Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Heart Failure 1
pn 141 test 1book: med surg nursing pg 642
| Question | Answer |
|---|---|
| def of heart failure | the inability of the heart to function as a pump to meet the needs of the body |
| what does it result from (3 things) | any condtion that impairs effective contractions of the heart muscle, chronically increases the workload of the heart, (3) acutely increases the workload of the heart |
| The incidence of heart failure increases with _____ | age |
| is it progressive? | yes |
| What stimulates the SNS and causes compensatory mechanisms to be activated | cardiac output to drop |
| When the SNS is stimulated what two things increase | HR, and stroke volume |
| The stimulation of the SNS causes ______ to constrict | the BV |
| when the BV constrict it increases venous return, what does that do to the heart | it increases ventricular filling and myocardial stretch (preload), and increases the force of contraction |
| Where does the blood flow divert to in the body when the cardiac output dropped | to the heart and brain in order to maintain perfusion to these vital organs |
| Causes of heart failure: what are impaired function causes | CHD, cardiomyopathies, rheumatic fever, infective endocarditis |
| Causes of heart failure: What are increased workload causes | HTN, valve disorders, anemia, congenital heart defects |
| Causes of heart failure: what are noncardiac causes | volume overload, Hyperthyroidism, fever, infection, pulmonary embolus |
| A fall in cardiac output also activates the renin-angitensin-aldosterone system, what does this do in the body | it produces additional vasoconstriction, salt and water retention which increases the blood volume to help restore cardiac output |
| what do the chambers of the heart do to acommodate the additional fluid volume? -- | they dilate |
| The dilation to the chambers of the heart initially help how? - - - | leads to more effective contractions |
| What happens to the cardiac muscle cells because of the overdilation of the heart chambers | they enlarge, leading to ventricular hypertrophy |
| with the dilation of the chambers and the stimulation of the sns, and the activation of the angiotensin aldosterone system they at first effectively increase CO, but what happens after awhile | these mechanisms no longer maintain a CO that meets the metabolic needs of the body and heart failure occurs |
| b/c the heart muscle is working so hard with the increased HR, arterial vasoconstriction, increased workload of the heart what happens to the heart muscle | the heart muscle will become larger than the coronary blood supply causing myocardial ischemia |
| Guidlines to an older adult in order to maintain good cardiac function | allow longer warm ups and cooldown period during exercise, engage in regular exercise, rest w/ feet elevated, maintain adequate fluid intake, reduce sodium intake |
| How many classifications of heart failure are there? | 4 A-D (A= hish risk for it, no structural damage, B= Structural heart disease, no s/s of heart failure, C= structural heart disease with current s/s of heart failure, d= Advanced heart disease w/ s/s of heart failure and rest) |
| Do clients have Heart failure have cardiac reserve (allows heart to adjust to meet metabollic needs) | very little |
| Any stresser can do what to a person with heart failure | tax their ability to meet the demand for axygen and nutrients |
| high output failure Def | heart failure that results from acute excessive demands placed on the heart, such as fluid overload, hyperthyroidism, or fever |
| Left sided heart failure: Why is this side affected more often then the right side | because of the its high workload and oxygen demand |
| Left sided heart failure: What does it result from | ventricular muscle damage or overloading, HTN, MI |
| Left sided heart failure: impaired emptying of the left ventricle leads to increased pressure where? | in the left side of the heart and in the pulmonary vascular system |
| Left sided heart failure: Because of the increased pressure in the pulmonary vascular system where is fluid pushed to | it is pushed from the blood vessels into the interstitial tissues and the alveoli |
| Left sided heart failure: The s/s of it are from what two things | pulmonary congestion, and decreased cardiac output |
| Left sided heart failure: s/s of it: forward effect | activity intolerance, fatigue, weakness, dizziness, syncope |
| Left sided heart failure: s/s of it: backward effect | SOB, dyspnea, orthopnea, caough, tachycardia, crackles in lung bases |
| Left sided heart failure: what are the common early s/s | DOE, fatigue, activity intolerance |
| Left sided heart failure: When does acute pulmonary edema occur; s/s of it | when it becomes severe; severe dyspnea, SOB, anxiety, skin is cool clammy and cyanotic, productive cough with pink frothy sputum, confused, crackles throughout |
