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