2000- Test 2 Heart Failure

Front 1

____ is a condition in which the heart can no longer pump enough blood to the rest of the body.

Back 1

Heart Failure

Front 2

2 diagnostic tests used for heart failure are

Back 2

EKG and Echocardiogram.

Front 3

An EKG is used with heart failure because the patient is at risk for ______ and it looks at _____

Back 3

dysrhythmias
electrical activity

Front 4

The echocardiogram looks at the

Back 4

heart chambers and the valves.

Front 5

The 3 main causes of heart failure are:

Back 5

CHD
MI
HTN

Front 6

Causes for heart failure other than CHD, MI and HTN are:

Back 6

valvular heart disease
congenital heart disease
alcohol and drugs

Front 7

The heart has the ability to adjust _____ based on the body's needs (exercise, sleep, illness).

Back 7

cardiac output

Front 8

Cardiac output=

Back 8

stroke volume x heart rate

Front 9

Heart failure occurs when there is one or more alterations in preload, afterload, contractility and heart rate leading to _____.

Back 9

decreased cardiac output.

Front 10

When the heart begins to fail, adaptive mechanisms are activated to maintain its pumping function. These 3 main adaptive mechanisms are:

Back 10

1-neuroendocrine responses (SNS, RAAS)
2-Frank Sterling Mechanism
3-Ventricular remodeling

Front 11

Ventricular remodeling results in cardiac muscle mass ____ or _____ or ______.

Back 11

dilation
hypertrophy
both

Front 12

As heart failure progresses compensatory mechanisms become ____ to muscle function.

Back 12

detrimental

Front 13

2 neuroendocrine responses that are part of the compensatory mechanisms which take over during heart failure are:

Back 13

sympathetic nervous system and renin angiotensin aldosterone system

Front 14

When there is decreased CO and BP the aortic baroreceptors will sense it and activate the _____. This causes increased HR and contractility as well as increased ____. The result is increased _____

Back 14

SNS
vasoconstriction
CO

Front 15

When the body detects decreased renal perfusion, the ____ is activated.

Back 15

Renin angiotensin aldosterone system

Front 16

Angiotensin I is converted to Angiotensin II in the ____.

Back 16

lungs

Front 17

Angiotensin II stimulates the secretion of _____ which increases ____ and _____ retention.

Back 17

aldosterone
water and sodium

Front 18

Angiotensin II stimulates secretion of _____ and this increases _____. Angiotensin II also causes constriction of vascular smooth muscle which increases ______.

Back 18

Aldosterone
increases preload

afterload

Front 19

The _____ initially causes an increase in end-diastolic volume and myocardial stretch- therefore a more powerful ____ and increased ______.

Back 19

Frank Starling Mechanism
contraction
stroke volume

Front 20

Eventually, the Frank-Starling Mechanism will result in ______.

Back 20

ineffective contraction

Front 21

_____ happens over time with the hearts use of compensatory mechanisms.

Back 21

Ventricular remodeling

Front 22

____ is ventricular remodeling in which the ventricular walls thin.

Back 22

Dilation

Front 23

____ is ventricular remodeling in which there is an increase in muscle cell size.

Back 23

Hypertrophy

Front 24

The most common type of heart failure is ____.

Back 24

left sided.

Front 25

____ failure means the heart is unable to contract.

Back 25

Systolic

Front 26

_____ failure means the heart is unable to relax.

Back 26

Diastolic

Front 27

The primary cause of right sided heart failure is ____.

Back 27

left sided heart failure

Front 28

Left-sided failure happens when the ____ is not effective. Blood backs up into the left atria then pulmonary veins and lungs causing _____.

Back 28

left ventricle
pulmonary congestion

Front 29

Symptoms of pulmonary congestion include:

Back 29

SOB, cough, wheezing, crackles

Front 30

Right sided failure occurs when the blood continues to back up into pulmonary artery, right ventricle and atria, SVC/IVC and then the rest of the body causing...

Back 30

visceral and peripheral congestion

Front 31

Manifestations of Left sided heart failure are

Back 31

-paroxysmal nocturnal dyspnea
-cough, crackles, wheezes
-restlessness
-orthopnea, tachycardia
-exertional dyspnea

Front 32

Manifestations of right-sided heart failure are

Back 32

-ascites
-enlarged liver and spleen
-distended jugular vein
-anorexia
-c/o GI distress
-swelling in hands and fingers
-dependent edema

Front 33

If a patient has severe heart failure, the ____ heart sound may be present.

Back 33

S3

Front 34

S3 heart sounds is also called the ______.

Back 34

ventricular gallop

Front 35

S3 closes after S2. It is during ____ and when there is closure of the _____.

Back 35

diastole
AV valves

Front 36

S3 heart sound indicates...

