NURS Clinical Exam 3 Prep - Heart Failure

What does the right ventricle pump?

blood to the lungs

What does the left ventricle pump?

oxygenated blood to the body

What happens during diastole?

the ventricles relax and fill

What happens during systole?

the ventricle contract and eject blood

What is required for effective circulation?

adequate filling and ejection

What is cardiac output?

heart rate x stroke volume

What does cardiac output measure?

blood pumped each minute

What is preload?

ventricles stretch at the end of filling

What influences preload?

venous return and volume

What is afterload?

resistance the ventricle must overcome to eject blood

What is contractility?

the strength of contraction at a given filling level

What is the pathophysiology of HF?

the heart cannot work effectively as a pump

Why can’t the heart pump effectively during HF?

contraction, filling, or both are impaired

What is the result of reduced forward flow?

decreased tissue perfusion

What can result from elevated filling pressures?

congestion behind the affected ventricle

What may occur together during HF?

congestion and decreased perfusion

What are causes and risk factors for HF?

hypertension, coronary artery disease/MI, valvular disease, cardiomyopathy

What is the result of hypertension?

increases ventricular workload

What can damage the myocardium?

coronary artery disease/MI

What can result form valvular disease?

pressure or volume overload

What does cardiomyopathy directly affect?

heart muscle structure or function

What can affect HF risk?

age, diabetes, weight, kidney disease, exposure, and lifestyle

What results from high systemic pressure?

increased left ventricular afterload

What must the ventricle do during hypertension?

generate more force to eject blood

What is myocradial hypertrophy?

initially supports the increased workload associated with hypertension

During hypertension, what can impair relaxation and filling?

thickening and fibrosis

During hypertension, what can result from continued stress?

adverse remodeling and impaired contraction

What can result from impaired contraction or filling?

increased left ventricular filling pressure

During left-sided HF, where does pressure rise?

left atrium → pulmonary veins and capillaries

During left-sided HF, what is the result of fluid moving into lung tissue?

causes dyspnea, orthopnea, and crackles

During left-sided HF, what results from reduced forward output?

fatigue, weakness, and decreased urine ouput

What results from reduced ejection fraction (EF)?

impaired contraction

During left-sided HF, how is contraction in the ventricle impaired?

cannot contract forcefully enought to eject blood effectivley

During left-sided HF, what may occur during impaired contraction or filling?

congestion and decreased perfusion

What results from preserved ejection fraction (EF)?

impaired filling

During left-sided HF, how is filling in the ventricles impaired?

difficulty relaxing and filling without elevated pressure

What is important to note about preserved EF?

does not mean normal heart function

During left-sided HF, what percentage is ejected with impaired contraction?

a small amount of filled volume

During left-sided HF, what percentage is ejected with impaired filling?

may reamin preserved despite abnormal filling

What are signs of right-sided HF?

JVD, dependent edema, hepatomegaly, abdominal congestion/ascites, fluid retention

What results from impaired right ventricular pumping?

impaired pressure in the systemic veins

What is jugular vein distention (JVD)?

distended neck veins

What is dependent edema?

swelling in the ankles/legs or sacrum

What is hepatomegaly?

enlarged liver, sometimes with tenderness

What is abdominal congestion/ascites?

abdominal swelling, fullness, nausea, and reduced appetite

What is fluid retention?

weight gain

What are expected cues of pulmonary congestion?

dyspnea, orthopnea, crackles, and cough

Why does pulmonary congestion occur?

elevated left-sided filling pressures affect pulmonary vessels

What are expected cues of systemic venous congestion?

