Module 7 Ch. 26

Question 1

What is the leading cause of death in the US

Answer 1

cardiovascular diseases

Question 2

What is heart failure

Answer 2

• Clinical syndrome resulting from structure or functional cardiac disorders that impair the ability of a ventricle to fill or eject blood

Question 3

What is myocardial disease in relation to heart failure

Answer 3

problem with the contraction of the heart or filling of the heart

Question 4

Is myocardial disease reversable

Answer 4

sometimes, not always

Question 5

What causes an onset of heart failure

Answer 5

it typically is a consequence of another disease or disorder including CAD, HTN, cardiomyopathy, valve disorders and renal dysfunction

Question 6

What is a primary cause of heart failure

Answer 6

atherosclerosis

Question 7

What is left sided heart failure

Answer 7

• Systolic
• Inability of left ventricle to fill or eject blood into the systemic circulation
• Can cause pulmonary congestion

Question 8

What is right sided heart failure

Answer 8

• Diastolic
• Inability of the right ventricle to fill or eject blood into the pulmonary circulation
• leads to congestion in peripheral tissues and viscera

Question 9

What are some manifestations of right sided heart failure

Answer 9

• viscera and peripheral congestion
• JVD
• Dependent edema
• Hepatomegaly
• Ascites
• Weight gain

Question 10

What are some manifestations of left sided heart failure

Answer 10

• Pulmonary congestion and crackles
• Ventricular gallop
• dyspnea of exertion
• low O2
• Dry non-productive cough
• Oliguria

Question 11

What is some treatment to help manage heart failure

Answer 11

• Oral and IV medications
• Lifestyle medications
• Supplemental O2
• Surgical intervention-ICD and heart transplant

Question 12

How are diuretics used for heart failure

Answer 12

• decreases fluid volume
• monitor serum electrolytes

Question 13

How are ACE inhibitors used for heart failure

Answer 13

• vasodilation, diuresis, decreases afterload
• Monitor for hypotension, hyperkalemia, cough and altered renal function,

Question 14

How are Angiotension II receptor blockers used for heart failure

Answer 14

prescribed as an alternative to ACE inhibitors, works similarly

Question 15

How are beta blockers used for heart failure

Answer 15

prescribed in addition to ACE inhibitors
- use with caution for asthma patients

Question 16

How is Ivabradine used for heart failure

Answer 16

decreases rate of conduction through SA node
- Look for decreased BP and HR

Question 17

How are Hydralazine and isosorbide dinitrate used for heart failure

Answer 17

alternate for ACE inhibs
- Look for decreased BP

Question 18

How is digitalis used for heart failure

Answer 18

• improved contractility, monitor for digitalis toxicity in hypokalemia patients

Question 19

How is dopamine used for heart failure

Answer 19

vasopressor to increase BP and myocardial contractility
- Use with loop diuretics

Question 20

How is dobutamine used for heart failure

Answer 20

used for patients with left ventricular dysfunction, increases cardiac contractility and renal perfusion

Question 21

How is milrinone used for heart failure

Answer 21

decreases preload and after load
- can cause hypotension and increases risk for dysrhythmias

Question 22

How are vasodilators used for heart failure

Answer 22

IV nitro, nitroprusside, nesiritide
- enhances symptom relief

Question 23

What are some other symptoms of heart failure an older adult may have

Answer 23

fatigue, weakness, somnolence

Question 24

What are some things to monitor when giving an older adult a diuretic

Answer 24

• decreased renal function can make them more sensitive
• monitor for bladder distension from a urethral obstruction from enlarge prostate gland

Question 25

What is an assessment for heart failure

Answer 25

- effectiveness of therapy - how patient self manages - signs and symptoms of worsening heart failure - emotional responses - Health Hx

Question 26

What are some collaborative issues with heart failure patients

Answer 26

- Pulmonary edema - hypotension/poor perfusion/cardiogenic shock - arrythmias - thromboembolism - pericardial effusion

Question 27

What are some goals for patients with heart failure

Answer 27

- Promoting activity and reducing fatigue - Relieve fluid overload - Decrease anxiety - Encourage verbalization of decisions - Education about therapeutic regimens

Question 28

What are some nursing interventions for a patient with heart failure

Answer 28

- Promote activity (30 min daily build up) - Bed rest for acute exacerbations - waiting 2 hrs post eating todo activity - Avoid activities in cold, hot or humid weathers - modify energy - Positioning - Managing fluid volume (I&O, daily weights) - Restrict fluids

Question 29

What are some education points for a patient in heart failure

Answer 29

- Medications - Low sodium diet - Fluid restrictions - Exercise and activity - Stress management - Prevent infections - Know when to call PCP - Ensure family is educated too

Question 30

What are some end of life considerations for someone with heart failure

Answer 30

- Its chronic and progressive - Consider when palliative or hospice care should begin