Heart Disease
The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home?
"I'm having trouble going up the steps during the day."
Want total cholesterol to be less than
200
normal ejection fraction
55-65%
resting stroke volume should be
60-130
A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The clients reports that these symptoms came on suddenly. The nurse knows that these are symptoms of what condition?
Acute pulmonary edema
A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing action?
Assess oxygen saturation
The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure?
Avoid the intake of processed and commercially prepared foods.
A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client?
BP and pulse measurements every 15 to 30 minutes
The nurse recognizes that which laboratory test is a key diagnostic indicator of heart failure?
Brain natriuretic peptide (BNP)
Which is a key diagnostic indicator of heart failure?
Brain natriuretic peptide (BNP)
cardiac output
CO = HR x SV
right sided heart failure can present as which disease process?
COPD
A client has been prescribed furosemide 80 mg twice daily. The asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next?
Check the client's potassium level.
CAD risk factors
ELEVATED LDL, tobacco use, hypertension, diabetes, metabolic syndrome
A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence?
Excess pericardial fluid compresses the heart and prevents adequate diastolic filling.
Which medication is categorized as a loop diuretic?
Furosemide
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?
Heart failure
The nurse is performing an initial assessment of a client diagnosed with heart failure. The nurse also assesses the client's sensorium and LOC. Why is the assessment of the client's sensorium and LOC important in clients with heart failure?
Heart failure ultimately affects oxygen transportation to the brain.
The nurse is preparing to administer hydralazine and isosorbide dinitrate. When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse?
Hold the medication and call the health care provider.
Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest?
IV
A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician?
JVD is noted 4 cm above the sternal angle.
The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following?
Left ventricular function
The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?
Low-sodium diet
Which describes difficulty breathing when a client is lying flat?
Orthopnea
The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide?
Potassium level of 3.1
A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient?
Potassium levels
A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client?
Pulmonary congestion
A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure?
Right-sided heart failure
left sided heart failure manifestation
SOB, low 02, kidney dysufnction, excess fluid buildup, HR often increases
Which is a manifestation of right-sided heart failure?
Systemic venous congestion
A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema?
The client says his rings have become tight and are difficult to remove.
A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client?
The development of left-sided heart failure
A nurse is teaching a client about heart failure. What will the nurse explain is causing the heart to fail?
The heart cannot pump sufficient blood to meet the body's metabolic needs.
The nurse is administering furosemide to a client with heart failure. What best describes the therapeutic action of the medication?
The medication blocks sodium reabsorption in the ascending loop and dilate renal vessels.
cardiac output
The volume of blood ejected from the left side of the heart in one minute.
The nurse documents pitting edema in the bilateral lower extremities of the client. What does this documentation mean?
There is excess fluid volume in the interstitial space in areas affected by gravity.
A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention?
Titrate oxygen therapy.
The client asked the nurse to describe Stage C heart failure. What is the best explanation by the nurse?
a client who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity
Atherosclerosis
accumulation of lipid deposits and fibrous tissue within arterial walls and lumen.
heart failure perfusion s/s
altered mental status, resting tachycardia, cool extremities, pallor/cyanosis, muscle wasting, unexplained weight loss, lightheadedness. thank oxygenation and getting nutrients to vital organs.
hydralazine/isosorbide dinitrate (BiDil)
alternative to ACE inhibitors
stroke volume
amount of blood ejected with each heartbeat
ejection fraction
amount of blood that is left in the heart after it's contracted
causes of increased afterload
atherosclerosis, plaque, any narrowing of arteries
atrial systole
atrial contraction forces a small amount of additional blood into ventricles
post procedure hearth cath. assessment
circulation, pedal pulses, color, temp., cap refill, huge risk for bleeding.
right sided heart failure results in
congestion in the peripheral tissues and the viscera
systole
contraction of heart (atrial and ventricular systole)
A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals coarse crackles in the lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing
decompensated heart failure with pulmonary edema.
The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema?
decreased left ventricular pumping
The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy?
decreased left ventricular workload
metabolic syndrome
diabetes, high cholesterol, hypertension
heart failure congestion s/s
dyspnea, orthopnea, crackles, rapid weight gain, edema, abdominal distension, ascites, JVD, sleep disturbances, fatigue
A client has been having cardiac symptoms for several months and is seeing a cardiologist for diagnostics to determine the cause. How will the client's ejection fraction be measured?
echocardiogram
right sided heart failure s/s
edema, fluid buildup, JVD/
left ventricular failure: diastolic heart failure is a
filling problem. EF is NORMAL. stiff and noncompliant heart muscle
preload
filling. the more stretch the more contraction.
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?
heart failure
The nurse is assessing a newly admitted client with chest pain. What medical disorder is most likely causing the client to have jugular vein distention?
heart failure
The nurse is caring for a client with advanced heart failure. What treatment will be considered after all other therapies have failed?
heart transplant
The critical care nurse is caring for a client with cardiogenic shock. What is the premise for inserting an intra-aortic balloon pump?
inadequate tissue perfusion
cardiac catheterization
invasive procedure used to measure cardiac chamber pressures, assess patency of coronary arteries
patients report angina pectoris when
ischemia occurs
left-sided heart failure refers to failure of the
left ventricle
The nurse is caring for a client with heart failure who is receiving a diuretic medication. What implementation will help the nurse evaluate the client's response of the medication?
measuring intake and output
A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client?
nausea and vomiting
When the client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating
orthopnea.
The nurse completes an assessment of a client admitted with a diagnosis of right-sided heart failure. What will be a significant clinical finding related to right-sided heart failure?
pitting edema
The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity?
potassium level of 2.8 mEq/L
angiotensin II receptor blockers (ARBs)
prescribed as an alternate to ACE inhibitors, works similarly
beta-blockers
prescribed in ADDITION to ace inhibitors; may be several weeks before effects seen; us with caution in patients with asthma
BNP (brain natriuretic peptide)
protein released by heart when there is excess stretch. a number greater than 100 indicates heart failure
left sided heart failure results in
pulmonary congestion
left ventricular failure: systolic heart failure is a
pumping problem. EF is severely REDUCED. weakened heart muscle.
diastole
relaxation and filling
afterload
resistance to ejection of blood from ventricle.
why don't we want EF to be lower than 55?
we don't want blood sitting and coagulating
why don't we want EF to be higher than 65?
we don't want the heart to empty fully of blood
right sided heart failure requires monitor of what
weight gain. 2-3 lbs overnight, 5 lbs in a week must be reported.
The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided heart failure?
ascites
increased contractility results in
increased stroke volume
planning/goals of heart failure
relieve fluid overload symptoms, anxiety management, promote activity and reduce fatigue, educate pt. about management of therapuetic regimen
right sided heart failure refers to the
right ventricle
need to check for what allergies prior to cardiac catheterization
shellfish or iodine
Frank-Starling Law of the Heart
the more the heart fills with blood during diastole, the greater the force of contraction during systole
angiotensin-convering enzyme (ACE)
vasodilation; diuresis; decreases afterload; monitor for hypotension, hyperkalemia, and altered renal function, cough
blood flow through the heart
vena cava (deoxygenated) right atrium tricuspid valve right ventricle pulmonary artery pulmonary vein lungs (becomes oxygenated, drop of CO2) left atrium mitral valve left ventricle aorta (through the body)
right sided heart failure
ventricle cannot eject blood and accomodate all returning from the venous circulation, causing backup of blood in venous system
