Flashcards
453: Test 2 Heart Failure
Flashcards do conjunto (34)
- 1Instead of the word "congestive" in congested heart failure, what words are used?acute and chronic
- 2PRIMARY RISK FACTORS FOR HEART FAILUREHYPERTENSION AND CAD
- 3Heart failure Caused by interference with normal mechanisms that regulate CO:Preload
Afterload
Myocardial Contractility
Heart Rate - 4PRIMARY CAUSES OF HEART FAILURECAD, MI
Hypertension
Rheumatic Heart Disease
Pulmonary Hypertension
Cardiomyopathy
Hyperthyroidism
Valvular disorders (MS, AS) - 5Precipitating causes of heart failureAnemia
Infection
Hypothyroidism
Dysrhythmias
Pulmonary Embolism
Hypervolemia - 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%
- 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 - 8Compensatory Mechanisms in HFAIMED AT MAINTAING CO AND BP
(HELPS AT FIRST)
SNS stimulation
Neurohormonal Response - RAAS
Dilation
Hypertrophy - 9Compensatory Mechanisms in HF: Counterregulatory MechanismsANP, BNP (renal, CV, and hormonal effects)
Nitric Oxide (NO) - 10What is CARDIAC COMPENSATION?Occurs when the compensatory mechanisms succeed in maintaining adequate CO to maintain central and local perfusion
- 11What is CARDIAC DECOMPENSATIONoccurs when compensatory mechanisms no longer maintain adequate CO and inadequate perfusion results
- 12MOST COMMON TYPE OF HEART FAILURELeft sided heart failure results form LV dysfunction
- 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
- 14What is the MAIN CAUSE OF RIGHT SIDED HEART FAILURE?LEFT-SIDED HF IS PRIMARY CAUSE OF RIGHT-SIDED HF
- 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 - 164 MAIN CLINICAL MANIFESTATIONS OF RIGHT SIDED HEART FAILUREPERIPHERAL EDEMA
JVD
HEPATOMEGALY
SPENOMEGALY - 17Acute Decompensated Heart Failure: Engorgement of the pulmonary vascular system As this increases, alveolar lining cells disrupted CAUSING WHAT?RBCs LEAK WITH FLUID
- 18CLINICAL MANIFESTATIONS WITH ACUTE DECOMPENSATED HFTACHYPENIC
DYSPNEIC AND ORTHOPNEIC
(RR>30)
DECREASE IN PaO2
ANXIOUS - 19ABGs IN ACUTE DECOMPENASATED HEART FAILUREWORSENING:
DECREASED PaO2
POSSIBLY INCREASED PaCO2
AND
PROGRESSIVE ACIDOSIS - 20CLINICAL MANIFESTATIONS ASSOCIATED WITH THE SKIN IN ACUTE DECOMPENSATED HFPALE
CYANOTIC
CLAMMY
COLD SKIN - 21LUNG SOUNDS WITH ACUTE DECOMPENSATED HFBILATERAL CRACKLES
POSSIBLY WHEEZES
COPIOUS FROTHY
PINK SPUTUM - 22IN ACUTE DECOMPENSATED HF WHAT VS ARE ELEVATED BUT THEN DROPTACHACARDIC
BP - 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 - 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 - 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 - 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*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 - 28Why DIURECTICS in ADHF?mainstay of treatment in HF patients with volume overload. Reduces preload. IV Loop therapy initially recommended.
- 29Why VASODILATORS in ADHF?reduces both preload and afterload. IV nitroglycerine most commonly used.
- 30Why MORPHINE in ADHF?reduces preload and afterload, improves gas exchange, reduces anxiety, and can reduce dyspnea
- 31Why POSITIVE INOTROPS in ADHF?Increases myocardial contractility and CO. Includes dobutamine (preferred), dopamine, epinephrine, norepi (Levophed), milrinone (Primacor), and digoxin
- 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 - 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 - 34When the heart is stretch BNP is released which causes what?Vasodilation and diuresis
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- FlashCards sobre 453: Test 2 Heart Failure , criado por brittny beauford em 25-02-2017.
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- brittny beauford
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