Term
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Definition
| HF (aka CHF) is not a disease but a "syndrome" and it is an abnormal condition involving impaired cardiac functioning. |
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Term
| What is HF associated with? |
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Definition
1. Long standing HTN.
2. CAD. |
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Term
| What are the risk factors for HF? |
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Definition
1. CAD and its risk factors (smoking, obesity, sedentary lifestyle). 2. Age. 3. HTN. 4. High Cholesterol. 5. African American descent. |
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Term
| Why are African Americans at risk for HF? |
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Definition
| They have a higher incidence of HTN and DM which contribute to HF. |
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Term
| How does HF start and progress? |
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Definition
| Most HF begins with failure of the left ventricle and progresses to failure of both ventricles. |
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Term
| What are the indications of left ventricular failure? |
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Definition
1. Decreased tissue perfusion from poor cardiac output.
2. Increased pulmonary congestion from increased pressure in the pulmonary vessels. |
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Term
| Left sided HF can be further divided into what 2 sub types? |
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Definition
1. Systolic failure.
2. Diastolic failure. |
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Term
| What happens in systolic failure? |
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Definition
| LV loses ability to generate enough pressure to eject blood forward and therefore blood gets backed up into the pulmonary system. |
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Term
| What happens to the ejection fraction during systolic failure? |
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Definition
| It drops from the normal range of 50-75% to below 40%. |
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Term
| What is diastolic failure? |
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Definition
| Impaired ability of ventricles to fill during diastole. |
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Term
| What is diastolic failure commonly caused by? |
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Definition
| Caused by HTN and is usually a result of LV hypertrophy. |
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Term
| What is the ejection fraction during diastolic failure? |
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Definition
| It is normal 50-75%. Only systolic failure reduces ejection fraction and diastolic failure is usually independent of systolic failure. |
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Term
| Cardiac output is influenced by what 5 factors? |
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Definition
1. Preload
2. Afterload.
3. Myocardial contractility
4. HR.
5. Metabolic state of individual. |
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Term
| One sided heart failure eventually leads to what? |
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Definition
| Biventricular (both sides) heart failure. |
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Term
| What are the 14 clinical manifestations of HF? |
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Definition
1. Pulmonary edema.
2. S/S of low cardiac output.
3. Fatigue.
4. Dyspnea(PND) or SOB.
5. Tachycardia.
6. Heart murmur, S3, S4.
7. Heaves/Lift.
8. Edema/Anasarca.
9. Nocturia.
10. Chest pain.
11. Weight changes.
12. Skin changes.
13. Sleep obstructive apnea.
14. Behavioral changes. |
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Term
| What are the 5 complications of HF? |
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Definition
1. Pleural Effusion.
2. Arrhythmias.
3. LV Thrombus.
4. Hepatomegaly.
5. Pulmonary Hypertension. |
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Term
| What are the NYHA CHF classifications according to functional status? |
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Definition
Class 1 - No symptom limitation with ordinary physical activity.
Class 2- Ordinary physical activity somewhat limited by dyspnea (long distance walking, climbing 2 flights of stairs).
Class 3 - Exercise limited by dyspnea at mild work loads (short distance walking, one flight of stairs).
Class 4 - Dyspnea at rest or with very little exertion. |
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Term
| What are the ACC/AHA classifications of CHF? |
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Definition
Stage A - High risk for developing HF (htn, dm, cad, family history of cardiomyopathy).
Stage B - Asymptomatic HF (Previous MI, LV dysfunction, valvular heart disease.
Stage C - Symptomatic HF (Structural heart disease, dyspnea and fatigue, impaired exercise tolerance).
Stage D - Refractory end-stage HF (Marked symptoms at rest despite maximal medical therapy). |
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Term
| What are the 10 diagnostic studies for HF? |
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Definition
1. History & physical exam.
2. AGBs, serum chemistries, LFT's (acute).
3. Chest X-ray.
4. 12-Lead ECG.
5. Hemodynamic assessment/monitoring.
6. Echocardiogram.
7. Stress testing.
8. Nuclear imaging studies.
9. Cardiac catheterization.
10. Lab tests: CBC, BMP, HBA1C, Lipid profile, thyroid levels, cardiac enzymes, and B type natriuretic peptide level (BNP). |
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Term
| What are the 8 nursing collaborative managements of acute HF? |
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Definition
1. Decreased intravascular volume.
2. Decreased venous return (preload).
3. Decreased afterload.
4. Improving gas exchange & oxygenation.
5. Improving cardiac fx.
6. Decreased anxiety.
7. Continuity of care.
8. For severely compromised cardiac fx:
a. Intra-aortic Balloon Pump.
b. Mechanical hearts.
c. Heart transplant. |
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Term
| Putting the patient in what position decreased venous return? |
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Definition
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Term
| What drug should you give to decrease intravascular volume? |
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Definition
| Loop diuretic such as Lasix or Bumex. |
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Term
| Decreasing afterload decreases what type of congestion? |
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Definition
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Term
| What are the 2 drugs you give for decreasing afterload? |
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Definition
1. IV nitroprusside (Nipride) - potent vasodilator.
2. Nesiritide (Natrecor) - both afterload & preload reducer. |
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Term
| What drug helps to improve gas exchange & oxygenation? |
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Definition
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Term
| What class of drugs decreases digoxin absorption? |
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Definition
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Term
| What are the 5 nursing diagnoses for chronic HF? |
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Definition
1. Activity intolerance.
2. Excess fluid volume.
3. Disturbed sleep pattern.
4. Impaired gas exchange.
5. Anxiety. |
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