symptoms
medications/ treatment
patient education
labs/ diagnosis
nursing interventions/ misc.
100

warning signs of worsening heart failure

- weight gain 1-2lbs overnight or 3+ lbs in a week

- decrease in exercise tolerance

- cough lasting >3-5 days

- excessive urination at night/ increased swelling 

- development of dyspnea or angina at rest 

100

what is ultrafiltration used for

- removes excess fluid for overload

- pulls saline (less work on kidneys than diuretics) 

- pulls 6L/day 

100

causes of heart failure in the peds population

- congenital (most common and at 8 weeks gestation)

- moms: alcohol use, virus (rubella), poor prenatal nutrition, diabetes, >40 y.o, chromosome abnormality 

100

what is BNP and how does it correlate to heart failure

- is secreted by the ventricle in response to being stretched. increased bp can indicate ventricle dilation. 

- BNP produces vasodilation

100

non-pharmacological treatment for managing heart failure

- taking medications

- reducing sodium (2-3g/day)

- daily physical activity

- keeping track of symptoms each day

200

signs/ symptoms of left sided heart failure

- decreased breath sounds

- crackles, rhonchi, wheezing, dyspnea, orthopnea

- dry hacking cough with pink frothy sputum

- PND, increased HR, s3, s4

200

why are medications given for heart failure

- decrease preload, afterload, anxiety

- oxygenation

- improve contractility

- control heart rate

200

what are the types of heart failure

- systolic (left) is the most common. occurs when the heart can't contract forcefully enough during systole to eject adequate blood into circulation

- diastolic (left) LV fails to relax adequately, known as a stiff ventricle 

- right sided can be caused by LV, RV MI, or pulmonary HTN 

200

what is the best diagnosis for heart failure

echocardiogram. it can be done at the bedside and it is an ultrasound that can identify structures, ventricle enlargement, valve problems, ejection fraction.

200

interventions for left sided heart failure symptoms 

- C&DB, incentive spirometer, walking or up in chair depending on tolerance

- sleeping with HOB up due to orthopnea 

300

symptoms of right sided heart failure

- JVD, tachycardia 

- organ swelling

- peripheral edema

- ascites, weight gain

- GI symptoms

300

which medications are given for heart failure management 

- oxygenation: airway support, bronchodilators

- decrease anxiety: morphine

- decrease preload: diuretics, NTG, morphine, high fowler's, fluid restriction, ultrafiltration

- decrease afterload: vasodilators, ACEs, ARBs

- improve contractility: positive inotropes (digoxin, dobutamine) 

- heart rate: digoxin, diltiazem, BB, HCN

300

what causes heart failure? 

- increase in workload (*HTN*), hr, valvular disease 

- loss of heart muscle mass *MI CAD*

- poor contractility (cardiomyopathy)

- inadequate heart rate (bradycardia) 

- abnormal anatomy (congenital), volume overload (iatrogenic) 

300

what are other labs to diagnose heart failure? 

- chest xray: cardiomegaly, pleural effusion

- ecg: hypertrophy (does not diagnose) 

- labs: BNP, kidney function, ABGs

- cbc: in kidney failure, erythropoietin isn't produced which promotes rbc production in the bone marrow. 

300

nursing interventions for peds with hf

- upright position

- promote rest

- maintain body temp

- fluids limits, sodium limits

- track I/Os

400

causes of HF in pediatrics

- rheumatic heart disease 

- endocarditis, myocarditis

- drug toxicity, chronic anemia 

- complications of heart surgery

- fluid overload

400

alternatives for heart failure management (surgery)

- cardiac transplant the only effective treatment for end stage failure

- bridge to transplant: LVAD (assistive device), IABP (intra aortic balloon pump)

- ICD to prevent sudden cardiac death 

- surgery is done to decrease ventricle size to support it. 

400

what's the difference between preload and afterload

preload: volume of blood in the ventricles at the end of diastole (EDP) increased in hypervolemia, regurgitation of valves, HF 

afterload: resistance left ventricle must overcome to circulate blood. increased in HTN & vasoconstriction

400

diagnosis of hf in peds

- primarily based on clinical manifestations such as tachycardia, respiratory distress and crackles

- cardiac catheterization (cam detect pulmonary stenosis/ transposition of great arteries)

- ecg, chest xray, physical exam

400

what are some chemical responses from heart failure? (BNP, ADH, etc.)

- BNP: released in response to fluid overload

- pro-inflammatory cytokines are remodeling

- endothelin: released with stretch (vasoconstriction)

- ADH: vasopressin > fluid retention + vasoconstriction 

500

symptoms of HF in pediatrics 

- tachypnea, tachycardia, LOW BP

- intercostal retractions, nasal flaring, grunting

- crackles, coughing, wheezing, swelling of hands, feet, periorbital area

- difficulty feeding (diaphoresis from being tired), failure to thrive, slow wt. gain

- irritability, cool extremities, oliguria, pallor, pain/ tenderness in abdomen

500

treatment for hf in peds

- meds (digoxin, lasix, ACEs)

- oxygen therapy 

- surgery (hf in peds can be fixed, but not in adults)

- managing condition until baby is strong enough and less risk involved (~1-2 years)

500

what is a  biventricular pacemaker

- aks cardiac resynchronization is used to treat the delay in heart ventricle contractions. it keeps R and L ventricles pumping together by sending small electrical impulses through the leads

500

what is the normal range of EF in a normal heart vs HF 

- normal: 50-70%

- heart failure: <40%

- risk for sudden cardiac death/ eligible for ICD: <30%

500

what occurs during each comp. mechanism?

#1: activation of SNS (catecholamine release) increased hr, bp, arterial & venous vasoconstriction, ventricular dilation

#2: myocardial hypertrophy increase in ventricular wall (muscle cells enlarge) chambers dilate and become o2 deprived, ventricular remodeling (decreased SV and contractile systolic function) 

#3: renin-angiotensin activation: decreased perfusion to kidneys, RAA compensates and increases afterload. aldosterone hangs on to Na+h2o to increase volume

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