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- 1Heart failure also called PUMP FAILURE is a?General term for the inability of the heart to work effectively as a pump.
- 2What are the major types of heart failure?Left sided HF
Right sided HF
High-output failure - 3Because the two ventricles of the heart represent two separate pumping systems, it is possible for one to?Fail by itself for a short period of time
- 4Most heart failure begins with?Failure of the left ventricle and progresses to failure of both ventricles.
- 5Typical causes of Left sided HF include?HTN, CAD, and valvular disease.
- 6Decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels indicate what?Left ventricular failure (LVF)
- 7Left sided heart failure was formerly referred to as?CHF, however, not all cases of LVF involve fluid accumulation.
- 8Left sided heart failure can be divided into two subtypes what are they?systolic heart failure and diastolic heart failure
- 9Systolic heart failure (heart failure with reduced ejection fraction) results when?the heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation.
- 10Systolic Heart Failure AKA forward failure.?Myocardium unable to contract forceful enough to eject volume out into circulation.
Decreased contraction = increased preload.
Increased peripheral resistance = increased afterload. - 11Diastolic Heart Failure.?Occurs when left ventricle is unable to relax preventing adequate filling with enough volume for adequate CO.
- 12Ejection Fraction (EF) 50-70% =?Normal
- 13Decreased EF =?decreased tissue perfusion.
- 14An ejection fraction of less than 30% are considered candidates for?Implantable cardioverter/defibrillator (ICD)
- 15Diastolic Heart failure occurs when?the left ventricle cannot relax adequately during diastole. Inadequate relaxation or "stiffening" prevents the ventricle from filling with sufficient blood to ensure an adequate cardiac output.
- 16Diastolic heart failure represents about 20 to 40% of all heart failure primarily in?older adults and in women who have chronic HTN and undetected coronary artery disease.
- 17Right Sided Heart failure may be caused by?Left ventricular failure, right ventricular myocardial infarction, or pulmonary HTN.
- 18In Right sided heart failure what happens?The right ventricle cannot empty completely. Increased volume and pressure develop in the venous system, and peripheral edema results.
- 19Right sided heart failure is also known as?Cor pulmonale
- 20Causes of right - sided heart failure?Left Ventricular Failure
Right Ventricular MI
Pulmonary HTN - 21High output Heart failurecan occur when cardiac output remains normal or above normal, unlike left and right sided heart failure which are typically low-output states.
- 22High output failure is caused by?Increased metabolic needs or hyperkinetic conditions such as, septicemia, higher fever anemia and hyperthyroidism.
- 23What heart Failure is not as common as the other types?High Output failure
- 24Classifying heart failureMay be done by stage of disease or by its’ effect on the patients' functional status.
Stages A, B, C, D(worst)
Classes: I, II, III, IV (most severe limitations). - 25if the body senses that cardiac output is not adequate, it tries to?compensate.
Sympathetic stimulation
Renin-angiotensin system
Neurohormonal responses
Myocardial hypertrophy - 26Left-sided Failure - Assessment ( Decreased cardiac output)Fatigue
Weakness
Oliguria (decreased day)
Nocturia (night)
Confusion, restlessness
Tachycardia, palpitations
Weak Peripheral Pulses
Cool Extremeties
Angina
Dizziness
Pallor - 27Left-sided Failure - Assessment (Pulmonary congestion)Hacking cough, worse at night.
Dyspnea
Crackles, wheezes
Frothy, pink Sputum (severe)
Tachypnea
Gallop (arrhythmia). - 28Often a Hypertrophied heart isSlightly oxygen deprived
- 29HF is caused by?systemic HTN in most cases
- 30Some patients experiencing MI also develop?HF
- 31The next most common cjause of HF besides HTN is?structural Heart changes, such as valvular dysfunction, particularly pulmonic or aortic stenosis, which leads to pressure or volume overload on the heart.
- 32The pateint in early left sided HF describes a cough as?irritating, nocturnal, and usually nonproductive.
- 33As left sided HF becomes very severe he or she may begin expectorating frothy pink sputum which is?a sign of life threatening pulmonary edema
- 34As exertional dyspnea develops the patient often stops?stops previously tolerated levels of activity because of the shortness of breath
- 35Patients who describe sudden awakening with a feeling of breathlessness 2 to 5 hours after falling asleep have?paroxysmal Nocturnal Dyspnea
- 36With right sided heart failure signs of congestion occur as the?right ventricle fails ,fluid is retained, and pressure builds in the venous system. Edema develops in the lower legs and may progress to the thighs and abdominal wall.
- 37Patients with right sided heart failure may notice that their shoes fit more?tightly or their shoes or socks may leave indentations on their swollen feet. They may have removed their rings due to swelling in fingers and hands.
- 38While providing care to a right sided heart failure patient you need to ask about?weight gain. An adult may retain 4 to 7L of fluid before pitting edema occurs.
