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M6 13-005
Exam 4: Cardiovascular System- Heart Failure/ Pulmonary Edema
| Term | Definition |
|---|---|
| Heart Failure | Results from the heart's inability to meet the demands of the body's metabolic needs. |
| Inefficient Circulation | This leads to congestion of body organs with blood and tissue fluid. |
| Neurohormonal | A hormone secreted by or acting on a part of the nervous system. |
| Catecholamines | Epinephrine and Norepinephrine |
| Toxic Effect, Negative Effect | Hormones of the sympathetic nervous system exert a _______ _______ & produce a _______ ________ on the failing heart. |
| Causes of CHF | Congenital Defects, Diseases of the heart & Blood Vessels |
| Diseases of the Heart and Blood Vessels | Artherosclerosis, Arteriosclerosis, MI, DM, HTN, Valvular heart disease. |
| Diseases that Increase Cardiac Output | Infection, Stress, Hyperthyroidism, Pregnancy, Anemia |
| Renin activates angiotensin I formation | ACE converts angiotensin 1 to angiotensin II (potent vasoconstrictor) |
| ACE converts angiotensin 1 to angiotensin II (potent vasoconstrictor) | II also includes aldosterone secretion from the adrenal gland (NA & H2o retention) |
| II also includes aldosterone secretion from the adrenal gland (NA & H2o retention) | Increase blood pressure |
| Causes of CHF factors | Increase strain on the heart b/c interference with blood supply to heart. Increase in workload to pump blood through narrowed, stiffened vessels. |
| Conditions that Increase Cardiac Output | Infection, stress, hyperthyroidism, Preganancy, Anemia |
| Heart Failure Clinical Manifestations | Decreased cardiac output. LEFT ventricular failure. RIGHT sided failure. |
| Left Ventricular Failure (Lungs) | Increased pressure in the left side of the heart backs up to the pulmonary system. |
| Cardiac Output | The amount of blood the heart pumps out in 1 minute. 4-8l/min |
| Left Ventricular Failure (Fluid) | Increased permeability to the capillaries causes fluid to be pushed into the pulmonary capillary bed resulting in pulmonary edema and pleural effusions |
| Left Ventricular Failure | Inability of the left ventricle to effectively pump enough blood to meet needs of body tissues. |
| S/S Left Ventricular Failure | Decreased Cardiac output. Pulmonary congestion. (Coughing, tiredness, Swelling in ankles and thighs). |
| Why does Left Ventricular Failure often occur 1st? | The left ventricle is most often affected by coronary atherosclerosis and HTN |
| Right Ventricular Failure | Most often caused by left-sided failure, but Chronic Pulmonary Disease & Pulmonary HTN also cause this. |
| Right Sided Heart Failure | Results in fluid accumulation in systemic circulation (Poor Venous Return). -> RV unable to pump blood to lungs b/c of increased pulmonary pressures -> Patients retain Sodium which worsens edema |
| Dependent Edema | Edema of ankles when patient is standing or sitting. May shift to sacral region when prone. |
| Pitting edema | When pressure is applied, pressure area becomes indented. When pressure is released, indentation disappears over time. |
| RIGHT Ventricular Failure S/S | Nocturia, Organ Dysfunction (Hepatomegaly w/ right upper quadrant pain, ABD edema (farts, anorexia, nausea, ABD distention), wieght gain, JVD |
| Heart Failure Subjective Data | Dyspnea, Orthopnea, Cough |
| Heart Failure Objective Data | Decrased Cardiac Output, Right Sided failure on digestive organs, cyanosis. |
| Dx Tests for CHF | Chest X-ray, Electocardiography (ECG), Echocardiography, Exercise Stress testing, Cardiac Catheterization |
