Causes.
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| What is Heart Failure? | Heart is unable to pump adequate amount of blood to meet the metabolic needs of body.
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| What are the causes of HF? | Damage of cardiac muscle, increased cardiac workload and increased ventricular filling.
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| What does damage of the cardiac muscle involve? | CAD, inflammation (myocarditis), degenerative process (cardiomyopathy), toxic effect of drugs,and hypoxia.
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| What does increased cardiac workload involve? | Aortic valve or pulmonic valve stenosis, HTN, pulmonary HTN, mitral valve or Tricuspid valve insufficiency, and fluid overload.
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| What does increased ventricular filling involve? | Arrythmias: (Tachycardia, PVC's) or cardiac temponade
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| What is cardiac reserve? | The ability of the heart to increase cardiac output in response to stress.
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| What are the 3 ways for cardiac Compensation mechanism? | Ventricular dilation, Sympathetic stimulation and Myocardial hypertrophy.
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| What happens in ventricular dilation? | decreased CO, Decreased renal perfusion, activation of renin-angiotension-aldosterone cycle, increase in na+ & H2O retention,increase in end diastolic ventricular volume, increase in length of myocardial fibers, increase in cardiac contractility.
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| What happens in Sympathetic stimulation? | Decreased CO, decreased BP, stimulation of barorecepters, activation of sympathetic responses, increased in HR, contractility and peripheral vasoconstriction, increase in BP.
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| What happens in Myocardial hypertrophy? | In response to persistent increased contractility due to ventricular dilation and sympathetic stimulation, an increase in diameter of muscle fibers and cardiac wall thickness occur.
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| What happens in cardiac Decompensation? | Occurs when the compensatory mechanism can no longer maintain adequate CO & signs & symptoms of HF appear.
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| What is congestive HF? (CHF or backward HF) | Inability of left ventricle (LV) to pump adequately during systole or to dilate during diastole, increase in filling pressure in LV, LA can't be emptied during diastole,flows to pulm veins, to alveoli, to RV then to RA, then venous congestion.
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| What are the S&S of Left side CHF? | S3,rales, profound dyspnea, pulmonary edema,gurgling breath sounds, frothy & blood tinged sputum.
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| What are the S&S of Right sided CHF? | increased CVP, JVD, edema, ascites, pleural effusion, anorexia (due to vascular congestion in the GI tract),hepatomegaly & splenomegaly (due to portral congestion).
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| What is Cardiogenic shock? (Forward HF) | Inadequate pumping of LV,CO and tissue perfusion.
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| What are the S&S of Cardiogenic shock? | Fatigue, hypotension, rapid & weak pulses, pale, cold, and clammy skin, decreased urine output, decreased bowel sounds, chest pain, rales & dyspnea, decreased LOC, metabolic acidosis.
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| What are the diagnostic tests for HF? | H & P exam, Chest X-ray, Echo, BNP(B-type Natriuretic Peptide):, Cardiac Catheterization.
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| How do you manage a PT with HF? | You need to reduce cardiac workload and increase cardiac contraction.
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| What Pharmacologic interventions would you use to treat HF? | O2, diuretics (Lasix,Bumex), Nitrates, morphine sulfate, BB, ACE inhibitors, B-Type Natri-uretic peptide (netrecor), positive inotropic agents:(Digitalis,dobutamine,dopamine),sodium bicarbonate.
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| What techniques would you use for a patient admitted with HF? | give morphine for the pain, teach relaxation techniques, use a calm approach to patient.
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| What lab would indicate the a patient is in severe congestive heart failure? | An elevated BNP (B-type natriuretic peptide. BNP<100 HF improbable, BNP 100-500 HF probable, BNP >500 HF very Probable!
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| A patient is goin home with an order of an ACE inhibitor, what instructions should you include? | Teach the patient on how to prevent orthostatic hypotension.
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| A patient with CHF is complaining of leg cramps at night. What interventions should you implement? | Monitor patients K+ level and assess the clients intake of bananas & OJ.
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| What is one way to find out if the diuretic is working efficiently? | By weighing your patient every day at the same time and on the same scale.
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| Sudden onset of symptoms, usually following an acute onset of a new illness-symptoms may appear over several hours | Acute CHF
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| Very slow and insidious onset of symptoms which may follow a new onset of an illness, symptoms may take years to become apparent. | Chronic CHF
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| How does Anemia cause chronic HF? | Due to Acute Hypoxia of cardiac tissues.
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| The abiliity of the cardiac fibers to stretch and snap back appropriately. | Frank-Starlings Law.
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| The pressure that the ventricles must pump against to empty the chamber effectively. | Afterload
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| The amount of blood available to fill the ventricles before contraction. (bullet) | Preload
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| The stroke volume x HR = | Cardiac Output
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| What are compensatory mechanisms? | What the heart uses to maintain cardiac output. (in response to decreased CO)
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| Name some of the compensatory mechanisms? | Tachycardia, ventricular dilation, ventricular hypertrophy.
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| What is LVHF? | Most common HF when the left ventricular cardiac output is less than volume received from pulmonary circulation.
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| What symptom of CHF due to hypoxia, decreased cardiac output and poor waste removal. | Fatigue
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| A patient with CHF is unable to lay flat with comfortable breathing & assumes a sitting position leaning forward, this is an advanced finding called? | Othopnea
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| Client wakes up gasping for air. Complains of feeling as if they are smothering which caused them to suddenly wake up from sleep. This is called? | PND: Paroxysmal Nocturnal dyspnea
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| Your patient has S4 heart sounds, what is this caused from? | Stiffness in the ventricles
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| If your patient has an S3 heart sound, what is this caused from? | Ventricular failure
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| Anxiety, irritability, confusion and memory loss may be due to what in clients with CHF? | Decreased cerebral perfusion-cerebral blood flow is dimished.
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| What happens to the organs when the venous circulation becomes congested? | Organs become congested-hepatomegaly and splenomegaly.
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| Describe pitting edema. | Leaves an indentation in the edematous area when pushed on by examiner's fingers.
1+=2mm in depth; 2+ = 4mm; 3+ = 6mm; 4+=8mm;
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| What is the difference between controlled and uncontrolled A-fib? | Controlled is HR<100. Uncontrolled is HR>100.
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| What test should be done before starting anticoagulant therapy following the 48hr rule? | TEE Transesphageal echo to check for thrombi
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| What is the primary goal for treatment for HF? | Determined underlying cause and treat it.
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| What is the medical management of HF? | O2, digoxin, diuretics, inotropic drugs.(dopamine and dobutamine); invasive cardiac monitoring, (Swan-ganz)
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| What is the purpose of Anti-hypertensives in HF? | To reduce afterload
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| What is the purpose of BB's in HF? | Block Renin secretion; slow HR, Metroprolol. S.E: hypoglycemia and bronchspasms.
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| What is the purpose of ARB's | block receptor that recieves enzyme; COZAAR (SE:cough)
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| What is nursing management of HF? | Maintain CO by ECG rhythms, VS, I&O, assess heart and lung sounds, assess peripheral pulses, effectiveness of meds, balance activity and rest, give small frequent meals.
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