Busy. Please wait.
Log in with Clever
or

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever
or

Username is available taken
show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.


Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.

Nursing Management of Heart Failure

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
        Help!  

Question
Answer
The "face" of HF   elderly, older you get the more likely you are to get HF. men and african-americans are more at risk.  
🗑
Flow of blood through the heart   vena cave to RA, through tricuspid valve to RV, through pulmonic valve to the lungs, through pulmonary arteries to LA, through mitral valve to LV, through aortic valve, through aorta to the rest of the body.  
🗑
Pre-Load   the volume of blood int he ventricles at the end of diastole. Means how much the heart is filling and stretching.  
🗑
After-Load   force that the heart has to work against. Resistance.  
🗑
After-Load: systemic vascular resistance   force the LV has to push against to push blood to the body  
🗑
After-Load: pulmonary vascular resistance   force the RV has to push against to push blood to the lungs  
🗑
Cardiac Output   HR x SV. normal is 3-6L/min. volume of blood per time.  
🗑
CO: SV   pre-load, after-load, and contractility.  
🗑
Frank-Starling Law   increased volume = more stretch; more stretch = more force of contraction. Rubber band: the more you stretch it, the further it will fly  
🗑
Heart Failure is...   ventricular dysfunction. diminished quality of life (activity intolerance, fatigue, dyspnea). Impaired cardiac pumping or filling (or both). occurs when the heart is unable to meet the metabolic demands of the body  
🗑
HF: most common causes/risk factors   diabetes; smoking; obesity; HTN (increases risk x3); CAD/MI; increased age.  
🗑
Systolic HF   PUMP problem. contraction isn't working. Characterized by a decreased ejection fraction.  
🗑
Systolic HF: main cause   MI. damage from MI causes ischemia, that part can't pump and starts to stretch due to increased end-diastolic pressure, further inhibiting it's ability to contract. Also caused by valvular disease and HTN.  
🗑
Diastolic HF   problem of FILLING. cant get enough blood INTO the heart. muscle can be hypertrophied, less room for the blood in the Vs. Ejection fraction will be normal (~60%) (contraction is good, less blood is coming in, less volume pumped out, but the % is same).  
🗑
Diastolic HF: main cause   chronic hypertension. increase after-load, vessels are clamped down and tight, causes the heart muscle to get very strong to get a bigger force of contraction, but this causes the muscle to hypertrophy.  
🗑
Diastolic HF: other main cause   aortic stenosis. blood can't pass through the valve, gets stuck in the LV, causes it to try and pump harder, muscle hypertrophies.  
🗑
R vs. L HF   determines the Sx the patient will have, determines the Tx. most of the time, pt's aren't one side or the other, they are a mixture of both  
🗑
L Sided HF   blood backs up to the lungs/pulmonary system causing pulmonary edema, dyspnea, cough, crackles, etc.  
🗑
L sided HF: causes   MI, HTN, cardiomyopathy (big floppy heart already having contraction problems).  
🗑
L sided HF: Assessments   lung sounds (crackles); RR (expect to be high - tachypicnic). frothy sputum, productive cough. cyanosis (poor perfusion). increased cap refill. SpO2 may be low.  
🗑
R Sided HF   blood backs up to the body, peripheral circulation  
🗑
R sided HF: causes   L sided failure (blood just keeps backing up. L backs up to lungs, R pumps to lungs which are already full, R starts to fill as well). MI on RV. chronic pulmonary disease (i.e. COPD - high pressure system, hard for heart to pump against, blood backs up).  
🗑
R sided HF: clinical manifestions   JVD. peripheral edema. hepatomegaly & spleenomegaly (sx: anorexia and nausea - GI syst congested w blood). weight gain.  
🗑
HF: Compensation Mechanisms   body sense decreased CO (all HF has this). SNS activation. RAAS. Biomarker Response. Remodeling. Dilation. Hypertrophy.  
🗑
Compensation Mechanisms: SNS activation   fight or flight. increased HR (to increase CO). vasoconstriction. increased contractility. this all increases O2 demand.  
🗑
Compensation Mechanisms: RAAS   water & sodium reabsorption (aldosterone) - increases preload (volume). vasoconstriction (angiotensin) - increases after-load (resistance). this increases the work on the heart on an already weak, damage heart, which makes things worse.  
🗑
Symptoms of decreased CO   kidneys: renal insufficiencies, oliguria, nocturia. brain: confusion, restlessness, change in LOC.  
🗑
Sx of increased workload on heart   angina (doesn't have O2 supply to keep up with work). increased RR. dysrhythmias. fatigue. activity intolerance (r/t imbalance between O2 supply & demands).  
🗑
Compensation Mechanisms; Biomarker Response   BNP (b-type naturetic peptide). overtime, as H is overstretched & overfilled, BNP is released. causes some vasodilation and minor diuresis (can help by nature! usually not enough to fix the problem).  
🗑
