ADH2 Exam 2: HF

What can HF result in? (3)

1. decreased CO

2. Myocardial hypertrophy

• abnormal thickening of heart muscle

3. Pulmonary and systemic congestion

What are the causes of HF?? (6)

1. MI

2. HTN

3. dysrhythmias

4. Valvular disease

5. Cardiomyopathy

• disease of heart muscle

6. Pericarditis

• swelling of sac around heart

• viral infx

• or MI

General lifestyle changes to prevent HF? (7)

• what vax should u get?

1. Quit smoking

2. Limit alc

3. Exercise

4. Low Sodium diet

5. Weight control

6. Control HTN, DM. HLD

7. Get flu and pneumonia vax

Key sign of L.S HF? (6)

• PULMONARY congestion!!

1. dyspnea

2. orthopnea (trouble breathing when laying flat—supine)

3. crackles

4. s3 sound

5. pink frothy sputum

6. altered LOC (lack O2 to brain)

Key sign R.S HF?? (6)

• SYSTEMIC Congestion!!—rest of body

1. JVD

2. dependent edema

3. ascites

4. hepatomegaly

5. weight gain

6. nocturia

What are the PRIMARY HF Diagnostic tests?? (3)

1. BNP!!

• < 100 safe

• elevated = HF

2. Echocardiogram

   • shows EF 

3. Chest Xray

Supportive HF dx test: (3)

HEMOdynamics

1. CVP (Central Venous Pressure): R. heart PREload/volume

2. PAP: (Pulmonary Artery Pressure): pulmonary circulation, RV AFTERload

3. PAWP: (Pulmonary Artery Wedge Pressure): L. Atrial pressure, LV PREload

What are the EF ranges? (3)

1. Normal

• 55-70%

2. <40% means reduced EF→ systolic HF (weak pump)

3. >40% but with poor filling means preserved EF → diastolic HF (stiff ventricle, poor filling NOT Pumping tho)

**lower the number, the less blood being ejected from heart in each beat

What does chest xray show in HF? (2)

1. Cardiomegaly

• enlarged heart

2. Pulmonary congestion

HF 3 general categories of nursing care:

• airway/O2 (2)

• monitoring (5)

• management/support (2)

1. Airway and O2:

• High fowlers

• give O2 as prescribed

2. Monitoring

• VS

• Hemodynamics (CVP, PAP, PAWP)

• Daily weights

• Strict I/O

• Labs: BNP, electrolytes

3. Management/ Support

• fluid and sodium restriction

• energy conservation

5 classes of HF meds and the prototypes:

1. Diuretics

• Loop (furosemide)

• Thiazide

• K-Sparing (spironolactone)

2. ACE inhibitors, ARBs, nitrates

3. Digoxin

4. BB

• metoprolol

• carvedilol

5. Anticoags

• warfarin

Meds that decrease PREload?

Diuretics (loop, thiazide, K-sparing)

• furosemide

• spironolactone

• rapid relief of fluid overload, P. Edma

Meds decrease AFTERload? (3)

1. ACE inhibitors (captopril)

2. ARBs (losartan)

3. Nitrates

Med improving contractility:

Digoxin!!

Dig toxicity (early and late)

• Early: GI issues (NVD; anorexia)

• Late: Vision changes

  • yellow, green halos

  • dysrhythmias

• 0.2-2 ng

What meds decrease WORKLOAD

• and why?

BB
- Metoprolol etc

• decreases HR and BP, allowing heart to fill better

• *start low and slow, may worsen symptoms if titrated too quickly!!!

What are major complications of HF?? (4)

1. Pulmonary Edema

• fluid OVERload

• impaired gas exchange

2. Cardiogenic shock

• severe pump FAILURE!! → hypotension

• poor perfusion

3. Dysrhythmias

• a. fib

• ventricular dysrhythmias

4. Organ dysfunction

• renal and liver failure from chronic poor perfusion!

Pulmonary edema HF complication findings: (8)

1. Severe dyspnea

2. orthopnea

3. cyanosis

4. anxiety

5. crackles

6. pink frothy sputum

7. cough

8. tachycardia

Management of Pulmonary edema: (6)

1. High fowlers

2. O2

3. Possible intubation

4. IV diuretics (furosemide)

• would need bed pan/ catheter

5. Morphine (decreases preload and anxiety)

6. Vasodilators as ordered (nitro)

• breath easier

HF basic pt education (3 categories):

• diet/fluid (3)

• self-monitoring (2)

• meds/lifestyle (2)

  • also, what med to avoid?

  • report how much weight gain?

Diet/ fluids—duh

• Low sodium diet

• fluid restrictions

• NO NSAIDS!!!!! (increases sodium and fluid retention)*******

2. Self-monitoring

• daily weight

• report >2 lb/day OR >5lb. week gain************

3. Meds and lifestyle:

• balance activity w/ rest

• take meds as prescribed

HF key points:

• definition

• causes (6)

• Left v Right

• Diagnostics (3)

• Nursing care (5)

• Meds (5)

• Complications (4)

• Education (5)

• definition: heart muscles pump badly→ decreased CO and congestion!

• causes (6)

1. MI

2. HTN

3. valvular disease

4. Cardiomyopathy

5. Pericarditis

6. Dysrhythmias

• Left v Right

  • Left: Lungs (dyspnea, crackles, frothy sputum)

  • Right: rest of body (ascites, edema, JVD)

• Diagnostics (3)

1. BNP: elevated = HF

2. ECG: EF <40% systolic; Preserved EF is diastolic)

• In systolic HF (reduced EF), the heart is weak and can’t pump enough blood out.

  🔹 In diastolic HF (preserved EF), the heart muscle is stiff, so it doesn’t relax and fill properly.

3. CXR: pulmonary congestion

• Nursing care (5)

1. High fowler

2. O2

3. Daily weight

4. I/O

5. fluid and Na restriction

• Meds (5)

1. Diuretics (decrease PREload)

2. ACE/ARBs (decrease AFTERload)

3. BB (decrease WORKload)

4. Digoxin (increase contractility)

5. Anti-coags (if clot risk)

• Complications (4)

1. Pulmonary Edema

2. Cardiogenic shock

3. Dysrhythimas

4. Organ failure

• Education (5)

1. Daily weight

2. Low sodium diet

3. fluid restriction

4. med adherence

5. report rapid weight gain (> 2lb/day OR >5lb/week)