Back 36

increased volume of blood within the ventricle.

Front 37

The S3 heart sound appears to be related to a sudden limitation of the movement of blood during _____.

Back 37

ventricular filling

Front 38

The S3 heart sound is best heard with the ____ of the stethoscope because it is used for lower frequency sounds.

Back 38

bell side

Front 39

The New York Heart Association scale classifies heart failure based on ____ in relation to _____.

Back 39

patient's symptoms
physical activity

Front 40

The American Heart Association and the American College of Cardiology Foundation staging system for heart failure focuses on ___ and ____.

Back 40

prevention and progression

Front 41

The Heart Failure classifications for the AHA and ACCF are

Back 41

Stages A-D

Front 42

Classification of HF with the NYHA is

Back 42

Stage I-IV

Front 43

A person with Stage ___ HF is symptomatic at rest.

Back 43

IV

Front 44

A pt with Stage D HF is

Back 44

on the heart transplant list.

Front 45

A person with Stage A HF is

Back 45

at high risk for HF

Front 46

A person with Stage B HF is _____.

Back 46

asymptomatic

Front 47

A person with Stage C HF is _____.

Back 47

symptomatic

Front 48

____ is the lab test done to see if SOB is r/t HF.

Back 48

BNP

Front 49

BNP or brain natriuretic peptide is a protein stored primarily in the _____.

Back 49

ventricular myocardium

Front 50

BNP is released when ____ rises.

Back 50

ventricular diastolic pressure

Front 51

An increased ventricular volume causes an increased ____.

Back 51

BNP

Front 52

A BNP > ____ suggests HF.

Back 52

100

Front 53

In addition to a BNP you should look at ___ and ____ for HF.

Back 53

electrolyte panel and CBC.

Front 54

Burdens of Heart Failure include:

Back 54

-Congestive symptoms
-Activity Limitation
-Dysrhythmias
-Hospitalizations
-Reduced survival

Front 55

Medications that are prescribed for heart failure include:

Back 55

ACE inhibitors
Angiotensin II Receptor Blockers
Beta Blockers
Diuretics
Nitrates
Cardiac Glycosides

Front 56

"-pril" medications are _____.

Back 56

ACE Inhibitors

Front 57

_____ are the med of choice for heart failure.

Back 57

ACE inhibitors

Front 58

ACE inhibitors work by

Back 58

reducing angiotensin II synthesis and therefore reduce aldosterone secretion and cause vasodilation.

Front 59

Reduced aldosterone secretion causes ____ preload.

Back 59

decreased

Front 60

Vasodilation causes ____ afterload.

Back 60

decreased

Front 61

ACE inhibitors decrease mortality and slow

Back 61

ventricular remodeling.

Front 62

Adverse effects of ACE Inhibitors are

Back 62

hyperkalemia
hypotension
renal insufficiency
acute angioedema
dry cough

Front 63

A life threatening adverse effect of ACE inhibitors is ____.

Back 63

acute angioedema

Front 64

Acute angioedema is the swelling of

Back 64

face, tongue and cheeks.

Front 65

Nursing responsibilities for pt on ACE inhibitors include:

Back 65

-monitor K for hyperkalemia
-check BP
-teach pt about orthostatic hypotension
-educate pt abt high K foods to avoid
-teach pt to report acute angioedema and dry cough

Front 66

"sartan" medications are _____.

Back 66

Angiotensin II Receptor Blockers (ARBs)

Front 67

ARBs work in the ____ not the lungs and block the action of _____ at its receptor sites directly.

Back 67

periphery
angiotensin II

Front 68

Nursing care for a pt on ARBs includes:

Back 68

-check BP
-monitor K (hyperkalemia)
-teach pt abt orthostatic hypotension
-educate abt acute angioedema

Front 69

Dry cough is not an issue with ARBs because they do not

Back 69

work in the lungs.

Front 70

_____ don't allow conversion of Angiotensin I to Angiotensin II whereas ____ don't allow Angiotensin II to attach to receptor sites.

Back 70

Angiotensin Converting Enzyme (ACE) Inhibitors

Angiotensin II Receptor Blockers (ARBs)

Front 71

-"olol" meds are _____.

Back 71

beta blockers

Front 72

Beta blockers work by blocking beta receptors on the heart muscle and therefore they

Back 72

decrease heart rate and contractility

Front 73

Adverse effects of beta blockers include:

Back 73

bradycardia
hypotension
dizziness
fatigue

Front 74

A serious side effect of taking beta blockers is

Back 74

rebound tachycardia.

Front 75

Rebound tachycardia may be seen within ____ if beta blockers are stopped abruptly.

