Heart/Circulation

What does CHF stand for?

Congestive Heart Failure

What are the respiratory findings of CHF?

Cough, dyspnea, orthopnea, pink frothy sputum, increased RR, and lower SpO₂

What is orthopnea?

Difficulty breathing when lying down

What type of sputum can occur with CHF?

Pink, frothy sputum

What respiratory support may be needed for CHF?

Supplemental oxygen or CPAP

What are the fluid and peripheral findings of CHF?

Bilateral extremity edema, weight changes, and the need for strict intake and output monitoring

What activity and neurological findings can occur with CHF?

Activity intolerance and altered mental status

What vital sign changes can occur with CHF?

Decreased SpO₂ and increased RR

How do you treat CHF immediately?

Place the patient in High Fowler's position and provide supplemental oxygen; CPAP may be used for respiratory distress

What position should a patient with CHF be placed in?

High Fowler's position

What does treatment for CHF focus on?

Managing fluid overload and reducing the workload on the heart

How does CHF treatment reduce the workload on the heart?

By reducing excess fluid, reducing preload and afterload, and managing hypertension when it is secondary to fluid overload

What ongoing interventions are used for CHF?

Strict I/O, daily weights, monitoring response to treatment, and monitoring for treatment side effects

What medications are used to treat fluid overload in CHF?

Diuretics such as furosemide, hydrochlorothiazide, and spironolactone

What medications may be used when hypertension is secondary to fluid overload in CHF?

ACE inhibitors and ARBs

What are common causes of CHF?

Coronary artery disease, damage from myocardial infarction (MI), drug use, infection, diabetes, and arrhythmias

What happens in right-sided heart failure according to the notes?

The right ventricle fails and fluid backs into the pulmonary system

What happens in left-sided heart failure?

The left ventricle cannot effectively pump blood throughout the body

What can help a CHF patient with breathing?

High Fowler position, supplemental oxygen, and CPAP

How can CPAP help a patient with CHF?

It can reduce preload, reduce afterload, improve cardiac output, reduce respiratory muscle work, and improve oxygenation

How does CPAP reduce preload?

CPAP increases intrathoracic pressure, which decreases the amount of blood returning to the heart, causing decreased preload

How does CPAP reduce afterload?

CPAP increases intrathoracic pressure, which decreases the pressure the heart has to pump against, causing decreased afterload

How does CPAP affect cardiac workload?

It reduces the heart's workload

How can CPAP potentially improve cardiac output?

By reducing the heart's workload and improving the heart's ability to pump blood effectively

How does CPAP help breathing?

It reduces the effort required to breathe, helps keep the air sacs in the lungs open, and improves gas exchange and oxygen levels

What is the CPAP connection in CHF?

CPAP → increased intrathoracic pressure → decreased preload + decreased afterload → decreased cardiac workload → potentially improved cardiac output

What should be monitored ongoing in a patient with CHF?

Strict I/O, daily weights, SpO₂, shortness of breath, edema, and weight stability

What test is used to check for dysrhythmias in CHF?

EKG

What can a chest X-ray show in CHF?

Cardiomegaly

What does an echocardiogram measure in CHF?

Ejection fraction (EF)

What is the normal EF according to the notes?

Greater than 55–60%

What happens to BNP in CHF?

BNP is elevated

What is cardiac output?

The amount of blood exiting the aorta each minute

What is stroke volume?

The amount of blood exiting the left ventricle during systolic contraction

What is preload?

The stretch required prior to contraction

What is afterload?

The force required during contraction

What CHF findings require close attention?

Lower SpO₂, increased RR, dyspnea, pink frothy sputum, altered mental status, orthopnea, bilateral extremity edema, and increasing activity intolerance

What should you assess when deciding if a CHF patient needs intervention?

Whether there are signs of increased distress, whether untreated findings could lead to more complicated and serious processes, whether findings are expected for the patient, and which findings require quick intervention

How do you know if CHF treatment is working based on oxygenation?

The patient's SpO₂ levels should improve

How do you know if CHF treatment is working based on breathing?

The patient should experience less shortness of breath

How do you know if CHF treatment is working based on fluid status?

The patient should have less edema, stable weight, and appropriate I/O findings

What treatment side effects should be monitored in CHF?

Hyperkalemia, blood pressure response, and increased urination

Why should increased urination be monitored in a CHF patient?

Increased urination can contribute to fall risk

What can happen to blood pressure when fluid is off-loaded in CHF?

Blood pressure may lower

What is venous insufficiency?

A condition where the veins in the legs do not function properly, leading to blood pooling and increased pressure.

What causes or increases the risk of venous insufficiency?

Damaged or weakened valves, deep vein thrombosis, pregnancy, obesity, and prolonged standing or sitting.

What happens when the veins in the legs do not function properly?

Blood pools in the legs and pressure increases.

What are the expected findings of venous insufficiency?

Swelling, heaviness and fatigue in the legs, varicose veins, skin discoloration, and ulcers.

