HEART FAILURE
heart failure leads to what type of cardiac output?
decreased.... causing fluid retention
treatment and goals for heart failure
• Treatment of the underlying cause: blood pressure control, diuretics for fluid volume overload, and symptom management.
• Goals:
manipulation of cardiac output through preload, afterload, and contractility;
control of compensatory mechanisms with reduced dyspnea and absence of fatigue;
reduced hospitalizations through blood pressure and glucose control, weight loss, optimizing serum lipids, and smoking cessation.
what is PAD and what are the risk factors?
obstruction of blood flow through large peripheral arteries causing partial or total occlusion.
ATHEROCLEROSIS (the most common risk factor), smoking, hypertension, diabetes, dyslipidemia, sedentary lifestyle, and ineffective stress management.
What is PVD and what are the risk factors?
Peripheral vascular disease is venous blockage or narrowed veins causing the blood to pool in the veins.
Risk factors: increased age, active cancer, varicose veins, prior venous thrombosis, pregnancy or postpartum, oral contraceptive/hormone therapy, and immobility
I am used to decrease the hearts workload and force of contraction.
used for angina and Heart failure
not good for AV block, bradycardia, or ppl with asthma
antidote is glucagon
can mask hypoglycemia
Metoprolol... beta blocker
P.S. A diabetic client on metoprolol may lose the tachycardia and tremor that normally warn of a low blood sugar. MEMORYTRICK: Beta Blockers Be Gone with GLUCAGON (the antidote).-LOL lowers rate, force, and pressure.
what are the risk factors for Heart failure?
and what are the manifestations?
CAD, HTN, diabetes mellites, obesity, smoking, high sodium intake
fatigue, weight gain (3lbs overnight or 5lbs in a week), tachycardia (for compensation), hypo or hypertension (dependent on the side of heart affected), murmurs, SOB, cannot lay down to sleep because they feel like they are drowning.
MUSTKNOW:Heart failure is not a disease that appears out of nowhere: CAD, hypertension, and diabetes are the top risk factors
MEMORYTRICK: Tachycardia in heart failure is compensation, not anxiety. The heart speeds up because CO = HRx SV and stroke volume has fallen
medications for heart failure
1.Lisinopril- (ace inhibitor or arb is ok if not tolerated well) vasodilates to lover BP (HAS NO EFFECT ON HR)
2.metoprolol- decreases workload of the heart
3.Digoxin- increases contractability and makes the heart pump STRONG and SLOW
4. calcium channel blockers- vasodilates to lower BP
5. nitroglycerin and hydralazine- vasodilators (DO NOT GIVE if taken SILDENAFIL within 24 hr. or systolic BP is below 100)
6 diuretics -
furosemide, torsemide, hydrochlorothiazide POTASSIUM WASTING (used in worsening or ACUTE HF)
spironolactone POTASSIUM SPARING
signs symptoms and assessment findings for PULSES, SKIN, COLOR AND TEMP, LESIONS, PAIN
• PULSES: decreased or absent
• SKIN: dry and thin, shiny, and missing hair
• COLORANDTEMPERATURE: pale, mottled skin, and cold/cool
• EDEMA: none, because there is no blood flow.
• LESIONS: eschar and necrosis on the ends of the toes and top of feet
• PAIN: intermittent circulation described as ache, cramp, numbness, or a sense of fatigue, classically in the calf muscle, that occurs during exercise and is relieved by a short period of rest
P.S. PAD is atherosclerosis in the legs. A client with PAD almost always has the same plaque in the coronary and cerebral arteries
clinical manifestations called the VIRCHOW'S TRIAD.
and PULSES, SKIN, COLOR TEMP, EDEMA, PAIN, LESIONS
the three key factors contributing to thrombosis:
1) decreased flow rate of blood (stasis)
2) damage to the blood vessel wall (endothelial injury).
3)increased tendency to clot (hypercoagulability)
PULSES-present
SKIN- thick and tough
COLOR TEMP- red, brown/yellow, warm
EDEMA- present (blood is pooling)
PAIN- constant, dull, achy
LESIONS- red, granulated and drainage, medial lower legs and ankles, shallow and irregular shaped.