JVD, ascites, dependent edema, hepatomegaly

Why does systemic venous congestion occur?

elevated right-sided pressure affect systemic veins

What are expected cues of decreased perfusion?

fatigue, cool extremities, reduced urine output

What does decreased perfusion occur?

forward flow is inadeqaute for tissue needs

What are compnesatory mechanisms for HF?

sympathetic stimulation, vasoconstriction, RAAS system, angiotensin II and aldosterone

What results form sympathetic stimulation?

increases heart rate and contractility to support cardiac output

What results form vasoconstriction?

helps maintain blood pressure and organ perfusion

What activates the RAAS system?

reduced kidney perfusion

What is the role of angiotensin II?

constricts vessels

What is the role of aldosterone?

promotes water and sodium retention

What is the initital purpose of compensatory mechanisms?

preserve circulation when effective perfusion falls

When does compensation become harmful?

persistent tachycardia, continued vasoconstriction, excess fluid retention, adverse remodeling

What results from persistent tachycardia?

increases oxygen demand and reduces filling time

What is results from continued vasoconstriction?

increases afterload, making ejection harder

What results from excess fluid retention?

raises filling pressures and worsens congestion

What does adverse remodeling include?

hypertrophy, dilation, and fibrosis

What is stage A HF?

at risk

What does stage A HF include?

risk factors without HF symptoms or cardiac abnormalities

What is stage B HF?

pre-HF

What does stage B HF include?

cardiac abnormaties or elevated biomarkers without current or prior HF symptoms

What is stage C HF?

HF?

What does stage C HF include?

current or prior symptoms/signs caused by a cardiac abnormality

What is stage D HF?

advanced HF

What does stage D HF include?

severe symptoms despite treatment, often with recurrent hospitalizations

What are NYHA classes I-IV?

describe activity limitations and symptom burden

What health history can indiacte HF?

hypertension, CAD/MI, valve disease and other contributors

What health history patterns should be monitored?

breathing, sleeping, and urinary

What symptoms should be monitored for HF?

weight changes, edema, and abdominal

What are cues of pulmonary congestion?

dyspnea, orthopnea, nocturnal dyspnea, cough and crackle, respiratory compromise

What should be assessed for dyspnea?

onset, severity, activity tolerance, and symptoms at rest

What should be assessed for orthopnea?

ask about pillow use and sleeping upright

What should be assessed for nocturnal dyspnea?

ask about awakening from sleep with breathlessness

What should be assessed for cough and crackles?

cough characteristics and the location/extent of crackles

What should be assessed for respiratory compromise?

rate, effort, SpO2, ability to speak, and mentla status

What are cues for decreased perfusion?

fatigue, cool extremities, reduced urine output, new confusion or restlessness, tachycardia or hypotension

What should be assessed for fatigue and activity tolerance?

changes in usual daily activities

What should be assessed for cool extremities?

skin temperature, pulses, and capillary refill

What should be assessed for reduced urine ouput?

output trends and renal function

What should be assessed for confusion or restlessness?

mental status and changes from baseline

What should be assessed for tachycardia or hypotension?

interpret alongisde other signs of impaired perfusion

What are signs of systemic congestion?

JVD, dependent edema, hepatomegaly, ascites, fluid retention

What should be assessed for JVD?

neck veins with appropriate positioning

What should be assessed for dependent edema?

ankles/legs and the sacrum in patients confined to bed

What should be assess for hepatomegaly?

tenderness, fullness, and appetite

What should be assessed for ascites?

abdominal distention when indicated

What should be assessed for fluid retention?

monitor consistent daily weights and intake/output

What diagnostic and lab assessments are used for HF?

echocardiogram, chest x-ray and ECG, BNP or NT-proBNP, potassium/sodium/magnesium, BUN/createnin/eGFR/CBC

What does an echocardiogram evaluate?

ejection fraction (EF), chamber size, wall motion, valves, and filling/function

What does a chest x-ray and ECG evaluate?

congestion/cardiac enlargement; rhythym or ischemic clues

What does a BNP or NT-proBNP evaluate?

supports diagnosis when interpreted with the clinical picture

What does potassium/sodium/magnesium lab evaluate?

disease and medication related electrolyte changes

What does a BUN/creatinine/eGFR/CBC evaluate?

renal perfusion/function’ anemia or other contributors