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AHII
heart failure
| question | answer |
|---|---|
| Who has the highest mortality in heart failure | women & african americans |
| what is the coorelation with heart failure and african americans | HTN |
| what is heart failure | heart cannot pump enough blood to meet the metabolic needs of the body; low flow to the kidneys which starts RAA |
| clinical syndrome of heart failure results in | volume overload due to RAA activation; inadequate tissue perfusion; poor exercise tolerance |
| heart failure AKA | CHF; cardiac insufficiency; ventricular failure |
| what does heart performance depend on | contractility;preload;afterload; heart rate |
| contractility = | pumping |
| preload = | amount of blood in ventricle at end of diastole |
| afterload = | the pressure against which the left ventricle ejects |
| patho of heart failure | abnormal loading; abnormal muscle function; limited ventricular filling; cor pulmonale |
| cause of abnormal loading | heart valve disorders; congenital defects |
| cause of abnormal muscle function | scarring; dead muscle from MI |
| cause of limited ventricular filling | hypertrophy of the ventricle; cardiomyopathy |
| cor pulmonale | right sided heart failure from right valvular disease; right heart MI; COPD |
| what happens with untreated unilateral heart failure | will lead to bilateral heart failure |
| sx of left side heart failure | dyspnea; orthopnea;pallor;tachycardia;cough;PND;crackles;wheeze;renal failure;decreased LOC;S3-S4;blood sputum;cyanosis;tachypnea;vasoconstrict;hypoxemia;fatigue |
| ejection fraction | percentage of blood ejected from the ventricle during systole; Norm 60-70% |
| complications of left side heart failure | acute pulmonary edema; Medical emergency |
| signs of pulmonary edema | frothy blood tinged sputum;abrupt onset; drowning in own secretions; fear and anxiety from hypoxemia |
| sx of right side heart failure | venous congestion;hepatomegaly;cirrhosis;dependent edema;anarsarca;fear;elevated liver enzyme;RUQ pain;jugular venous distension |
| diagnostic test for heart failure | x-ray;echocardiogram;ECG;radionuclide imaging |
| x-ray findings in heart failure | cardiomegaly; pulmonary effusion; infiltrates |
| echo findings in heart failure | ejection fraction; valve function |
| ANP or BNP | peptide that opposes the RAA system;higher peptide = worse heart failure; |
| Marker for CHF | ANP artial natriuetic peptide or BNP brain naturietic peptide |
| what releases ANP | excessive atrial/ventricular stretch |
| what does ANP do | causes natriuresis and reduction in blood |
| ANP norm | < 100 pg/ml |
| medical management of heart failure | O2; digoxin; diuretics;Iv inotropic drugs (dopamine, dobutamine); invasive cardiac monitoring (swan-ganz) |
| main goal in heart failure | optimize preload and decrease afterload ( w/antihypertensive) Possible need to reduce preload |
| purpose of digoxin | increase contractility & cardiac output |
| therapeutic range of digoxin | narrow 0.8-2.0 ng/ml |
| sx of digoxin overdose | N/V/D; anorexia; palpitations; heart block; visual changes; lethargy; ataxia |
| what to assess when using digoxin | e-lytes; especially potassium; if hypokalemic more likely to be digtoxic; assess pulse (hold if < 60) |
| drug for digoxin overdose | digiband |
| iv administration of digoxin | over 5 min |
| when to take digoxin levels | 4 hours after iv and 6 hours after oral |
| purpose of diuretics | reduce fluid overload; reduce preload |
| what to assess w/ diuretics | e-lytes; daily weight |
| diuretic of choice for heart failure | lasix or potassium sparring diuretic aldactone |
| how to administer lasix | at a rate of 20mg/min |
| complications caused by lasix | to rapid infusion can = hearing loss due to ear bone calcium loss; can waste magnesium as well as calcium |
| purpose of antihypertensives in heart failure | reduce AFTERLOAD |
| antihypertensive of choice for heart failure | beta blocker COREG |
| purpose of beta blockers in heart failure | block renin secretion; slow HR; METOPROLOL-hypoglycemia, bronchospasm |
| purpose of ace inhibitors in heart failure | block angioten 1 change to angioten 2; CAPTOPRIL- dry cough; angioedema |
| purpose of ace receptor blockers | block receptor that recieve enzyme; COZAAR-cough |
| why no calcium channel blockers with heart failure | they relax the muscle & interfere w/ myocardial contractility |
| nursing management of heart failure | maintain cardiac output by: ECG rhythms; vs; I&O; asses heart & lung sounds; assess peripheral pulses; effectiveness of meds; balance activity & rest; small frequent meals |
| goal of heart failure | stable VS. urinary output wnl; regular cardiac rhythm |
| maintaining fluid balance w/ heart failure | I&Os; assess for edema; abdominal assess (hepatomegaly); fluid sodium restriction, assess lung sounds;effectiveness of diuretics; assess wt (1 kg = 1L of fluid) |
| goal of fluid balance in heart failure | maintain normal weight; clear lung sounds; less edema |
| when is weight gain a concern in heart failure | more than 2 pounds in one day or 5 in one week |
| activity intolerance and heart failure | space activities; schedule rest periods; monitor response to activity; increase activity as tolerated |