P.S. MEMORY TRICK: Venous = Warm, Wet (edema), and Wide (swollen). Arterial = Cold, Colorless, and Contracted (no edema)
I vasodilate and retain potassium
I am used for HF, HTN ,and heart disease
not intended for pregnant people and ppl with renal failure
can cause orthostatic hypotension, cough, potassium retention, and angioedema
lisinopril - ace inhibitor
P.S. MEMORY TRICK: -PRIL problems: Pressure down, Potassium up, Persistent dry cough, Puffy face (angioedema).
can use ARB in place of
left sided heart failure affects what organ with what type of signs and symptoms
right sided heart failure affects what organs and with what symptoms
Left side LUNGS- dyspnea, SOB, crackles/ wetness, fatigue, pink frothy sputum (chronic coughing and will always want a nap because they do not ever feel rested)
Right side REST OF BODY- peripheral edema, ascites, JVD, hepatomegaly
exacerbation looks like ^ BP ^HR decreased breathing because it becomes hard for deep breaths
what are the sign and symptoms for digoxin toxicity and what is the antidote.
anorexia, N/V, diarrhea, blurry vision, blind spots, yellow-green tint and haloes around lights, bradycardia, dangerous irregular heart rhythms, confusion, extreme tiredness, weakness, dizziness.
P.S. make sure they are on telemetry and check apical pulse for 60 seconds.
if apical pulse is below 60 hold med and notify provider.
monitor potassium. low potassium levels increase toxicity.
ANTIDOTE: CARDIAC GLYCOSIDE
diagnosis and treatment of PAD both MEDICATIONS and SURGICAL
diagnose >with ABI (ankle brachial index) FORMULA: ABI = ankle BP /brachial BP (anything less than 0.9 is diagnostic of PAD)
treatment >
meds... BETA BLOCKERS (METOPROLOL)- calcium channel blockers- ACE INHIBITORS (LISINOPRIL)- arb's if you can tolerate ace- ASPRIN- antilipidemic
surgical... PERCUTANEOUS TRANSLUMINAL ANGIOPLASY (balloon to dilate)
LASER- ASSISTED ANGIOGRAPHY (may need PTA after)
ATHERECTOMY (cut out plaque)
PERIPHEERAL BYPASS GRAPH (reroute occluded artery)
diagnosis and treatment of PVD both MEDICATIONS and SURGICAL
diagnostics - d-dimer elevated (due to clot break down)- compression ultrasonography (visualizes clots and can be done at bed side)
MEDICATIONS- ASPRIN- HEPARIN (Xa inhibitor... labs PTT and will be an injection) - ENOXAPARIN (low molecular weight heparin short acting and does not have to be monitored quite as much) - WARFARIN (labs... pt + INR, used for longer maintenance)
SURGICAL- RARELY USED
THROMBOECTOMY, BALLOON ANGIOPLASTY, STENT PLACEMENT, VENA CAVA INTERRUPTION (to prevent clot from going into heart and causing a PE)
Which medication-monitoring pairs should the nurse identify as correct? Select all that apply.
A. Heparin- PTT (therapeutic on heparin 47-70 seconds)
B. Warfarin- PT/INR (therapeutic on warfarin 2.0-3.0)
C. Digoxin- apical pulse and serum level (therapeutic 0.5-2.0 ng/mL)
D. Furosemide- serum potassium (expected 3.5-5) and daily weight
E. Metoprolol- baseline heart rate, EKG, and blood pressure
F. Spironolactone- potassium supplements given with every dose
A. Heparin- PTT (therapeutic on heparin 47-70 seconds)
B. Warfarin- PT/INR (therapeutic on warfarin 2.0-3.0)
C. Digoxin- apical pulse and serum level (therapeutic 0.5-2.0 ng/mL)
D. Furosemide- serum potassium (expected 3.5-5) and daily weight
E. Metoprolol- baseline heart rate, EKG, and blood pressure
what are the nursing interventions for Heart failure?
vital signs
breath sounds
skin color, temp, peripheral pulses (cool skin, moist from edema, 3+ pitting edema, pulses faint)
dry persistent cough this will be chronic...if anything is coughed up it will be pink and frothy
activity intolerance not able to walk from chair to bathroom
urine output will be reduced unless diuretics are given
strict I&O
Lab data...BNP, K+, Na+
depression screening for thoughts of suicide due to decreased quality of life
social support Social isolation is an independent predictor of mortality among heart failure clients
surgical treatment for HF
what happens when the disease gets worse?