| Left sided heart failure: is pulomnary edema a medical emergency; why or why not | yes: the pt is drowning as a result of fluid in the alveolar and pulmonary spaces and must be treated immediately |
| Right sided heart failure: s/s of: forward effect | fatigue, activity intolerance |
| Right sided heart failure: s/s of it: backward effect | jugular vein distention, peripheral edema, anorexia, nausea, abdominal distention, ascites, liver spleen enlargment |
| Right sided heart failure: most common cause of it | left sided heart failure |
| Right sided heart failure: what happens to the right ventricle and atrium | they become distended and blood accumulates in the systemic venous system |
| Right sided heart failure: Abdominal organ congestion and peripheral tissue edema is caused by what | increased venous pressure |
| Right sided heart failure: where does fluid collect | in the dependent areas of the body because of gravity (feet and legs while upright, and in the sacrum of one who is reclining) |
| Right sided heart failure: s/s of congestion in the vessels of the abdomen | rUQ pain, anorexia and nausea |
| biventricular failure: definition | when both ventricles fail to function |
| biventricular failure: Def of paroxysmal nocturnal dyspnea(PND) | frightening condition where the pt awakens at night acutely SOB, . it occurs when edema fluid that occurs during the day is reabsorbed into circulation at night, causing fluid overload and pulmonary congestion. |
| biventricular failure: pt with this severe heart failure will have dyspnea when | at rest |
| Acute failure: occurs how | as a result of acute damage to the heart muscle (acute MI) |
| Chronic heart failure: develops how | is gradual, as result of long standing or progressive condition (HTN, valve disease) |
| What are the main goals of care for a pt with heart failure | reduce cardiac workload, improve cardiac pumping ability, aand control fluid retention |
| Testing: What will an x-ray show | pulmonary vascular congestion and cardiomegaly (if heart is dilated or hypertrophied) |
| Testing: what may be elevated in the blood with heart failure | cardiac hormones, atrial natriuretic factor and b-type natriuretic peptide |
| Testing: what will an ecg show | changes associated with ventricular enlargement, may show dysrhythmias, myocardial ischemia, or MI |
| Hemodynamic monitoring: why is it used | to assess CV function and pt response to tx |
| Hemodynamic monitoring: what is done | a multilumen cath is inserted through a central vein into the right side of the heart and pulmonary artery is used to measure the central venous pressure, pulmonary artery pressure and CO. |
| Hemodynamic monitoring: What are the risks involved with this | infection, bleeding, thrombus formation, puncturing of the lung |
| Meds: why are they given | to reduce cardiac workload and improve cardiac function |
| Meds: what are the 4 main ones used | ACE inhibitors, diuretics, inotrophic meds, direct vasodilators |
| meds: ACe inhibitors: names of common ones given | lisinipril (zestril), captopril (capoten), fosinopril |
| meds: ACe inhibitors: what do they do | they block the effect of the renin-angiotensin aldosterone system, reducing vasocontriction and sodium and water retentio. This results in decreased cardiac workload and reduced edema |
| meds: ACe inhibitors: Nursing implications | don't DC abruptly, give captopril one hor before meals, maintain bedrest and monitor BP for 3 hours after 1st doese (b/c significant hypotension can develop), monitor sreum potassium levels (hyperkalemia can develop) |
| meds: ACe inhibitors: Pt teacing | do not stop med abruptly, slowly change positions, report wt gain, easy bruising, edema, breathing problems |
| meds: diuretics: names of them | hydrochlorothiazide, furosemide (lasiix), spironolactone (aldoctone), acetazolamide (Diamox) |
| meds: diuretics: what do they do | act on different portions of the kidney tubule to promote sodium excretion and water excretion, except for the potassium sparring diuretics, they also promote potassium excretion, increasing the risk for hypokalemia |
| meds: diuretics: nursing implications | monitor fluid volume status (BP, I&O, wt, skin turgor, edema), assess for volume depletion (dizziness, orthostatic hypotension, tachycardia, muscle cramping), check electrolyte values |
| meds: diuretics: Pt teaching | report abdominal pain, dark urine, jaundice, bleeding, s/s of electrolyte imbalance. Check BP, pulse and wt daily (report wt change of 2 pounds to md), avoid sudden position changes, drink enough water, take w/ meals, take potassium |
| MEd: positive inotropic agent: Names | digoxin (lanoxin) |
| MEd: positive inotropic agent: what do they do | they increase the strength of the hearts conctraction by increases CO and stroke volume. it will slow hr and oxygen consumption |
| MEd: positive inotropic agent: Nursing implications | assess apical pulse before (hold if <60), assess serum electrolyte and digoxin levels |
| MEd: positive inotropic agent: s/s of digitalis toxicity | anorexia, n/v, abdominal pain, weakness, vision changes, dysrhythmias |
