N300 Heart Failure Captivative Lecture

Front 1

The condition that involves impaired cardiac pumping?Heart can't pump sufficient blood flow to meet metabolic needs and pump to the rest of the body.

Back 1

Heart failure-The most common reason bringing in ppl over 65 to hospital."congestive heart failure"

Front 2

Mi's, dyrrythmias, hypertensive crisis, or pulmonary embolism, characterized by significant overload to the lungs (pulmonary edema) is what kind of heart failure?

Back 2

Acute, quick changes in status

Front 3

Slow and over time heart failure, caused by HTN, coronary artery disease, congenital or rheumatic heart disease, anemia, cardiomyopathy (heart muscle disease) or pulmonary HTN, is what heart failure?

Back 3

Chronic

Front 4

What is the number 1 risk factor for developing heart failure?

Back 4

Coronary artery disease, along with age

Front 5

What are other risk factors for developing heart failure?

Back 5

HTN, smoking, diabetes, high cholesterol, obesity, african american

Front 6

If right side of the heart is not pumping effectivly, not pumping into pulmonary circulation, then?

Back 6

Blood is back flowing into venous circulation, and will be seen in abdomen and extremities.

Front 7

If heart is not pumping and ejecting all the blood it is supposed to when contracting, this is called?

Back 7

systolic heart failure-means left over blood in ventricles

Front 8

If heart has impaired ability to relax, having decreased filling of ventricles and lower stroke volume is called?

Back 8

Diastolic heart failure

Front 9

What is the difference in backward vs forward heart failure?

Back 9

Backward heart failure-increased venous back pressure
Forward heart failure- failure to supply adequate arterial perfusion

Front 10

What is low output heart failure vs high output heart failure?

Back 10

Low output heart failure- low cardiac output with high systemic resistence
High output heart failure- high cardiac output with low vascular resistance

Front 11

1(no heart failure and no physical limitation)- 4 (severe heart failure, all activity with pain) classification systems, using functionality is what?

Back 11

New York Heart Association

Front 12

What association classifies based on risk using A-D and development of structural heart disease?
A-no risk, no defects
D-risk factors, hospitalized

Back 12

American Heart Association

Front 13

When we have heart failure and our cardiac output falls, what does our sympathetic nervous system do to compensate?

Back 13

Baroreceptors sense the fall in cardiac output.
1. SNS(first and least effective mechanism)
Released catacholamines (epinephrine, noepinephrine)
Increases HR
Increases heart contractability
Peripheral vasoconstriction(increases our preload)
Increase stroke volume (CO=SV x HR)

Front 14

Is the initial increase in cardiac output as a compensary mechonism good and helpful for the pts with heart failure?

Back 14

No, increasing cardiac output increases venous return (which is already volume overloaded) and worsens ventricular performance. Doing more harm then good!

Front 15

Explain neurohormonal response 1 and how the kidneys attempt to compensate for decreased cardiac output from heart failure.

Back 15

Decrease cardiac output causes less blood to reach kidneys.
Kidneys release renin.
Renin converts angiotensinogen to angiotensin 1.
Angiotensin 1 is converted to angiotensin 2 by enzyme made in the lungs
Stimulates aldosterone-increase sodium retenetion, water retention, plasma retention

Front 16

Angiotensin 2 causes what 2 compensatory mechanisms for heart failure to happen?

Back 16

Angiotensin 2 causes adrenal cortex to release aldosterone (Increase sodium and water retention)
Increases peripheral vasoconstriction (increase BP)
**Doing worse than heart failure**
Called "renin-angiotensin-aldosterone" system

Front 17

Explain the neurohormonal response 2 and the compensatory mechanism of the brain not receiving enough blood.

Back 17

Low cardiac output causes lower cerebral profusion pressure
Posterior pituitary releases antidiuretic hormone (ADH)
-causes increased water absorption in renal tubules causing
-water retention
-increase blood volume
Good for when V is low or blood loss, but it is taxing the system that cant handle the fluid it already has.

