - heart failure Flashcards Preview

PNH > week 6 - heart failure > Flashcards

Flashcards in week 6 - heart failure Deck (30)
Loading flashcards...
1

Heart Failure

Also called pump failure
General term for the inability of the heart to work effectively as a pump

2

Diastolic failure-

inability of ventricle to relax

3

Systolic failure

MOST COMMON
inadequate ventricular contraction*

4

Most Common Causes

CAD- Myocardial Infarction

Systemic hypertension

5

Left-Sided Heart Failure FORMALY KNOWN AS

Formerly known as congestive heart failure

6

Left-Sided Heart Failure Typical Causes

Hypertension
Coronary Artery Disease
Valvular disease

7

Indicators of LVHF:

- Decreased tissue perfusion due to poor CO and pulmonary congestion from increased pressure in the pulmonary vessels
-Mitral or aortic valves affected
-Failure may be chronic or acute, mild to severe

8

Right-Sided Heart Failure TYPICAL CAUSES

-left ventricular failure
-right ventricular MI
- pulmonary hypertension
-Lung disease

9

Right-Sided Heart Failure

Right ventricle not able to empty completely
Increased volume and pressure in the venous system and peripheral edema

10

Most HF begins with

LVF and progresses to failure of both ventricles

11

RHF without LHF

usually due to pulmonary problems eg: COPD, pulmonary HTN

12

Left heart failure usually leads to

right heart failure

13

Heart Failure

Biventricular failure very difficult to treat

Need for increased volume or “stretch” on right while left cannot accommodate increased volumes

Fatigue may be only presenting symptom

14

High-Output Failure

-Less common
-Cardiac output remains normal or above normal
-Caused by increased metabolic needs of hyperkinetic conditions such as:
((Septicemia
Anemia
Hyperthyroidism))

15

Compensatory Mechanisms

Purpose: Maintain required Cardiac Output (CO)
How does the body compensate?
((Increased heart rate
Improved stroke volume
Arterial vasoconstriction
Sodium and water retention
Myocardial hypertrophy))

*These mechanisms cause damage to the pump over time

*Manifestations of HF occur when compensation fails

16

Left-Sided Heart Failure Manifestations

Cough-irritating, nocturnal, non-productive *early manifestation
Weakness
Fatigue
Dizziness
Confusion…especially in elderly
Palpitations/chest discomfort
Anxiety
Pulmonary congestion
Air hunger, tachypnea, pulmonary edema= moist cough with pink frothy sputum *life-threatening
Dyspnea on exertion (DOE)
Orthopnea
Tachycardia
Diaphoresis
Cyanosis or pallor
Insomnia
Anorexia
Low 02 saturation
Oliguria
Death

What assessment questions you would ask?
What teaching does your patient need?

17

LHF Assessment Findings

Decreased BP
Orthostatic hypotension
Tachycardia
Dysrhythmias
Tachypnea
Crackles
S3-gallop

18

Right-Sided Heart Failure Manifestations

Distended neck veins
increased abdominal girth
due to ascites or dependent edema
Hepatomegaly
Abdominal tenderness
N & V, constipation, anorexia
Dependent edema
Hands, feet/legs, sacrum or abdomen depending on positioning
Nocturia
Decreased U/O
Weight—the most reliable indicator of fluid gain or loss*** check daily in a.m.
BP may increase or decrease

19

RHF Assessment Findings

Hepatomegaly
Splenomegaly
Dependent pitting edema
Jugular vein distention (JVD)
Positive hepatojugular reflex
Ascites

20

Assessments

--Psychosocial assessment
Anxiety, potential depression
--Lab
Electrolytes, liver enzymes and renal function (BUN, Creatinine)
INR
Arterial Blood Gases (ABGs)
B-type Natriuretic Peptide (BNP)

CXR, CT, MRI
Trans-esophageal Echocardiogram *diagnostic of HF
Coronary angiography/cardiac catheterization

---Electrocardiography
Monitor for dysrhythmias **atrial fib most common

21

Collaborative Management

Treat underlying cause and precipitating factors

Provide oxygen and support ventilation

Provide medications to relieve symptoms

Manage acute pulmonary edema

Initiate low-calorie(prn) and low-sodium diet

Initiate device or electronic therapy

22

Drugs that reduce afterload

ACE inhibitors and Beta Blockers are first line therapy
ARBs
human B-type natriuretic peptides

23

ACE inhibitors-

watch for cough, monitor K+, check fluid status

24

Interventions That Reduce Preload

---Nutrition therapy (ie: reduce sodium, reduce calories prn)
----Fluid restriction 1500-2000 ml/day

---Drug therapy
diuretics and venous vasodilators
Digoxin*, other inotropic drugs, beta-adrenergic blockers (enhance contractility)


Teach patient to notify MD if weight gain > or = 1 kg/day x 2 days

25

Potential for Pulmonary Edema

---Assessment:
crackles in the lung bases, cough with frothy pink sputum, dyspnea at rest, disorientation, and confusion, tachycardia, anxiety, restlessness, decreased U/O
*crackles start at bases and progress upwards as condition worsens
---Interventions:???

26

Digoxin

-Slows the rate of contraction
-Increases the strength of contraction
-Check the apical pulse for one full minute before administration. Hold if HR less than 60
-Therapeutic level 0.5-2.0

27

Digoxin Toxicity

Bradycardia
Other arrhythmia
Anorexia, nausea, diarrhea
Blurred vision
Depression
Patients may think they have the ‘flu’

**monitor dig levels**
Report HR below 60 and above 100
Keep K+ above 4…hypokalemia=potential for dysrhythmias

28

Activity Intolerance

--Interventions include:
Balance activity and rest
Nap to restore energy
Recognize energy limitations
Conserve energy
Adapt lifestyle to energy level
Report adequate endurance for activity
ROM, physio to maintain strength
Organize nursing care to allow for rest periods

What are S & S of activity intolerance?

29

Other Nursing Diagnoses

--Risk for or Actual:
Impaired Mobility
Ineffective tissue perfusion
Excess fluid volume
Acute confusion
Ineffective therapeutic regimen management
Anxiety

30

Community-Based Care

Home care management

Health teaching*** MAWDS

Health care resources