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84 Cards in this Set

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What is the only heart disorder that is increasing in prevalence and mortality?
Heart failure.
what is heart rate X stroke volume?
Cardiac output.
What is stroke Volume?
the amount of blood ejected from the left ventricle during systole.
What is Preload?
The amount of blood left in the ventricles at the end of diastole.
What is Afterload?
The pressure the left ventricle must overcome to eject its contents.
What is systemic vascular resistance otherwise known as?
Afterload.
name at least three causes of myocardial dysfunction.
CAD, cardiomyopathy, dysrhythmias, infarction, ischemia.
what does Hypertension and aortic stenosis cause?
pressure overload.
what does valvular insufficiency cause?
volume overload.
Valvular stenosis, tamponade, and restrictive pericarditis are all examples of what kind of heart failure disorder?
filling disorders.
what is valvular stenosis?
a narrowing of the valves.
why can anemias and fever lead to heart failure?
because there is decreased Oxygen and that leads to Increased metabolic demand.
What is it "activated" when the body tries to make up, or compensate for heart failure and/or Decreased cornary output?
Activation of the Compensatory Mechanisms.
What does activation of the compensatory mechanisms RESULT in?
Increased preload
name 5 things besides increased preload that occurs because of activation of the compensatory mechanisms.
1) increased heart rate.
2) Improved stroke volume
3) Arterial vasoconstriction.
4) Sodium and water retention.
5) Myocardial hypetrophy
What happens to the ventricles when preload occurs?
they weaken.
A doctor explained to a patient that they have "Forward Heart Failure" since their all dumb, the nurse explains to the patient in a way they can understand that forward heart failure, put in simple terms simply means that what is effected?
the hearts ability to EJECT blood is effected.
when explaining "Backward" heart failure to a patient what would you explain to them is effected?
the hearts ability to fill with blood properly, its a FILLING problem.
what does it mean when someone has low output heart failure?
it means the heart is failing as a pump.
What type of heart failure is it when the cardiac output is normal but the metabolic demands arn't being met?
High output heart failure.
name at least three things you would see, or check for in patients with right sided failure.
peripheral edema, GI complaints, and their nutrition ,(specifically salt intake)
what would you expect to hear in someone with pulmonary congestion?
Rales, and crackles.
name two physical findings you could expect to see in someone with Left ventricular vailure.
decreased cardiac output,
Pulmonary congestion.
name two physical findings you could expect to see in someone with Right ventricular failure?
jugular vein distention and dependent (peripheral) edema.
Tolerance to activity
cough
mental status changes
chest discomfort and dyspenea
can all be expected of a patient in what type of failure?
Left sided failure
how does the New york heart association determine the amount of heart failure someone has?
based on activity and functional ability
numbered I - IV
how does the American heart Association make their classifications?
according to structural problems
Stages A - D
if a patient is asymptomatic, and can tolerate ordinary activity how would they be classified according to the NY heart ass. and what stage would they be in according to the AHA?
Class I (NY)
Stage A or B (if valve disorder but still no signs or symptoms, AHA)
If some one is classified as being in stage C according to the AHA classifications, what class would they be in according to the NY heart ass?
what do these classes mean?
Stages 2 AND 3, there is structural disease with current or past s/s they are confortable at rest and ordinary (or less) results in symptoms.
If a patient has reached class 4 according to NY classifications when are their symptoms present?
at rest and they have symptoms with ANY physical activity.
If a patient has advanced structural disease that's refractory (or does not respond to medical treatment) what stage according to the AHA are they in?
Stage D
The compensatory mechanisms in relation to heart failure increase the heart rate. (among other things) when the heart rate is increased what else happens (name 3 things)
1) Renin-Angiotension system is activated
2) B/P increases because of constriction (caused by the renin angiotension system
3) body holds on to Na+ and water.
when The Angiotension system is activated why does this actually end up hurting your heart in the long run?
because it increases your fluid volume.... this leads to preload.
How does increased preload contribute to decreased cardiac output?
it stretches the heart so the heart looses ability to pump correctly.
if a person is in heart failure and you trying to decrease their fluid volume what foods should you suggest to them to stay away from?
Foods with high sodium such as cheese, pop, cured meats.
Why should a person with heart failure rest often?
because the blood pressure decreases, the heart reserves increase and the work load decreases.
what is a pericarditis friction rub called?
pericarditis.
what are some laboratory tests that may be run on heart patients?
Electrolytes, BUN, Creatnin, ABG's, BNP's,
What does BNP stand for, when is it released, do you want your numbers high or low?
Brain naturitic peptide, its released when your vessels stretch, and is indictive of heart failure, the higher the number the worse off you are.
What are interventions for patients with pulmonary edema secondary to heart failure?
Position in orthpnic position and administer diaretics.
explain a little about BNP
its a natural diretic that is released when you have an enlarged heart (vessels) it is produced in order to decrease fluid volume.
why could they use a Echocardogram on a pt with heart failure?
to dected thinking of the ventricles.
what does MUGA stand for?
