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Flashcards

453: Test 2 Heart Failure

brittny beauford English 34 cards

Cards in this deck (34)

  1. 1Instead of the word "congestive" in congested heart failure, what words are used?acute and chronic
  2. 2PRIMARY RISK FACTORS FOR HEART FAILUREHYPERTENSION AND CAD
  3. 3Heart failure Caused by interference with normal mechanisms that regulate CO:Preload
    Afterload
    Myocardial Contractility
    Heart Rate
  4. 4PRIMARY CAUSES OF HEART FAILURECAD, MI
    Hypertension
    Rheumatic Heart Disease
    Pulmonary Hypertension
    Cardiomyopathy
    Hyperthyroidism
    Valvular disorders (MS, AS)
  5. 5Precipitating causes of heart failureAnemia
    Infection
    Hypothyroidism
    Dysrhythmias
    Pulmonary Embolism
    Hypervolemia
  6. 6Patho of SYSTOLIC HEART FAILUREheart can't pump effectively---> LV can't generate enough pressure to push blood in to aorta--> LV becomes dilated and hypertrophied --> hallmark sign is decreased EF, usually less the 45%
  7. 7Patho of DIASTOLIC HEART FAILUREventricles can't relax and fill during diastole (usually due to HTN) (usually called HF with a normal EF)
    Occurs more frequently in older adults, women and obese individuals
  8. 8Compensatory Mechanisms in HFAIMED AT MAINTAING CO AND BP
    (HELPS AT FIRST)
    SNS stimulation
    Neurohormonal Response - RAAS
    Dilation
    Hypertrophy
  9. 9Compensatory Mechanisms in HF: Counterregulatory MechanismsANP, BNP (renal, CV, and hormonal effects)
    Nitric Oxide (NO)
  10. 10What is CARDIAC COMPENSATION?Occurs when the compensatory mechanisms succeed in maintaining adequate CO to maintain central and local perfusion
  11. 11What is CARDIAC DECOMPENSATIONoccurs when compensatory mechanisms no longer maintain adequate CO and inadequate perfusion results
  12. 12MOST COMMON TYPE OF HEART FAILURELeft sided heart failure results form LV dysfunction
  13. 13The following is the patho of which type of heart failure and what does it result in? Back up of blood from LV--> LA--> pulmonary veins--> leakage into interstitium and alveoliPULMONARY CONGESTION AND EDEMA FROM LEFT SIDED HEART FAILURE
  14. 14What is the MAIN CAUSE OF RIGHT SIDED HEART FAILURE?LEFT-SIDED HF IS PRIMARY CAUSE OF RIGHT-SIDED HF
  15. 15Which type of heart failure is compounded by pulmonary diseases and pulmonary hypertension?Right sided HF
    Back up of blood into right heart and systemic venous circulation
  16. 164 MAIN CLINICAL MANIFESTATIONS OF RIGHT SIDED HEART FAILUREPERIPHERAL EDEMA
    JVD
    HEPATOMEGALY
    SPENOMEGALY
  17. 17Acute Decompensated Heart Failure: Engorgement of the pulmonary vascular system As this increases, alveolar lining cells disrupted CAUSING WHAT?RBCs LEAK WITH FLUID
  18. 18CLINICAL MANIFESTATIONS WITH ACUTE DECOMPENSATED HFTACHYPENIC
    DYSPNEIC AND ORTHOPNEIC
    (RR>30)
    DECREASE IN PaO2
    ANXIOUS
  19. 19ABGs IN ACUTE DECOMPENASATED HEART FAILUREWORSENING:
    DECREASED PaO2
    POSSIBLY INCREASED PaCO2
    AND
    PROGRESSIVE ACIDOSIS
  20. 20CLINICAL MANIFESTATIONS ASSOCIATED WITH THE SKIN IN ACUTE DECOMPENSATED HFPALE
    CYANOTIC
    CLAMMY
    COLD SKIN
  21. 21LUNG SOUNDS WITH ACUTE DECOMPENSATED HFBILATERAL CRACKLES
    POSSIBLY WHEEZES
    COPIOUS FROTHY
    PINK SPUTUM
  22. 22IN ACUTE DECOMPENSATED HF WHAT VS ARE ELEVATED BUT THEN DROPTACHACARDIC
