care of patients with cardiac problems c37 med
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| types of heart failure | left-sided (CHF), right-side, high output
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| Most heart failure beings with failure of the? | left ventricle
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| typical causes of left-sided heart (ventricular) failure | hypertensive, coronary artery and valvular disease of mitral or aortic valve.
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| indications of left ventricular failure (LVF) | decreased tissue perfusion from poor CO and pulmonary congestion from increased pressure in pulmonary vessels
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| Variations of left-sided heart failure | acute, chronic, mild, severe. systolic HF and diastolic HF
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| systolic HF (systolic ventricular dysfunction) | heart cannot contract forcefully enough during systole to eject adequate blood into circulation.
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| ejection fraction | percentage of blood ejected from heart during systole
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| diastolic heart failure (heart failure with preserved left ventricular function) | left ventricle cannot relax adequately during diastole.
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| right-sided heart (ventricular) failure causes | left ventricular failure, right ventricular MI, pulmonary hypertension.
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| right-sided heart failure | right ventricle cannot empty completely.
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| high-output heart failure | can occur when CO remains normal or above normal. Caused by increased metabolic needs or hyperkinetic conditions (septicemia (fever), anemia and hyperthyroidism). Not as common.
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| When CO is insufficient, ____ operate to improve CO | compensatory mechanisms
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| major compensatory mechanisms include: | sympathetic NS stimulation, Renin-angiotensin system activation, chemical responses, myocardial hypertrophy
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| most immediate compensatory mechinism | stimulation of sympathetic NS
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| afterload | the resistance against which the heart must pump
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| renin-angiotensin system activation occurs as a response to? | reduced blood flow to the kidneys, common in low-output states.
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| When endothelial cells are stretched what is secreted? | endothelin
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| myocardial hypertrophy | enlargement of myocardium, walls of heart thicken to provide more muscle mass, thus more forceful contractions increasing CO. oxygen supply is not as fast as growth of heart.
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| 75% of the cases of HF are caused by | systemic hypertension.
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| Second most common cause of HF is | structural heart changes.
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| common risk factors/causes of HF | hypertension, coronary artery disease, cardiomyopathy, substance abuse, valvular disease, congenital defects, cardiac infections and inflammations, dysrhythmias, diabetes, family history, hyperkinetic conditions (e.g. hyperthyroidism)
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| right sided HF in the absence of left-sided Hf is usually a result of | pulmonary problems
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| describe a cough related to HF | irritating, nocturnal and nonproductive. severe HF - expectorating frothy, pink-tinged sputum (sign of pulmonary edema)
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| exertional dyspnea | patient often stops previously tolerated levels of activity because of SOB
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| orthopnea | dyspnea in recumbent (lying flat) position
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| paroxystmal nocturnal dyspnea | sudden awakening with feeling of breathlessness 2 to 5 hours after fallin gasleep.
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| proportional pulse pressure | systolic bp - diastolic bp % systolic BP
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| impaired gas exchange expected outcomes | normal; pulmonary artery pressure, respiratory function, respiratory rate, ABGs and pH, oxygen saturation
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| decreased CO expected outcomes | normal; systolic/diastolic bp, apical pulse rate, ejection fraction, peripheral pulses, skin color, urine output, cognitive status
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| impaired gas exchange interventions | monitor respiratory rate, rhythm and quality q1-4h. auscultate breath sounds q4-8h, oxygen as ordered, high fowlers (if dyspnea), pillows under each arm. repositioning, cough deep break q2h.
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| mitral valve prolapse | occurs because valvular leaflets enlarge and prolapse into the left atrium during systole. usually benign but may progress to pronounced mitral regurgitation.
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| aortic stenosis | aortic valve orifice narrows and obstructs left ventricular outflow during systole.
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| expected outcomes for activity intolerance | balances activity/rest, uses naps to restore energy, recognizes limitations, organizes activities to conserve energy, adapts lifestyle to energy level, reports adequate endurance for activity.
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| key features of pulmonary edema | crackles, dyspnea at rest, disorientation, tachycardia, hypertension, hypotension, reduced urinary output, cough with frothy pink tinged sputum, premature ventricular contractions, dysrhthmia, anxiety restlessness, lethargy
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| after a mitral valve replaceent patients will be on what type of medication for the rest of their lives | anticoagulant, such as coumadin
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| infective endocardidits | infection of endocardium.
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| pericardial effusion | complication of pericardidis, when space between parietal and visceral layers of the pericardium fill with fluid. puts patient at risk for cardiac tamponade
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| cardiac tamponade | excessive fluid within the pericardial cavity, restricting diastolic ventricular filling and CO. symptoms: JVD, paradoxical pulse, decreased CO, muffled heart sounds, circulatory collapse
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| rheumatic carditis is a major indicator of | rheumatic fever
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| signs of rheumatic fever | tachycardia, cardiomegaly, new or changed murmur, pericardial friction rub, precordial pain, ecg changes (prolonged PR interval), indications of HF, evidence of strep infection
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| indications of streptococcal pharyngitis | moderate to high fever, abrupt onset of sore throat, reddened throat with exudate, enlarged and tender lympth nodes
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| classifications of cardiomyopahty | dilated, hypertrophic, restrictive and arrhythmogenic right ventricular
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| signs of heart transplant rejection | SOB, fatigure, fluid gain, abdominal bloating, new bradycardia, hypotension, atrial fibrillation or flutter, decreased activity tolerance, decreased ejection fraction (late sign)
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