453: Test 2 Heart Failure

Questão	Responda
Instead of the word "congestive" in congested heart failure, what words are used?	acute and chronic
PRIMARY RISK FACTORS FOR HEART FAILURE	HYPERTENSION AND CAD
Heart failure Caused by interference with normal mechanisms that regulate CO:	Preload Afterload Myocardial Contractility Heart Rate
PRIMARY CAUSES OF HEART FAILURE	CAD, MI Hypertension Rheumatic Heart Disease Pulmonary Hypertension Cardiomyopathy Hyperthyroidism Valvular disorders (MS, AS)
Precipitating causes of heart failure	Anemia Infection Hypothyroidism Dysrhythmias Pulmonary Embolism Hypervolemia
Patho of SYSTOLIC HEART FAILURE	heart 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%
Patho of DIASTOLIC HEART FAILURE	ventricles 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
Compensatory Mechanisms in HF	AIMED AT MAINTAING CO AND BP (HELPS AT FIRST) SNS stimulation Neurohormonal Response - RAAS Dilation Hypertrophy
Compensatory Mechanisms in HF: Counterregulatory Mechanisms	ANP, BNP (renal, CV, and hormonal effects) Nitric Oxide (NO)
What is CARDIAC COMPENSATION?	Occurs when the compensatory mechanisms succeed in maintaining adequate CO to maintain central and local perfusion
What is CARDIAC DECOMPENSATION	occurs when compensatory mechanisms no longer maintain adequate CO and inadequate perfusion results
MOST COMMON TYPE OF HEART FAILURE	Left sided heart failure results form LV dysfunction
The 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 alveoli	PULMONARY CONGESTION AND EDEMA FROM LEFT SIDED HEART FAILURE
What is the MAIN CAUSE OF RIGHT SIDED HEART FAILURE?	LEFT-SIDED HF IS PRIMARY CAUSE OF RIGHT-SIDED HF
Which 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
4 MAIN CLINICAL MANIFESTATIONS OF RIGHT SIDED HEART FAILURE	PERIPHERAL EDEMA JVD HEPATOMEGALY SPENOMEGALY
Acute Decompensated Heart Failure: Engorgement of the pulmonary vascular system As this increases, alveolar lining cells disrupted CAUSING WHAT?	RBCs LEAK WITH FLUID
CLINICAL MANIFESTATIONS WITH ACUTE DECOMPENSATED HF	TACHYPENIC DYSPNEIC AND ORTHOPNEIC (RR>30) DECREASE IN PaO2 ANXIOUS
ABGs IN ACUTE DECOMPENASATED HEART FAILURE	WORSENING: DECREASED PaO2 POSSIBLY INCREASED PaCO2 AND PROGRESSIVE ACIDOSIS
CLINICAL MANIFESTATIONS ASSOCIATED WITH THE SKIN IN ACUTE DECOMPENSATED HF	PALE CYANOTIC CLAMMY COLD SKIN
LUNG SOUNDS WITH ACUTE DECOMPENSATED HF	BILATERAL CRACKLES POSSIBLY WHEEZES COPIOUS FROTHY PINK SPUTUM
IN ACUTE DECOMPENSATED HF WHAT VS ARE ELEVATED BUT THEN DROP	TACHACARDIC BP
Bonnie 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
Which 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
After 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
After 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
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
Why DIURECTICS in ADHF?	mainstay of treatment in HF patients with volume overload. Reduces preload. IV Loop therapy initially recommended.
Why VASODILATORS in ADHF?	reduces both preload and afterload. IV nitroglycerine most commonly used.
Why MORPHINE in ADHF?	reduces preload and afterload, improves gas exchange, reduces anxiety, and can reduce dyspnea
Why POSITIVE INOTROPS in ADHF?	Increases myocardial contractility and CO. Includes dobutamine (preferred), dopamine, epinephrine, norepi (Levophed), milrinone (Primacor), and digoxin
Ongoing 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
Ongoing 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
When the heart is stretch BNP is released which causes what?	Vasodilation and diuresis

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453: Test 2 Heart Failure

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	Criado por brittny beauford aproximadamente 7 anos atrás