Multi graded angiogram scan
What is a good goal for a nurse to make concerning a patient with heart failure
to improve cardiac output.
what are some good ways to reduce preload name 4 ways.
Salt restrictions, fluid restrictions, diretics.
Name 5 ways to reduce afterload
Venous vasodilators
ACE inhinitors
inotropes
beta blockers
VAD (ventricular assist device.
Thiazide is what kind of medication? when is it most effective.
a Diuretic, its most effective when a patient has volume overload.
give an example of venous vasodilators, what do they do.
Nitrates like Isordil (isosorbide dinitrate), nitro-Dur (nitroglycerin.) they decrese preload and afterload
What blocks the conversion of angiotension 1 into angiotension 2?
ACE inhibitors.
Give two medication names for ACE inhibitor
Capoten (Captopril)
Vasotec (Enalapril maleate)
Angiotendin II recptor blockers (ARD) are used when and give two names of drugs that are ARD's
ARD's are used when the patient can not tolerate ACE inhibitors and
Losartan (Cozaar)
Valsartan (Diovan)
are two common ARD's.
name a beta blocker that is often used.
Coreg (carvedilol)
What type of medication is Digoxin and what does it do?
Inotrope, it improves and helps maintain CO while increasing the contraction of the heart.
name two Inotropes
Digoxin and Dobutamine.
when would the Inotrope Dobutamine be used?
for acute exacerbations in the advanced heart failure patient.
What do Phosphodiesterase inhibitors (Inodilators) do?
They strengthen contractility and also enhances peripheral vasodilation.
what type of medication is IV Milrinone?
phosphodiesterase inhibitors or A.K.A Inodiators.
what medication facilitates diaphresis
Nesiritide (natrecor)
if BNP was above what number, would it be indictive of heart failure?
if it was greater than 100.
name two special nursing considerations that must be followed when Nesiritied (Natrecor) is given.
1) Natrecor must have its own IV live.
2) Can NOT run with heprin.
during what class (NY) and what stage (AHA) would patients be appropriate candiates for IV heart failure medications?
NY- class 3 or 4
AHA - Stage D
Only used in end stage pt's when traditional therapy has failed and their ineligible or awaiting transplant.
name (or try to remember) 7 nursing implications that are important to do when taking care of someone with HF.
1) monitor respiratory status
2) monitor fluid and electrolyte balance
3) Work toward increasing tolerance to activity
4) Teach salk and fluid restrictions
5) teach importance of daily weights
6) teach reportable Sand symptoms
7) teach orthnc position (leaning forward, perhaps over a table.
why are heart failure clinics so effective?
decrease the rate of re-hospitalization and length of stay, often telephone based, education b/p and wt checks and IV meds are monitored.
Name 4 risk factors that can be midified for a patient with HF.
1) Quit smoking
2) Control hypertension
3) decrease serum lipids
4) change type a behaviors.
how many pounds untill a patient should call the doctor?
3 - 5 ibs over a coupple days.... call the doctor.
When does heart failure occur ?
when the heart muscle is unable to pump effectively.
what does heart failure result in
inadequae cardiac output, myocardial hypertrophy, and pulmonary/ systemic congestion.
Left sided heart (ventricular )failure has two forms..... Name them.
1) Systolic heart (ventricular) failure
2) Diastolic heart (ventricular) failure.
Low Output Heart Failure can initially occur where?
either the left or right side of the heart.
when the ejection fraction is below 40% and pulmonary and systemic congestion occur what type of heart failure is this?
Left sided, systolic heart failure.
when someone has Left sided, Diastolic heart (ventricular) failure what does this result in?
inadequate relaxation or "stiffening" prevents ventricular filling.
What yealds the result of inadequate ventricle output and systemic venous congestin?
Right-sided heart failure.
when the cardiac output is normal or above normal, what kind of heart failure is this?
High output failure
What are the risk factors/causes for high-output heart failure?
Increased metabolic needs spticemia, aepticema, anemia
when a patient with HF reports increased shortness of breath you give him oxygen and than do what?
Assist the patient into high-fowler's position.
what are the benifits of placing a patient in high-fowler's position?
it will decrease venous return to the heart (preload) and will help relieve lung congestion.
when should Thiazide be taken?
thiazide is a diuretic so it should be taken in early morning and early afternood so your not up peeing all night long.
why should Oxygen therapy be given to a pt with HF?
it increases myocardial and systemic oxygen supply
why are diuretics given?
because they decrease preload.
why are patients taught fluid restriction?
it decreases vascular volume leading to decreases preload.
what should you teach the patient about taking digoxin?
take pulse for one minute, notify the provider if pulse is below set limit.
what do Inotropic agents do?
increase contractility.
a client with a Dx of heart failure asks how to limit fluid intake to 2,000 mL/Day, The nurse's best response would be what?
"This is the same a a 2L bottle of soda. pour the amount of flid you drink ito an empty pop bottle to keep track of how much you drink.
concerning Na+ and K+ what should patients be doing?
in general clients pt's with heart failure may need to reduce sodium intake and to increase potassium intake.