Int Med Surg Heart Failure

Front 1

Causes of HF

Back 1

Drug/Alcohol use
HTN
MI (Most common cause)

Front 2

HF is the most common reason __ and ___ people are hospitalized

Back 2

Geri's and Obese

Front 3

Who is more affected by HF, men or women?

Back 3

Men

Front 4

How does alcohol and drug use cause HF?

Back 4

Drugs and alcohol lead to cardio myopathy, heart muscles get thicker and more rigied beause it is working harder

Front 5

Systolic Heart Failure

Back 5

Heart is unable to contract forcefully enough during systole to eject enough blood into the circulatory system. PRELOAD & AFTERLOAD both INCREASE. EJECTION FRACTION DROPS TO <40%.

Front 6

What is a normal ejection fraction?

Back 6

(Normal is 50-70%).

Front 7

Systolic Heart Failure has to do with a problem ______

Back 7

emptying

Front 8

Diastolic Heart Failure

Back 8

Left ventricle cannot relax enough during diastole which prevents it from filling with enough blood, which leads to decreased cardiac output.

Front 9

Diastolic Heart Failure has to do with a problem _______

Back 9

filling

Front 10

Right sided heart failure

Back 10

right ventricle cannot empty completely which causes increased volume in the venous system leading to peripheral edema

Front 11

What are the outcomes of Right Sided heart failure?

Back 11

peripheral EDEMA- starts low, abdominal distention, JVD- jugular vein distention, dependent edema, hepatomegaly/splenomegaly, high BP, WEIGHT GAIN

Front 12

1kg of weight gained or lost is = how much water?

Back 12

1 Liter of water

Front 13

Right sided Heart Failure interventions?

Back 13

fluid restrictions,
daily weights,
Diet- restrict salt,
dangle feet

Front 14

Left Sided Heart Failure is divided into...

Back 14

Systolic and Diastolic

Front 15

What is a late/severe sign of Left Sided Heart Failure?

Back 15

Frothy pink tinged sputum

Front 16

Left Sided Heart Failure Results in

Back 16

Decreased Cardiac Output- (fatigue, weakness, dizzy, weak pulses) Pulmonary congestion/edema (hacking cough- early sign, dyspnea, SOB, crackles, Frothy pink tinged sputum- sign of late/severe HF, S3/S4 gallop, fatigue!

Front 17

Interventions for Left Sided Heart Failure

Back 17

raise HOB, check CO2, Cough, deep breathe, supplemental O2, provide for times of rest, CPAP, heart transplant

Front 18

Left sided Heart Failure results in 2 things... Decreased ____ ____ and _____ ______

Back 18

Decreased Cardiac Output

Pulmonary Congestion

Front 19

What is an early manifestation of Left sided HF?

Back 19

Hacking cough, worse at night, nonproductive

Front 20

S/S Pulmonary congestion

Back 20

Hacking cough
Dyspnea, SOB
Crackles or wheezes
Frothy, pink-tinged sputum (very end, life threatening)
Tachypnea
PND
S3, S4 gallop

Front 21

PND

Back 21

paroximal nocturnal dyspnea, occurs suddenly at night,

Front 22

acute dyspnea, secondary to lung congestion at night,

Back 22

wakes them up suddenly- related to position, needs lots of pillows to prop them up

Front 23

Why do Right sided HF pts get Nocturnal Polyuria?

Back 23

body trying to absorb more fluid at night

Front 24

How much fluid retained is needed to demonstrate pitting edema?

Back 24

4-7 liters

Front 25

Which pts NEED TO BE ON DAILY WEIGHTS?

Back 25

Right sided HF

Front 26

Interventions for Pulmonary edema?

Back 26

Dangle
high flow O2 therapy
expect Nitroglycerin, Lasix IVP, Morphine (↓ preload and ↓afterload) and vasodilators
rest
I&O
Fowlers position
Daily weights
Lung assessment

Front 27

During HF, the body compensates for the failing pump, what does ADH do?

