Heart Failure Chronic Exam 2

Heart Failure

also called pump failure, is general term for the inability of the heart to work effectively as a pump.

What is heart failure caused by

systemic hypertension in most cases

some patients experiencing myocardial infarction develop what?

Heart failure

second common cause of heart failure

structural changes- valvular dysfunction, particularly pulmonic or aortic stenosis, which leads to pressure or volume overload on the heart

common causes and risk factors for HF

cardiac infections and inflammations, cardiomyopathy, congenital defects, coronary artery disease, diabetes, dysrhythmias, family history, hyperkinetic condition (hyperthyroidism), hypertension, obesity, severe lung disease, sleep apnea, smoking/tobacco use, substance misuse (alcohol and drugs), valvular disease

Older adult considerations/ exacerbation factors

HF is a common cause among older adults, long term NSAID use for arthritis and other persistent (chronic) pain can cause fluid and sodium retention, NSAIDs may cause peripheral vasoconstriction and increase the toxicity of duiretics and angiotensin-converting enzyme inhibitors (ACEIs)

3 major types of HF

left sided, right sided, and high output failure

progression of HF

most HF begins with failure of the left ventricle and progresses to failure of both ventricles

Left sided heart failure

with left ventricular systolic dysfunction, cardiac output is diminished, leading to impaired tissue perfusion, anaerobic metabolism, and unusual fatigue

Exertional Dyspnea (LSHF)

develops as previously tolerated levels of activity cause SOB

Orthopnea (LSHF)

dyspnea when lying flat (recumbent position) and resolves within seconds of sitting, ask how many pillows are used to sleep or whether the pateint sleeps in an upright position in a recliner

Paroxysmal nocturnal dyspnea (PND) (LSHF)

sudden awakening with a feeling of breathlessness 2-5 hours after falling asleep. Sitting upright, dangling feet, or walking usually relieves this condition

cough (LSHF)

as amount of blood elected from the left ventricle diminishes, hydrostatic pressure builds in the pulmonary venous system and results in fluid filled alveoli and pulmonary congestion, which results in a cough. Patients in early HF describe couch as irritating, nocturnal (at night), usually nonproductive. As HF becomes severe, patient may begin expectorating frothy, pink tinged sputum- sign of life threatening pulmonary edema

auscultation findings of Left sided heart failure

ausculatate for crackles and wheezes of the lungs,, late inspiratory crackles that repeat themselves from breath to breath and do not diminish with coughing indicate HF

perfusion and cardiac symptoms of Left sided HF

patients report chest pain or describe palpitations, skipped beats, or a fast heartbeat, assess activity tolerance (ex ability to perform ADLs, climb stairs, or carry groceries without fatigue or dyspnea)

Right sided heart failure etiology

may be caused by left ventricular failure, right ventricular myocardial infarction, cardiomyopathies, pulmonic valvular disease, or pulmonary hypertension. Righjt sided HF in the absence of left sided HF is usually the result of COPD or pulmonary hypertension. Acute respiratory distress syndrome may also cause right sided HF

Right sided heart failure pathophysiology

right ventricular failure is associated with increased systemic venous pressures and congestion. The right ventricle cannot empty completely, causing increased volume and pressure to develop in the venous system and peripheral edema

signs of right sided HF

neck vein distension, abdominal swelling, hepatomegaly (liver engorgement), edema

ascites and how it affects nutrition

abd fluid can reach volumes of over 10 L, pressure placed on the stomach and intestines leads to early satiety and malnutrition, as well as reports of nausea and anorexia

edema and right sided heart failure

in ambulatory pt. edema is presented in ankles and legs, when on bed rest rest fluid accumulates in the sacrum, develops in the lower legs and may progress to thighs and abdominal wall, shoes/socks may leave indentations on skin; rings may fit tighter on fingers and hands, pt. may retain 4-7 L of fluids before ptting edema occurs

renal symptoms in right sided HF

decreased blood flow to major body organs can cause dysfunction, especially renal failure. Nocturia may occur when the patient is at rest

pulse assessment right sided HF

may be tachycardic, or alternate in strength (pulsus alternans). Take the apical pulse for a full minute, noting any irregularity in heart rhythm

Electrolytes

electrolyte imbalnaces may result from complications of HF or as a side effect of drug therapy, especially diuretic therapy. regular evals of electrolytes (including sodium, potassium, magnesium =, and chloride) are essential

CBC

hemoglobin and hematocrit tests should be performed to identify HF resulting from anemia. If fluid excess is present, hematocrit levels may be low as a result of hemodilution

ABGs

ABG values often reveal hypoxemia (low blood oxygen level) because oxygen doesn not diffuse easily through fluid filled alveoli

chest x rays

can be helpful in diagnosing left ventricular failure. Typically the heart is enlarged (cardiomegaly), representing hypertrophy or dilation

echocardiography

considered the best tool in diagnosing HF. Cardiac vaalvular changes, pericardial effusion, chamber enlargement, and ventricular hypertrophy can be diagnosed with this noninvasive technique

Acute pulmonary edema

assess for and report early symptoms, such as crackles in the lung bases, dyspnea at rest, disorientation and confusion, especially in older patients. Document the precise location of the crackles because the level of fluid progresses from the bases to higher levels in the lungs as the condition worsens

assessing fluid retention and weight

Edema is an extremely unreliable sign of HF, Realiable Indicator: assessing weight at the same time of the morning using the same scale is important. Weight is the most reliable indicator of fluid gain and loss

Digoxin

a cardiac glycoside, provides symptomatic benefits for patients in chronic HF with sinus rhythm and atrial fibrilation

Digoxin benefits

reduces exacerbations of HF and hospitalizations when added to a regimen of ACEIs or ARBs, beta blockers, and duiretics, increased contractility, reduced heart rate, slowing of conduction through the atrioventricular node, inhibition of sympathetic activity while enhancing parasympathetic activity

digoxin safety and dosing cautions

considered a second line agent becasue it may increas mortality as a result of drug toxicity, especially in older adults, absorbed from the GI tract erratically; many drugs especially antacids, interfere with its absorption. eliminated primarily by renal excretion,

digoxin-lower doses should be maintained in

older adults, patients with impaired renal function, patients with low lean body mass