Pathophysiology
The two categories, or types, of dysfunction in heart failure.
What is systolic (HFrEF) and diastolic (HFpEF)?
This measurement is used to determine the % of blood ejected through the ventricle with each contraction.
What is ejection fraction?
Two of the earliest and most common symptoms of HF
What are fatigue, dyspnea, tachycardia, edema
The nurse caring for the CHF patient identifies that Impaired Gas Exchange is a common nursing diagnosis for a CHF patient. These are three interventions that can be done by the nurse to improve gas exchange in the patient.
1. monitor resp status for pulmonary edema (O2, RR, s/s of hypoxemia)
2. monitor and administer oxygen appropriately
3. position patient to alleviate dyspnea, decrease venous return and increase thoraccic capacity
This category of medication will help decrease fluid volume (decreasing preload). Lasix is the most common one used.
What is a diuretic?
Hypertension and Coronary Artery Disease (including MI)
What are the two most common causes of heart failure?
Patients who have an ejection fraction of this amount or less typically require specialist intervention
What is less than or equal to 40% EF
Classic clinical signs of left sided failure
This nursing diagnosis has many interventions - some of which involve helping patients reduce sodium intake, monitor effects of diuretics, weigh patients daily and monitor intake and output.
What is Excess Fluid Volume.
This position for a CHF patient can help decrease venous return to the LV (reducing preload, allowing the LV to contract more efficiently, and improving CO).
As the body compensates for chronic HF, changes in the size, shape and mechanical performance of the ventricle take place. This is called. . . .
What is ventricular remodelling?
This cardiac diagnostic test is done early in diagnosis to evaluate the EF and the degree of HF present.
What is an echocardiogram?
Classic clinical signs of right-sided HF
What are peripheral edema, weight gain, ascites, JVD, hepatomegaly
Helping patient understand the the role of sodium intake can help manage fluid volume overload and edema. This is the recommended amount of sodium for a HF patient.
What is 2g/day sodium for for mild HF, and 1.5g/day sodium for severe HF.
Patients with CHF are often on a salt/sodium restricted diet for this reason.
A neurohormonal response where the kidneys retain sodium and water as the body tries to compensate for HF.
What is activation of the RAAS?
This blood test is used to diagnose HF. It measures the presence of a counterregulatory protein hormone released when the ventricles are being overstretched with too much blood volume.
What is BNP?
(B-type natriuretic peptide)
Clinical manifestations in HF - caused by reabsorption of fluid when patient is lying flat (usually at night). Causes patient to wake up in a panic with feelings of suffocation, and NEED to stand up.
What is paroxysmal nocturnal dyspnea?
Monitoring edema and weight gain is a nursing intervention for patients with CHF, under the Excess Fluid Volume nursing diagnosis . The nurse knows that THIS amount of weight gained (in a certain time period) is of concern and indicates exacerbated HF.
What is 2kg (4 lbs) in 24h or 2.5kg in a week?
B-Adrenergic blockers are a classification of medication used with CHF. They directly block the negative effects of the SNS on the failing heart (SNS wants to increase HR). One of the most common B-Adrenergic blockers is Metoprolol. These side effects of Metoprolol need to be carefully monitored.
What is bradycardia and hypotension.
As the body tries to compensate for HF, the SNS is activated, causing this early clinical manifestation.
What is tachycardia?
These two tests are also helpful supportive tools in diagnosing HF.
What are ECG and chest x-ray?
Nocturia is a clinical manifestation of HF because of this.
Patients with HF have decreased renal perfusion and decreased urine output during the day. When they lie down at night, fluid moves from interstitial spaces back into the circulatory system, which increases renal perfusion and fluid volume.
A patient with acute decompensated heart failure may exhibit these symptoms: severe dyspnea, orthopnea, very high RR, wheezing, productive cough with frothy blood-tinged phlegm, rhonchi and crackles throughout lungs, tachycardia, anxiety, palor, and cyanosis. ALL these symptoms point to to THIS clinical manifestation.
What is pulmonary edema?
This medication acts by preventing the conversion of angiotensin I to angiotensin II (a potent constrictor). This allows for vasodilation (decreased BP) and increased CO (better tissue perfusion). It is often the first med to be given to HF patients.
What is an ACE inhibitor - Ramipril or Enalapril