| MEd: positive inotropic agent: pt teaching | take pulse before dose, call doc if s/s of toxicity, avoid antacids and laxatives (they decrease absorption of digoxin), increase potassium in diet |
| MEd: Vasodilators: names | dopamine, dobutamine, amrinone, milrinone |
| MEd: Vasodilators: what do they do | they vasodilate and improve the force of the ventricular contraction, they decrease cardiac workload |
| MEd: Vasodilators: nursing implications | administer IV, don't DC abruptly, |
| MEd: why is morphine gieven | drug of choice for pulmonary edema b/c it relieves anxiety, improves breathing and is also a venous vasodilator |
| Meds: digoxin/ Digitalis: what does it mean that digoxin has a narrow therapeutic index? | therapeutic levels and very close to the toxic levels |
| Meds: digoxin/ Digitalis: What blood levels increase the risk for toxicity | low serum potassium levels, low magnesium leves, and high calcium levels |
| Diet: what is it | low sodium (decreases sodium and water retention) |
| When would the pt be on bed rest | during acute episodes of heart failure |
| What is the primary Tx for end stage heart failure? | heart transplant |
| What does the heart transplant consist of? | Diseased heart is removed, leaving portions of the atria, the donar heart is sutured in place |
| what is a "piggyback" transplant? | the pt heart is left in place and the new heart is sutured to it, so they have two functioning hearts |
| Nursing care for a heart transplant: what are the two major post-op concerns | infections and rejection |
| Heart transplant: what drugs are give nto prevent rejection | immunosuppressive drugs (but they leave pt with impaired defense mechanisms) |
| Surgery- dynamic cardiomyoplasty: what is it? | involves wrapping a skeletal muscle graft around the heart to lend support to the failing myocardium (doesn't show to improve either survial or quality of life) |
| What is the major nursing goal of care for heart failure | reducing the oxygen demand on the heart |
| Nx Dx: decreased CO- What may be heard when auscultating breath sounds | an s3 or s4, crackles |
| Nx Dx: decreased CO- S/s of it | cool clammy skin, tachycardia, diminished pulses, pallor, dysrhythmias |
| Nursing Dx: Excess fluid volume- S/s of acute pulmonary edema | hunger, sense of impending doom, panic, tachycardia, orthopnea, cough w/ productive pink frothy sputum |
| Nursing Dx: Excess fluid volume- with wt gain 1 liter of fluid = how many extra pounds | 2.2 lbs |
| Nursing Dx: Excess fluid volume- why dhould pt be placed in fowlers position? | it reduces venous return to the heart, decreasing its work and improves lung expansion |
| Nursing Dx: Excess fluid volume- what med helpa excrete sodium and water | diuretics |
| What are activty guidelines for pt with heart failure | perform as many as they can, space meals (six a day), allow rest periods, rest if you get tired, stop activities that cause chest pain, SOB, excessive weakness, sweating, avoid straining, eat high fiber diet, begin gradual exercise program |
| two main problems of heart failure | increased workload, decreased pump function |
| what issues increase the workload of the heart | HTN< anemia, valve disease, fluid overload, COPD, pulmonary edema |
| why does COPD increase the workload of the heart | not enough o2, right side is more effected because it has to pump harder to get blood into lungs |
| what issues decrease the pump function of the heart | MI, cardiomyopathy, CAD, |
| causes of right sided heart failure: | R vent MI, PHTN, L heart failure` |
| what is mural thrombi: | blood clots on the wall of the right ventricle |
| mural thrombi: when do they occur (L or R sided HF) | right sided |
| Nursing goals for CHF pt (from most important to least) | workload of the heart (reduce it), vessel and tissue congestion, impaired gas exchange (to treat the first one will help prevent the rest) |
| what will a chest xray reveal | enlarged heart, fluid in lungs |
| meds given in stage one: | ace inhibitors, ARBs (sartans) |
| meds given in stage 2: | beta blockers, diuretics |
| meds given in stage 3 | inotrpics, vasodilaters |
| stage four tx: | all meds in first three stages and heart transplant waiting list |
| Angiotensin 2 receptor antagonists: what do they end in | sartan |
| Angiotensin 2 receptor antagonists (sartan): uses | HTN, CHF |
| Angiotensin 2 receptor antagonists (sartan): adverse effects | dizziness, URI infections, |
| Angiotensin 2 receptor antagonists (sartan): action | they bind angiotensin 2 at various receptor sites in the vascular smooth muscle and adrenal gland which blocks the vasoconstrictive effect of the renin-angiotensin system, which lowers BP |
| inotropic drug: what is the common one | digoxin |
| digoxin: action | increases CO through positive inotropic activity (increase in the force of the contraction), they slow the conduction velocity through the AV node in the heart and decrease the heart rate |
Created by:
jmkettel
Popular Nursing sets