| Lab Tests of CHF | ABG (hypoxemia & acidosis), LFT, Serum Electrolytes & Enzymes (Na, Mg, K, BUN, Creat) |
| Digitalis Preparations (Cardiac Glycosides) | Improve cardiac output and increase contractile force of ventricles. Also slows heart rate. |
| Heart Failure Drug Therapy | Diuretics, Nitrates, ACE Inhibitors |
| Diuretics | Reduce excess fluid and sodium stored in tissues |
| Nitrates | Peripheral vascular resistance, increase left ventricular output, increase left ventricular emptying, and increase cerebral and renal blood flow. |
| ACE Inhibitors | Decrease peripheral vascular resistance, improve cardiac output and studies have shown to extend and improve the lives of the patient with heart failure. |
| 1L of fluid | 1kg or 2.2 lbs |
| 1+ trace | Slight, rapid |
| 2+ Mild | 4mm (0-1/4 in), 10-15 seconds |
| 3+ Moderate | 6mm (1/4-1/2 in), 1-2 Minutes |
| 4+ Severe | 8mm (1/2-1 in), 2-5 Minutes |
| Nursing Management for Heart Failure | Prevent Disease Progression, and Complications |
| Pulmonary Edema | Accumulation of fluid in the air sacs (alveoli) in the lungs caused primarily/ most often by heart failure. |
| Process of pulmonary edema | Blood from L side backs up into the lungs-> 1.Fluid accumulates in the interstitial lung tissue and alveoli 2.decrease gas exchange -> Resp. Distress; frothy sputum; may be blood tinged |
| Clininal Manifestations of Pulmonary Edema | Frothy Sputum: produced from air mixing with fluid in the alveoli. Blood tinged: from cells busting into the alveoli. |
| Pulmonary Edema s/s | Restlessness, agitation, severe dyspnea, tachypnea, tachcardia, cyanosis, cough, wheezes, crackles, cold extremities |
| Pulmonary Edema Dx Tests | Physical exams, CXR, ABG sampling |
| Pulmonary Edema Medical Management | Improve Oxygenation, Cardiac Output, Reduce Pulmonary Congestion |
| Morphine (10-15mg) Titrate IV | Decrease pt anxiety, slow respirations, reduce venous return, dilate pulmonary blood vessels |
| Pulmonary Edema Management (Oxygen 40-60 (100)% | Non-rebreather face mask; intubation PRN to promote oxygenation, and increase tidal volume |
| Pulmonary Edema Management (Nitroglycerin SL) | INcrease myocardial blood flow |
| Pulmonary Edema Management (Diuretics) | reduce pulmonary edema and increase renal excretion |
| Inotropic Agents (Dobutamine/Dobutrex) or (Amrinone/Inocor) | increase myocardial contractility without increasing mycardial oxygen consumption |
| Nitroprusside/Nitropress | vasodilator to improve myocardial contraction and reduce pulmonary congestion |
| Nursing Intervention for Pulmonary Edema | Improve Oxygenation and cardiac Output |
| Intropic Agents Action | Stimulates Best 1 (myocardial)-adrenergic receptors with relatively monitor effect on heart rate or peripheral blood vessels |
| Inotropic Agents Therapeutic Effects | Increased cardiac output, blood pressure and improved renal blood flow |
| Inotropic Agents Indication: Dobutamine (Dobutrex) | Inotropic support in CHF, Cardiogenic Shock |
| Inotropic Agents Indication: Dopamine (Inotropic) | Hypotension associate with shock, renal insufficiency |
| Inotropic Agents Side Effects | Headache, SOB, CV: HTN, Increased HR, Premature Ventricular Contractions, Angina Pectoris, Arrythmias, Nypotension, palpations. N/V |
| Inotropic Agents Nursing Implications | Monitor BP, HR, ECG, PCWP, Cardiac Output, CVP and urinary Output continuously during administraion |
| Inotropic Agents Laps Considerations | Monitor K concentrations during therapy, may cause Hypokalemia. Monitor electrolytes, BUN, Creat and PT weekly during prolonged therapy. |
Created by:
jtzuetrong
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