: automatic internal cardiac defibrillator (ICD) and pacemaker for dysrhythmia control and ventricular resynchronization (CRT), and ventricular assist device (VAD) for mechanical circulatory support
pulmonary edema and renal failure
P.S.: Worsening HF checklist = E-S-F-O: Edema, Shortness of breath, Fatigue, Orthopnea.
client education for PAD
make sure to let legs hang (elevating legs will make pain worse), inspect feet daily, report chest discomfort (stroke) or neurological changes (pulmonary edema), life style changes.....
DASH diet, limit alcohol, stop smoking, moderate excersise
client education for PVD
early ambulation
ELEVATE LEGS (dangling legs will make edema worse)
avoid SCD to not trap DVT
encourage adequate fluid intake
administered meds as ordered
Which statements about anticoagulant therapy are correct? Select all that apply.
A. Protamine sulfate is the antidote for heparin.
B. Clients on warfarin should take OTC NSAIDs for pain.
C. Vitamin K is the antidote for warfarin.
D. aPTT on heparin should be 47-70 seconds (30-40 seconds when not on heparin).
E. INR on warfarin should be 2.0-3.0 (less than 1 when not on warfarin).
F. Enoxaparin is a low molecular weight heparin used for DVT prevention and treatment.
A. Protamine sulfate is the antidote for heparin.
C. Vitamin K is the antidote for warfarin.
D. aPTT on heparin should be 47-70 seconds (30-40 seconds when not on heparin).
E. INR on warfarin should be 2.0-3.0 (less than 1 when not on warfarin).
F. Enoxaparin is a low molecular weight heparin used for DVT prevention and treatment.
what do we use to diagnose heart failure
: stress test, electrocardiogram (identifies dysrhythmias), chest x-ray (may show infiltrates and cardiomegaly), cardiac catheterization, and echocardiogram (measures ejection fraction).
MEMORYTRICK: BNPclimbs with the ladder: under 100 normal, 300 mild, 600 moderate, 900 severe
HF nursing interventions and education.
Nursing interventions> O2, EHOB, elevate legs and frequent position changes, fall risk precautions
client education>(given to EVERYONE involved in care)- Medication management, maintain activity as tolerated (moderate), daily weights (same scale, time, clothes), cardiac rehabilitation, S&S of worsening HF, DIET (FLUID AND SODIUM RESTRICTION) DASH DIET or Mediterranean diet
Disease process complications. What is the diffrence between critical limb ischemia and acute limb ischemia?
CRITICAL- had PAD for long period of time where not even rest helps, chronic ischemia, ulceration, gangrene, limb loss
ACUTE- like a stroke to the limb, typically caused by an embolus, sudden decrease of blood flow, may be first symptom in asymptomatic patient
P.S. Critical = Chronic and Creeping. Acute = All of a sudden, usually an Embolus
disease process complications. what is the ratio of people who will get a pulmonary embolism and what does post thrombotic syndrome look like?
1/3 people with DVT will get a Pulmonary Embolism
the syndrome presents as -limb swelling-discomfort, leg pain- skin changes- ulcers.
it is a long term complication that occurs in 20-50% of people after a DVT
A client received morphine for chest pain 20 minutes ago. Which three assessments are the priority?
A. Respiratory rate and depth
B. Level of consciousness and sedation
C. Pain rating and relief
D. Bowel sounds in all four quadrants
E. Capillary blood glucose
F. Deep tendon reflexes
A. Respiratory rate and depth
B. Level of consciousness and sedation
C. Pain rating and relief