- 39In a Right sided HF patient reports of Nausea and anorexia may be a direct consequence of?Liver Engorgement resulting from fluid retention.
- 40In advanced Right sided heart failure, Ascites and an increased?abdominal girth may develop from severe liver congestion.
- 41Patients with HF may experience increased thirst and do what?Drink excessive fluids (4000 to 5000ml/day) because of sodium retention
- 42S/S of HF depends on?The type of failure, the ventricle involves and the underlying cause.
- 43Impaired tissue perfusion and pulmonary congestion are associated with?Left ventricular failure (Left sided HF)
- 44Systemic venous congestion and peripheral edema are associated with?Right ventricular failure (right sided HF)
- 45Right-side hf - assessmentJVD
Enlarged lived/spleen
Anorexia/nausea
Lower Extremity edema
Distended abdomen
Swollen hands/fingers
Weight Gain
Polyuria at night
Increased BP (from excess volume or Decreased BP (from failure).
Have Na+ retention so many have decreased thirst. - 46An irregular heart rhytm resulting from premature atrial contractions (PACs), PVCs or AF is very common in a patient who has?HF
- 47Older adults are frequently disoriented or confused when the heart fails. This is a result of?brain hypoxia
- 48Increased heart size is common with?displacement of the apical impulse to the left.
- 49A third heart sound S3 is an?early diastolic filling sound indicating an increase in left ventricular pressure. This is often the FIRST SIGN OF HF
- 50A fourth heart sound S4 can occur but?it is not a sign of failure but rather a reflection of decreased ventricular compliance.
- 51Auscultate for crackles and wheezes of the lungs. Late inspiratory crackles and fine profuse crackles that repeat themselves from breath to breath and?Do not diminish with coughing indicate HF
- 52Crackles are produced by interalveolar fluid and are often noted in the bases of the lungs and?Spread upward as the condition worsens.
- 53Wheezes indicate?a narrowing of the bronhcial lumen caused by engorged pulmonary vessels.
- 54Edema is an extremely unreliable sign of HF be sure that?accurate daily weights are taken to document fluid retention. Weight is the most reliable indicator of fluid gain and loss.
- 55Patients with HF especially those with advanced disease are at high risk for?depression
- 56What is a major indicator of well being for patients with HF?Hope
- 57Any impairment of renal function resulting from inadequate perfusion causes?elevated blood urea nitrogen and serum creatinine and decreased creatine clearance levels.
- 58Hemoglobin and Hematocrit test should be performed to?identify HF resulting from anemia.
- 59If the patient has fluid volume excess, the hematocrit levels may be?low as a result of hemodilution
- 60A BNP is used for?diagnosing HF (in particular diastolic HF) in patients with acute dyspnea
- 61Urinalysis may reveal proteinuria and high specific gravity. Microalbuminuria is an early indicator of?decreased compliance of the heart and occurs before the BNP rises. It serves as an "early warning detector"
- 62T4 and TSH levels should be assessed in patients who are older than 65 years old, have AF or have evidence of thyroid disease because?HF may be caused or aggravated by hypothyroidism or hyperthyroidism
- 63Respiratory alkalosis may occur because of?hyperventilation
- 64Respiratory acidosis may occur because of?carbon dioxide retention
- 65Metabolic acidosis may indicate?accumulation of lactic acid
- 66What is considered the best tool in diagnosing heart failure and also Ejection Fraction?Echocardiography
- 67Multigated blood pool scans (MUGA)provide information about left ventricular ejection fraction and velocity, which are typically low in patients with HF
- 68What diagnostic exam is not helpful in determining the presence or extent of HF?Electrocardiogram (ECG)
- 69Interventions for heart failureProvide 02 to maintain oxygen saturation 90% or better
Monitor respiratory status
High fowlers positions if dyspnea
Pillows under arms maximize chest expansion
Coughing, deep breathing
Collaboration with respiratory therapy. - 70For patient with acute HF the health care provider may prescribe?An IV push ACE inhibitor such as Vasotec IV
- 71Interventions Heart Failure – non surgical (CPAP)Improves sleep apnea, CO, EF
Reduces afterload, preload, BP, and dysrhythmias - 72Interventions Heart Failure – non surgical(CRT) Permanent pacer – for advanced HF or EF >35%.
- 73Interventions Heart Failure – non surgical (Gene therapy)Damaged cell replacement – growth factor
- 74Interventions Heart Failure – non surgical (CardioMems)implanted PAP monitoring system.
- 75Heart Transplantation is the?Most definitive surgical option for patients with refractory end stage HF
- 76Energy management – heart failureGoal is to NOT develop pulmonary edema, decreased fatigue, and gain energy.
Achieved by:
Early recognition of symptoms
Rehabilitation
Check BP, pulse, 02 saturation before and after any activity
Increased change in VS can indicate activity too stressful. - 77—
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- Fichas sobre Sin título, creado por Cobee Shepard el 05/09/2023.
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