BNP Lab   can be a lab valve to see what is happening to the heart. if they are releasing a lot of this peptide, then their heart is stretching a lot.  
🗑
Compensation Mechanisms: Remodeling   either remodeling of dilation or remodeling of hypertrophy  
🗑
Compensation Mechanisms: Dilation   Systolic increases pressures & increases chamber size. eventually leading to decreased CO. Systolic HF.  
🗑
Compensation Mechanisms: Hypertrophy   increased muscle mass & wall thickness. also means it needs more O2 & coronary circulation. now at increased risk for dysrhythmias (electrical impulse may not get through the big thick muscle). Diastolic Hf.  
🗑
HF Complications   Acute Decompensated Heart Failure. Dysrhythmias. Chronic HF.  
🗑
ADHF   chronic patient becomes a more life-threatening situation. everything now is decompensated. Pulmonary edema.  
🗑
ADHF: causes   L ventricular failure  
🗑
ADHF: Sx   increased RR. decreased PaO2, SpO2. cool. slammy skin (poor perfusion due to dec CO). frothy blood-tinged sputum. crackles, wheezing, rhonchi. increased HR. anxious (feel like suffocating, can't breathe). exhausted.  
🗑
ADHF: Treatment   determine the underlying cause, treat the cause  
🗑
HF Diagnostics   ECHO. Labs. Chest X-Ray.  
🗑
HF Diagnostic Labs   BNP (has the H stretched over time?). cardiac enzymes (have they had an MI?). ECG (rhythm? dysrhythmia? changes? trends?). LFT. CBC. CMP.  
🗑
Nursing & Collaborative Care   positioning. oxygen. monitoring & continued assessments. drugs. anxiety reduction. teaching. priority actions.  
🗑
Nursing & Collaborative Care: positioning   high fowlers, preferably feet dangling. decrease venous return and increases thoracic capacity.  
🗑
Nursing & Collaborative Care: Oxygen   supplemental, nasal canula or mask, or ICU on a ventilator.  
🗑
Nursing & Collaborative Care: monitoring & continued assessments   vitals (Q4H at least), hemodynamics status, central lines, IV, tele/continuous ECG, I/Os, daily weights.  
🗑
Nursing & Collaborative Care: drugs   Lasix. Digoxin. Beta-blockers. Anti-coagulants. ACE inhibitors. Calcium-Channel blockers. vasodilators. Morphine.  
🗑
Nursing & Collaborative Care: anxiety reduction   low stimulus (low lights). breathing exercises, calm breathing. let they know the plan for the day. be there with them, sit down and talk.  
🗑
Nursing & Collaborative Care: teaching   daily weights (call if >5lbs in a week, or 2lbs in 1 day). energy conservation. exercise & activity. low Na diet. new drugs: medication teaching. BP checking.  
🗑
Nursing & Collaborative Care: priority actions   Vitals. sit up, O2. ECG. IV. drugs. head to toe assessment.  
🗑
Nrs Dx: Impaired gas exchange   R/T fluid in the lungs, alteration in alveolar capillary membrane AEB SpO2, PaO2, CO2, RR.  
🗑
Nrs Dx: decreased CO   R/T alteration in preload or after-load, impaired myocardial contractility, L ventricular dysfunction AEB fatigue, pulses, cap refill, HR, urinary output.  
🗑
Nrs Dx: activity intolerance   R/T imbalance between O2 supply & demand AEB SOB with minimal exertion.  
🗑
Nrs Dx: fluid volume excess   R/T ventricular dysfunction  
🗑
Goals of Care   decrease Sx. improve heart function. improve quality of life. decrease mortality and morbidity.  
🗑
Lasix   loop-diuretic. decreases pre-load by decreasing intravascular volume.  
🗑
Digoxin   positive inotrope. increases myocardial contractility (problem: increases O2 demand - can decrease survival). ordered for systolic HF only (diastolic has plenty of contraction, they can't fill, they need to relax the heart).  
🗑
Beta-Blockers   block sympathetic NS stimulation. decrease HR and workload. some are non-specific (alpha and beta - also do some vasodilation), others are specific and only block beta.  
🗑
Anti-Coagulants   in the pt has a dysrhythmia, the pooling blood puts them at risk for stroke. Lovenox or Heparin.  
🗑
Anti-Coagulants: Potassium   lasix decreases K.  
🗑
Digoxin: Potassium   when a pt has hypokalemia, they are more likely to have digitoxicity  
🗑
Ace Inhibitor   blocks angiotensin I from converting to II, thereforce blocking aldosterone. blocks sodium and water reabsorption, decreasing intravascular volume. blocks vasoconstriction. decreases after-load, decreases pre-load, decrease intravascular volume.  
🗑
ACE inhibitors: Side Effects   angioedema, dry cough  
🗑
Calcium Channel Blocker   decrease amount of Ca in the cell, decreases contractility and HR. Verapamil. Vasodilation.  
🗑
Vasodilators   not as common, but maybe Rx. nitroglycerin. decreases after-load which decreases pre-load.  
🗑
Morphine   decreases anxiety. vasodilates the pulmonary AND systemic systems, helping with breathing. decreases work-load on the heart.  
🗑


   

Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
 
To hide a column, click on the column name.
 
To hide the entire table, click on the "Hide All" button.
 
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
 
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.

 
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
Created by: malysab14
Popular Nursing sets