Back 27

It causes O2 to be retained and causes vasoconstriction... It is stimulated to absorb Na & H2o

Front 28

Does ADH increase or decrease preload and afterload?

Back 28

It increases preload and afte load because it is retaining water, causing more fluid buildup

Front 29

Why do we need to check kidney function labs, BUN and Creatinine, for HF pts?

Back 29

We need to see kidney function before starting diuretic therapy. If there is impaired bloodflow to the kidneys the result will be more fluid backup
(Kidney failure can lead to HF and vice versa)

Front 30

Why do we check CBC for HF pts?

Back 30

Low RBCs and low H&H (anemia can cause HF)

Front 31

Why do we check BNP in HF pts?

Back 31

(B-type(Brain) natriuretic peptide)- The hormone that is secreted in response to fluid overload, secreted by the ventricles, normal BNP <100, in HF pts BNP will be REALLY elevated

Front 32

Why do we check U/A for HF pts?

Back 32

Check for protein, spec protein specific gravity, (this is looking at their renal perfusion)

Front 33

Why do we want to check ABG for HF pts?

Back 33

want to assess for hypoxia or acidosis from lactic acid buildup (or alkylosis from hyperventilation)

Front 34

Echocardiogram for HF pts

Back 34

looking at valve function and L Vent function, at wall motion (this machine is where they get ejection fraction)

Front 35

Thallium/technicium scan for HF pts

Back 35

going to assess cause of HF, radio isotope dye injected to the heart, will see area of cold spots indicating the area is affected

Front 36

EKG for HF pts

Back 36

looking for any type of abnormalities in rhythm or ischemia

Front 37

If there is decreased Cardiac Output, so we want to increase or decrease Afterload?

Back 37

Decrease afterload

Front 38

If there is decreased Cardiac Output, so we want to increase or decrease Preload?

Back 38

Decrease preload

Front 39

If there is decreased Cardiac Output, so we want to increase or decrease contractility?

Back 39

Increase Contractility

Front 40

What drugs reduce afterload?

Back 40

Ace Inhibitors
Bidyl
ARBs
nBNPs
morphine

Front 41

How do Ace Inhibitors reduce afterload?

Back 41

they decrease arterial pressure so that more can be pumped out of the heart with less resistance

Front 42

What race are Ace Inhibitors less effective in?

Back 42

African Americans

Front 43

What is Vasotec?

Back 43

An IV push Ace Inhibitor

Front 44

Who is Bidyl prescribed for?

Back 44

Only for African Americans. This is the first drug that is ethnicity specific FDA approved.

Front 45

What is Bidyl?

Back 45

It is a vasodilator, not an ace inhibitor

Front 46

When are ARBs prescribed?

Back 46

When pts cannot tolerate Ace Inhibitors

Front 47

When are hBNPs (nesiritide) given?

Back 47

See in ICU mainy, causes pt to vasidilate given IV drip

Front 48

How does morphine work to reduce afterload?

Back 48

It dilates the arteries which reduces the arterial pressure the heart must pump against.

Front 49

What are some interventions to reduce preload?

Back 49

Diet therapy (restrict salt)
Fluid restriction (daily weights)
Medications
Dangle feet- to decrease venous return to the heart

Front 50

What med work to reduce preload?

Back 50

Diuretics
morphine (relaxes and causes vasodilation)
Vasodilators

Front 51

What drug works to enhance contractility?

Back 51

Digoxin

Front 52

What drug classification is Digoxin?

Back 52

cardiac glycoside, an Inotropic drug

Front 53

What drugs are NOT USED FOR ACUTE HEART FAILURE?

Back 53

Beta Blockers and Digoxin

Front 54

How does Digoxin work?

Back 54

alters the Na/K pump, increasing intracellular Ca resulting in increased effective contraction, decreased conduction, slow HR allowing improved fill (C.O. is increased)

Front 55

How does Digoxin decrease conduction?