    BP
  23. 23Bonnie is a 66-year-old female with a history of hypertension, Inferior MI two years ago, atrial fibrillation, chronic heart failure, Type 2 DM, obesity, hyperlipidemia, hypothyroidism and depression. What meds do you expect her to be on?amiroderone
    lasix
    warfarin
    synthroid
    beta blocker
    metformin
    lipitor
  24. 24Which of these meds help with HF? Benazapril, Carvedilol, Lasix, Nitroglycerine, Digoxin, Lipitor, Warfarin, Metformin, Glucotrol, Lexapro, synthroid*Check in class
    Benazapril (ACEI)-vasodilation
    Carvedilol(beta-blocker) O2 demand
    Lasix (loop diuretic) decrease preload
    Nirtoglycerin
    Digoxin
    Glucotrol works on pancreas
  25. 25After 2 days of increasing SOB, orthopnea (3 pillow), and a 5 Lbs weight gain, Bonnie begins coughing up copious amounts of pink frothy sputum. She is brought to the ED by her husband. VS: 100/84, HR: 110, RR: 32, T – 96.2, SpO2–75% What could have led to this exacerbation? Describe how you think Bonnie will look…..exacerbation: L sides and progressed to R side, med incompliance, not following diet
    look: SOB, pale, cold, diaphoresis
  26. 26After 2 days of increasing SOB, orthopnea, and a 5 Lbs weight gain, Bonnie begins coughing up copious amounts of pink frothy sputum. She is brought to the ED by her husband. VS: 100/84, HR: 110, RR: 32, T – 96.2, SpO2–75% What nursing interventions will you implement? What diagnostics do you expect?interventions: Fluids, oxygen, displace the fluid around the heart, put in high fowlers position, daily weights
    Diagnostics: portable chest x-ray, 12 lead EKG
  27. 27*Managing ADHF* Assess, Assess, Assess! High flow oxygen, consider CPAP or intubation Cardiac monitor, IV (maybe 2), positioning Calm environment, include family 12 lead, Rainbow labs, consider ABGs, portable CXR, consider echo WHAT MEDS WILL WE LIKELY ADMINISTER?DIURETICS
    VASODILATORS
    MORPHINE
    POSITIVE INOTROPES
  28. 28Why DIURECTICS in ADHF?mainstay of treatment in HF patients with volume overload. Reduces preload. IV Loop therapy initially recommended.
  29. 29Why VASODILATORS in ADHF?reduces both preload and afterload. IV nitroglycerine most commonly used.
  30. 30Why MORPHINE in ADHF?reduces preload and afterload, improves gas exchange, reduces anxiety, and can reduce dyspnea
  31. 31Why POSITIVE INOTROPS in ADHF?Increases myocardial contractility and CO. Includes dobutamine (preferred), dopamine, epinephrine, norepi (Levophed), milrinone (Primacor), and digoxin
  32. 32Ongoing complications with ADHF?Pleural effusion
    Dysrhythmias – enlargement of heart has ongoing potential to change electrical conduction pathways
    LV thrombus
    Hepatomegaly – especially if Right-sided heart failure progresses
    Renal failure – r/t ongoing low perfusion states
  33. 33Ongoing options with ADHF?Maximizing medication options – some new drugs on the horizon and used in Europe
    Cardiac resynchronization therapy – biventricular pacing and internal cardioverter-defibrillator
    LVAD
    Cardiac Transplantation
    End-of-life care
  34. 34When the heart is stretch BNP is released which causes what?Vasodilation and diuresis

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Flashcards on 453: Test 2 Heart Failure , created by brittny beauford on 25/02/2017.
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