| goal for activity intolerance | improved level of activities w/out dyspnea |
| rheumatic heart disease | inflammatroy disorder caused by group A beta- hemolytic strep |
| rheumatic fever | diffuse inflamm disease which can affect the heart valves |
| rheumatic heart disesase affects what | aortic & mitral valves (left side) |
| when to tx strep infection | in 9 days of diagnosis to reduce risk of rheumatic fever |
| patho of rheumativ heart disease | immune response causes inflamm lesion in connective tissues of heart, joints, skin ; pericardial & myocardial inflamm is mild & self limiting; endocardial inflamm causes swelling and vegetative lesions on valve leaflets leading to scarring/deformity |
| endocarditis | inflamm of any part of the endothelial lining of the heart; valves are usually affected; infectious; uncommon |
| risk factors for endocarditis | previous heart damage; iv drug use (tricuspid); invasive catheters; dental procedures; oral injections; any invasive procedure |
| patho of endocarditis | veg lesions from platelet-fibrin collect on valves; organisms colonize the vegetations & covers bacterium; they can embolize and travel to other organs; they can scar valves causing turbulance (stenosis or regurg) |
| sx of endocarditis | fever;malaise;arthralgias;cough;dyspnea;murmur;anorexia;abd pain;heart failure;splenomegaly;infarct of organs (emboli); abcess;aneurysm |
| embolic complications of endocarditis | petechiae; splinter hemorrhage; osler nodes; janeway lesions; roths spots |
| osler's nodes | painful pea sized nodules on fingertips, toes |
| janeway lesions | flat non tender spots on palms, soles |
| roth's spots | white or yellow center spots with red halos on the optic disc |
| edocarditis meds | antibiotics; 1 hr for preventitive dental, IV for active infection 2-8 weeks, 6-8 week IV for prosthetic valve infections |
| surgical tx for endocarditis | replace/remove valve if fungal infection, remove large vegetations |
| stenosis | narrowed fused valve obstructs forward flow of blood through heart |
| complications with stenosis | decreased CO & SV; backflow will occur; increased workload BEHIND incompitent valve |
| what does mitral stenosis affect | left atrium |
| stenosis leads to what | hypertrophy, dilation and eventual heart failure |
| regurgitation | valve fails to close properly allowing blood to flow back through the chamber the blood just left |
| cause of regurgitation | deformity/erosion of valve cusp caused by MI or dilation due to heart failure |
| why does valve not close w/ regurgitation | valve annulus is stretched so edges no longer close |
| true for all valve disorders | may be asymptomatic; can cause decreased fillin of the chamber BEFORE it and this will decrease CO as filling is decreased ( mitral = left ventricle);all cause dilation of chamber BEHIND it as pressure increase (mitral = left artium), |
| mitral valve prolapse | common in young women; RHD; ischemic HD; usually benign; marfan's syndrome |
| aortic/mitral disorders cause sx of | left sided failure as disease progresses |
| tricuspid/pulmonic disorders cause sx of | right sided failure as disease progresses |
| diagnostic tests for valve disorders | echocardiography (TEE, NPO, sedation); chest x-ray; ECG; cardiac cath |
| medical tx of valve disorders | percutaneous balloon valvuloplasty; open valve repair; valve replacement |
| pericarditis | acute or chronic inflammation of the parietal and visceral pericardium |
| what is acute pericarditis usually | viral |
| normal pericardial fluid | 50cc |
| amount of pericardial fluid in pericarditis | 100-3000 cc |
| subjective sx of pericarditis | mimic MI pain or pleurisy, malaise, joint pain, N/V |
| objective sx of pericarditis | pericardial friction rub; temp; elevated ESR; elevated WBC; cardiac ezymes norm or elevated |
| interventions for pericarditis | sitting up relieves pain; NSAIDs; rest |
| diagnostic tests for pericarditis | echocardiogram; usually transthoracic |
| cardiac tamponade | life threating; blood/fluid accumulate in pericardium;compress the heart; cause hypotension; decreased CO |
| when does cardiac tamponade occur | post open heart; trauma |
| pulsus paradoxis | occurs with cardiac tamponade; a decrease in the systolic pressure by 10 mmHg w/ inspiration |
| immediate intervention for cardiac tamponade | pericardiocentesis |
| cardiomyopathy | heart muscle disorder |
| dilated cardiomyopathy | most common; involves dilation of both sides of heart; muscle fiber deteriorate & replaced with fibrotic tissue |
| cardiomyopathy causes | poor contractility and blood pooling |
| causes of cardiomyopathy | alcohol; toxins; pregnancy; connective tissue disorders; genetics |
| Tx of cardiomyopathy | tx like heart failure; pt with poor EF% (10-15%) are placed on a transplant list |
| aorta anotomical site | rt of sternum 2nd intercostal space |
| pulmonic anotomical site | left of sternum 2nd intercostal space |
| erb's point | 3rd left intercostal space |
| tricuspid anatomical site | left 5th intercostal space |
| mitral anatomical site | apex |
| S1 loudest at | mitral;tricuspid |
| S2 loudest at | aortic;pulmonary |
| S3 & S4 loudest at | mitral |
Created by:
aclelan
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