Back 55

Decreased conduction because of stimulation of the vagus nerve, which then depresses the SA node, and prolongs conduction to the AV node

Front 56

What drugs interfere with Digoxin absorption?

Back 56

Antacids interfere with absorption

Front 57

What condition causes increased sensitivity to Digoxin?

Back 57

Hypokalemia

Front 58

What are s/s of Dig toxicity?

Back 58

Halos, color change in vision, dangerous heart rhythms, GI Distress

Front 59

What is the most serious adverse effect for Digoxin?

Back 59

Ventricular fibrillation

Front 60

How is digoxin absorbed?

Back 60

Erratically ( this is why it does not have to be stopped before dialysis, it is already absorbed in the tissues)

Front 61

What is the antidote to Digoxin?

Back 61

digoxin immune Fab (Digibind)

Front 62

What is the normal Digoxin level?

Back 62

.9 - 1.2 ng/ml

Front 63

What needs to be monitored while on Digoxin?

Back 63

Dig levels and K levels

Front 64

Why do we need to monitor K levels with Digoxin?

Back 64

If pt has really low levels of K, pt will be more sensitive to Digoxin which will cause toxicity much easier

Front 65

What pulse to take before admin Digoxin?

Back 65

Apical Pulse (hold if <60)

Front 66

What meds does Digoxin interact with?

Back 66

TONS AND TONS AND TONS of meds!!!!

Front 67

Pulmonary edema occurs with what sided HF?

Back 67

Left sided HF

Front 68

What are s/s of pulmonary edema?

Back 68

Crackles, dyspnea at rest, disorientation, confusion, anxious, tackycardia, tackypnea

Front 69

Pulmonary edema is caused by?

Back 69

Severe overload

Front 70

What are the s/s of increasing severity of pulmonary edema?

Back 70

moist productive cough, frothy pink or blood tinged sputum, clammy

Front 71

Interventions for Pulmonary edema?

Back 71

dangle feet over bed, sit up HOB
High flow oxygen therapy
Expect Ntg, lasix IVP, Morphine

Front 72

What do pts with pulmonary edema r/t HF look like?

Back 72

very anxious pts, stressed, tired, pale, ashy skin, muscle wasting, thin, room is messy,

Front 73

*** Patient teaching for HF/Pulmonary edema? ***

Last page of test

Back 73

Worsening symptoms
If wt gain 1-2 lb overnight/day or 3 lbs/wk call HCP
Manage energy appropriatly
Take frequent rests and perform activities in small groups
Eat small frequent high calorie snacks

Front 74

What are increased O2 needs and indicator of (in HF w/ pulmonary edema)?

Back 74

Indicates improvement of condition (their CO2 drives breathing with resp conditions, increased O2 requirements means they are able to tolerate more O2 and their CO2 drive is higher/better)

Front 75

Beta Blockers are ONLY used with acute or chronic HF?

Back 75

Only with chronic

Front 76

What diet for HF pts??

Back 76

no salt,
no salt substitute (high in K),
high calorie,

Front 77

Special considerations in the elderly with Heart Failure- Mental status

Back 77

assess esp with Geri- they alter quicker and it is the first indicator that something is wrong, or even only presenting symptom

Front 78

Special considerations in the elderly with Heart Failure- Thyroid disease-

Back 78

Check T3 and T4, HF may be due to thyroid disease

A.fib common with hyperthyroidism which can lead to stroke

Front 79

Special considerations in the elderly with Heart Failure- Caution w/ Diuretic use

Back 79

because little old people are prone to dehydration (check BUN, creatinine, E levels- Na, K, check turger, daily weight)

Front 80

Special considerations in the elderly with Heart Failure-Digoxin toxicity

Back 80

watch out for toxicity because the half life is so long and decreased renal function so they will have this med in their system much longer, the half life can be increased even past the 48 hrs