What can help a patient with venous insufficiency?

Exercise, avoiding prolonged sitting or standing, elevating the legs, managing weight, wearing compression stockings, practicing skin care, and recognizing early signs.

What non-surgical treatments are used for venous insufficiency?

Compression stockings and positioning the legs for comfort.

When are diuretics used for venous insufficiency?

When edema is present.

Why are anticoagulants used for venous insufficiency?

To prevent blood clots.

Why are antibiotics used for venous insufficiency?

To treat infection processes.

What is sclerotherapy used for in venous insufficiency?

It closes off incompetent veins.

What is vein stripping?

A surgical procedure that removes damaged veins.

What should be checked when evaluating a patient with venous insufficiency?

Check for skin breakdown and educate the patient to prevent worsening symptoms.

What are the complications of venous insufficiency?

Skin infections, leg ulcers, and deep vein thrombosis (DVT).

What is Peripheral Artery Disease (PAD)?

A condition where arteries that carry blood to the limbs become narrowed and blocked.

What causes or increases the risk of PAD?

Atherosclerosis, smoking, diabetes, high blood pressure, high cholesterol, and obesity.

What is intermittent claudication?

Cramping pain that is worse when walking.

What are the expected findings of PAD?

Intermittent claudication, cold feet or toes, weak or absent pulses in the legs, and skin changes such as discoloration, ulcers, and sores.

What skin changes can occur with PAD?

Discoloration, ulcers, and sores.

What happens to the feet or toes with PAD?

They can become cold.

What happens to the leg pulses with PAD?

Pulses can become weak or absent.

What diagnostic tests are used for PAD?

Ultrasound and angiogram.

What is an ultrasound used for in PAD?

To evaluate the arteries.

What is an angiogram used for in PAD?

To evaluate the arteries for narrowing or blockage.

What are the treatments for PAD?

Angioplasty, surgery, and amputation.

What is angioplasty used for in PAD?

It opens blocked arteries.

What is surgery used for in PAD?

It opens blocked arteries.

What medications are used for PAD?

ASA, Plavix, atorvastatin, lisinopril, and losartan.

What can help a patient with PAD?

Angioplasty or surgery to open blocked arteries, checking for complete occlusion, and patient education to prevent worsening symptoms and recognize when to call the provider.

What should be checked for in a patient with PAD?

Check for complete occlusion.

What should a patient with PAD be taught?

How to prevent worsening of symptoms and when to call the provider.

What can arterial occlusion lead to in PAD?

Amputation.

What complications can occur with PAD?

Arterial occlusion that can lead to amputation, stroke or MI from “throwing a clot,” non-healing ulcers, infection, and gangrene.

What can happen from “throwing a clot” with PAD?

Stroke or myocardial infarction (MI).

What can happen to a PAD ulcer?

It can become a non-healing ulcer.

What complications can occur from a non-healing ulcer in PAD?

Infection and gangrene. What is deep vein thrombosis (DVT)?

Where does DVT most commonly occur?

The lower extremities.

Where else can DVT occur?

The upper extremities and pelvis.

What type of venous thromboembolism is DVT?

DVT is a type of venous thromboembolism (VTE).

Can DVT have no manifestations?

Yes. DVT can have no manifestations and go unnoticed.

Why is DVT serious?

The thrombus can become dislodged, travel to the lungs, and cause a pulmonary embolus (PE).

What can happen if a DVT becomes dislodged?

It can travel to the lungs and cause a pulmonary embolus (PE).

Why is a pulmonary embolus (PE) dangerous?

A PE is life-threatening.

What are the expected findings of DVT?

Swelling, usually unilateral; pain in the affected limb; redness; warmth of the affected extremity; and possibly enlarged or bulging veins.

What type of swelling is usually seen with DVT?

Unilateral swelling.

What happens to the affected extremity with DVT?

It can become painful, red, and warm.

What type of veins may be seen with DVT?

Enlarged or bulging veins may occur.

Can a patient with DVT have no manifestations?

Yes. DVT may have no manifestations and go unnoticed.

How is DVT treated?

Anticoagulants, compression stockings, and thrombectomy.

How do anticoagulants treat DVT?

They prevent the clot from growing or spreading.

How do compression stockings help with DVT?

They help improve blood flow.

What is a thrombectomy?

Surgery to remove the clot.

What medications are used to treat DVT according to the notes?

Anticoagulants are used to prevent the clot from growing or spreading. Specific anticoagulant names are not provided in the notes.

What causes or increases the risk of DVT?

Prolonged inactivity, trauma, obesity, pregnancy, certain medications, contraceptives, and hormone replacement.

What can help a patient with DVT?

Compression stockings to improve blood flow, anticoagulants to prevent the clot from growing or spreading, thrombectomy to surgically remove the clot, checking for skin breakdown, and patient education to prevent worsening of symptoms.

What should be checked for in a patient with DVT?

Check for skin breakdown.

What should a patient with DVT be taught?

How to prevent worsening of symptoms.