Front 18

Explain the neurohormonal response 3 of the vascular endothelial trying to compensate for heart failure?

Back 18

ADH, catacholomines, and angiotensin 2 stimulate endothelian production and causes
-increase in cardiac contractability
-arterial vasoconstriction
-hypertrophy

Front 19

In response to the compensatory mechanisms, the body has a response to them to counteract them. What hormones does the heart produce that promotoes venous and arterial vasodilation?

Back 19

Natriureic peptides-
Atrial natriueric peptides and B-type natriureic peptides
**Decreases preload and afterload by enhancing diaphoresis**

Front 20

What happens to the ventricles as a result of heart failure, compensatory mechanisms, and counteracting?

Back 20

Ventricular dialation-enlargement of ventricles becoming inadequate and decreasing cardiac output

Front 21

How does the heart end up hypertrophied after heart failure and compensatory mechanisms happen?

Back 21

Increases in muscle mass, cardiac wall thickens d/t chronic dialation-leads to heart having poor contractability and needing more oxygen, poor coronary artery circulation

Front 22

D/t the hypertrophy of the heart in pts with heart failure puts a pt at risk of developing?

Back 22

Ventricular dysrrhythmias-abnormal electronic activity in heart

Front 23

What is also released by the vascular endothelium and helps smooth muscle to relax resulting in vasodilation and decreases afterload?

Back 23

Nitric oxide

Front 24

Overall why are these compensatory mechanisms not helpful for pts with heart failure?

Back 24

B/c increases workload on heart and oxygen demand

Front 25

What type of heart failure is the most common and what causes it?

Back 25

Left sided heart failure- d/t CAD, HTN, MI, cardiomyopathy -disease of the heart muscle

Front 26

Left sided heart failure causes?

Back 26

Reduced capacity to pump blood, decreased cardiac output, backs up into pulmonary congestion and edema **CRACKLES**

Front 27

What is one of the most common causes of right sided heart failure?

Back 27

Left sided heart failure
ALSO caused by cor polmonale- R ventricle dialation and R ventricular MI

Front 28

What clinical manifestations will tell us a pt has right sided heart failure?

Back 28

Distended jugularvenous
Hepatomegly-right upper quad pain
Spleenomegly
Ascities-abdomen edema
Peripheral edema -extreme water weight gain and sudden!

Front 29

If I was taking vital signs, what sign is increased in both right and left sided heart failure?

Back 29

Increased heart rate

Front 30

How do heart signs differ in pts with right sided vs left sided heart failure

Back 30

Left sided- S3 S4 gallop ryhthm
Right sided- Murmurs

Front 31

What sided heart failure will present with a decrease in SaO2 and PaO2?

Back 31

Left sided HF d/t not getting oxygenated blood out of heart muscle efficiently

Front 32

Dyspnea on exertion would be a symptom of what HF?

Back 32

Left sided HF

Front 33

Pt with what HF will have orthopnea (pillows to breathe ok) and paryoxymal noctural dyspnea (trouble breathing at night) and dry hacking cough?

Back 33

Left sided HF

Front 34

What are we looking for in HF pt with a chest x ray?

Back 34

Can show cardiomegaly-enlarged heart

Front 35

What can the echocardiogram tell us about a HF pt?

Back 35

The function of the heart- decreased ventricular function and decreased ejection fraction

Front 36

What would an electrocardiogram tell us about a pt with HF?

Back 36

Dysrrhythmias, electrical conduction problems

Front 37

What kind of lab studies would we look at for pts with heart failure?

Back 37

Cardiac enzymes tells us if previous MI
BNP- counterregulatory hormone-tells us what stage heart failure is in based on how much heart muscles release BNP

Front 38

How will acute heart failure pts want to be sitting?