Back 75

48-72 hours

Front 76

Nursing care for a pt taking beta blockers includes:

Back 76

-assess HR and BP prior
-assess for a report contraindications to therapy (HF, bradycardia, AV block, asthma, COPD)
-teach pt to take radial pulse before taking
-med may cause fatigue

Front 77

____ diuretics inhibit the exchange of chloride and sodium in the distal loop of henle.

Back 77

Thiazide

Front 78

______ diuretics inhibit reabsorption of Na in the distal and collecting tubules.

Back 78

K-sparing/Aldosterone Antagonists

Front 79

____ diuretics inhibit exchange of chloride, sodium and potassium in the ascending loop of henle.

Back 79

Loop

Front 80

2 diuretics that are most commonly prescribed for the HF patient due to Fluid Volume excess are:

Back 80

K-sparing and Loop diuretics

Front 81

Nurses should monitor K for patients who are on ____ diuretics.

Back 81

loop

Front 82

"-actone/-one" meds are ____.

Back 82

K-sparing diuretics (Aldosterone antagonists)

Front 83

K-sparing diuretics (Aldosterone antagonists) work by

Back 83

blocking aldosterone receptors in the distal and collecting tubules in the kidney. This increases the excretion of sodium and water.

Front 84

If a patient is on a K-sparing diuretic they should be told to

Back 84

maintain regular diet; don't increase intake of bananas, cantaloupe, etc...

Front 85

Patients with heart failure have trouble with ventricular contraction. ____ improves the ventricular contraction making it more forceful.

Back 85

Digoxin

Front 86

Cardiac Glycosides, like Digoxin, slow conduction thru the ____ and improve myocardial contraction by interfering with the _____.

Back 86

AV node
Na/K/ATPase pump

Front 87

Digoxin binds to the N/K/ATPase pump causing more sodium to stay inside the cell and slowing down the Na Ca exchange. Since Ca is inside the cell longer there is a _____.

Back 87

more forceful contraction

Front 88

Digoxin does not cause hypokalemia, however, it the pt is already hypokalemic and digoxin is administered, they are at increased risk for ____.

Back 88

digoxin toxicity

Front 89

S/Sx of digoxin toxicity are

Back 89

anorexia, nausea, vomiting, and vision changes.

Front 90

Nursing care for a pt taking digoxin includes:

Back 90

-check apical pulse 1 full minute
-monitor for hypokalemia
-check therapeutic levels
-monitor for signs of digoxin toxicity
-teach pt check radial pulse 1 minute at home
-withhold digoxin if pulse<60

Front 91

The therapeutic range for digoxin is _____ng/mL.

Back 91

0.8-2.0

Front 92

1 liter fluid= ___kg= ____lb

Back 92

1 liter fluid= 1 kg = 2.2 lb

Front 93

Some nursing diagnoses for HF are

Back 93

-Decreased CO
-Excess Fld Volume
-Activity Intolerance
-Knowledge deficient
-Ineffective Therapeutic Regimen Management

Front 94

Nursing interventions for a patient with HF are:

Back 94

-teach about Na restriction (2g/day)
-daily weights
-fluid restriction (2L/day)
-avoid smoking
-limit alcohol
-stress management
-take prescribed meds as ordered
-give written med schedule

Front 95

HF discharge instructions include providing well written instructions and or educational material regarding:

Back 95

-activity level
-diet
-medications
-f/u appointment
-weight monitoring

Front 96

_____ is excessive edema even when pt is on extensive medication regimen.

Back 96

Acute Pulmonary Edema

Front 97

During Acute Pulmonary Edema the lungs are....

Back 97

filling rapidly with fluid.

Front 98

Acute Pulmonary Edema is characterized by

Back 98

-dyspnea of sudden onset
-crackles
-gasping respirations
-rapid pulse
-decreased urine output
-skin that is cool, moist, ashen gray or cyanotic

Front 99

Manifestations of Acute Pulmonary Edema include:

Back 99

-tachypnea
-labored breathing
-productive cough
-pink, frothy sputum
-crackles, wheezes
-congestion

Front 100

Treatment options for a patient with Acute Pulmonary Edema are:

Back 100

-reduce excess fluid with loop diuretic
-O2 by mask
-MS by IV
-diuretics

Front 101

MS by IV is used for Tx of Acute Pulmonary Edema because is causes ____ and reduces ____ to heart which alleviates effects of the SNS.

Back 101

vasodilation
preload

Front 102

Pulmonary Edema is a
MAD DOG

Back 102

Morphine
Assess R, O2, lung sounds
Dobutamine

Diuretics (Lasix)
Oxygen
Gases (ABGs)

Front 103

Positioning for a pt with Acute Pulmonary Edema includes

Back 103

HOB raised and allow feet/legs to dangle