Back 38

Upright to reduce pulmonary congestion and permit gas exchange

Front 39

What is CVP?

Back 39

Central venous pressure-monitor, especially in right side HF pts

Front 40

What must we monitor especially if on diuretics?

Back 40

Potassium- electroyles can also build up in HF pts

Front 41

What drugs do we give pts to reduce preload, improve venous capacity, improve ventricular contraction, decrease heart size, avoid stimulation of neuralhormonal response system?

Back 41

Vasodilators- like NITROGLYCERIN
WATCH FOR HYPOTENSION

Front 42

What drugs reduce afterload by reducing systemic resistence to increase cardiac output

Back 42

ACE inhibitors-angiotensine converting enzymes
examples: Captopril, Benzapril, Enalpril ***PRIL!!!***
WATCH FOR HYPOTENSION

Front 43

What do angiotension 2 receptor blocker DRUGS do what to decrease afterload?

Back 43

Interupt vasoconstrictor and block aldosterone secreting effects of angiotension 2
EXAMPLES: LOSARTAN AND VALSARTAN

Front 44

What drugs do we give that block the negative effects of the sympathetic nervous system on the heart by keeping down the heart rate?

Back 44

Beta blockers
COREG AND METAPROL

Front 45

What drugs decrease cardiac preload, decrease pulmonary congestion, decrease cardiac work, increase cardiac output?

Back 45

diurectics

Front 46

What are the two types of diurectic brands we give and what do we need to monitor before we give it?

Back 46

POTASSIUM
LASIX-watch for low potassium levels cause it depletes electrolytes
SPIRONOLACTONE-watch for high potassium
***LASIX LOWERS POTASSIUM**

Front 47

How does morphine help pts with heart failure?
And what should we monitor with morphine?

Back 47

Sedates pts and vasodilates to help decrease work load on heart.
Watch for hypotension and RR

Front 48

What common drug improves contractability and stroke volume?
What must we check before administering?

Back 48

Digoxin
Check apical HR!
If lower than 60 or above 120, HOLD

Front 49

Water consumption and heart failure?

Back 49

Keep drinking water- will not improve retention
DECREASE SODIUM

Front 50

What is the most common complication of heart failure?

Back 50

Pleral effusion-in pleral cavity there is small amt of fluid to lubercate the cavity. With HF and elevated pressure, there is excess fluid. Causes SOB, chest pain, dyspnea.

Front 51

What is the most common dyrrythmia with heart failure?

Back 51

Atrial fibrilation-loss of cardiac kick and can reduce cardiac output by 10-20%

Front 52

Atrial fibrilation cause cause what to form and increase in risk for?

Back 52

Clots to form, risk for strokes. Treatments inclue cardioversion, antidyssryhtmias, anticoagulants

Front 53

What is ejection fraction?

Back 53

The amount of blood pumped out of each ventricle with each heart beat

Front 54

What are some of heart failure complications, leading to possible death?

Back 54

Fatal dysrryhtmias- sudden cardiac death, ventricle tachycardia-with heart failure and an ejection fraction of less than 35%

Front 55

What are the goals for our pt with heart failure?

Back 55

BP within normal limits
keep edema to a minimum
maintain weight
maintain function and activity
Client maintains diet, weight, and meds

Front 56

Nursing diagnosis for pt with heart failure?

Back 56

activity intolerance
anxiety
impaired gas exhange
fluid excess
knowledge deficit

Front 57

What are the options for pts that have end stage heart failure?

Back 57

Placed on list for heart transplant. Determine who would better the most (stable, younger) and who would make lifestyle changes for this surgery.

Front 58

Heart transplant pts are on what, starting in operating room?

Back 58

Immunosupressive therapy

Front 59

Most common complication within first year of heart transplant is?

Back 59

Infection and rejection

Front 60

What are the major causes of death within the first year of heart transplant?

Back 60

Lymphoma (malignancy) and coronary artery vasculopathy