Patho Ch 26 Heart failure
The nurse notes that a patient with heart failure (HF) has had a gradual reduction in daily urine output. Which mechanism describes the reason for the decrease in urine output? As perfusion falls to the tissues, the sympathetic nervous system decreases afterload and decreases perfusion to the kidneys. As tissue perfusion falls due to decreased cardiac output, the kidneys initiate the renin-angiotensin-aldosterone system (RAAS) to help increase perfusion pressure. As oxygenation decreases, the kidneys respond by retaining sodium and water in the vascular space. The kidney responds to fluid volume overload by increasing kidney activity and initiates the renin-angiotensin-aldosterone system (RAAS) to help decrease circulatory volume.
As tissue perfusion falls due to decreased cardiac output, the kidneys initiate the renin-angiotensin-aldosterone system (RAAS) to help increase perfusion pressure. As left ventricular output decreases, blood pressure typically falls. The cardiac muscle initially enlarges or hypertrophies, and the heart rate increases in response to stimulation of the sympathetic nervous system (SNS) due to the decreased cardiac output (CO). The renin-angiotensin-aldosterone system (RAAS) is activated, leading to increasing preload and afterload. The RAAS tells the kidneys to retain sodium and water, increasing fluid retention and decreasing urine output. The RAAS system increases circulatory volume. It is perfusion pressure that triggers the RAAS, not oxygenation. The SNS increases afterload with vasoconstriction.
A patient with heart failure (HF) is placing a lunch order. Which lunch choice is the best option for this patient? Prime rib, mashed potatoes Bacon, lettuce, and tomato sandwich Baked chicken, steamed broccoli Tomato soup and grilled cheese sandwich
Baked chicken, steamed broccoli Patients with heart failure (HF) are expected to follow a low-sodium diet, and they may be instructed to limit their fluid intake. Baked chicken and steamed broccoli is a good choice for the patient. Prime rib, mashed potatoes, bacon, tomato soup, and a grilled cheese sandwich are not low sodium or a healthy choice for a HF patient.
A patient reports increased fatigue and shortness of breath during exercise but feels fine when not exercising. Which disorder should the nurse suspect? High-output heart failure (HF) Right-sided heart failure (HF) Heart failure with preserved ejection fraction (HFpEF) Heart failure (HF) related to systolic dysfunction
Heart failure with preserved ejection fraction (HFpEF) A form of heart failure (HF) commonly known as diastolic heart failure is seen in patients with normal contractility of the heart but abnormal relaxation of the heart. This type of HF is called heart failure with preserved ejection fraction (HFpEF), because these patients have HF in the presence of a normal EF. Left ventricular EF may be normal in these individuals at rest, but during exercise or at other times of increased demand, myocardial contractility may remain the same or even worsen. It is not related to just right-sided HF, high output HF, or systolic HF.
A patient is admitted with heart failure (HF). Which finding should cause the nurse to suspect right-sided HF in this patient? Dyspnea Confusion Cyanosis Hepatomegaly
Hepatomegaly Hepatomegaly (enlarged liver) is a result of the backward effects of right-sided HF due to congestion in the systemic venous system. Dyspnea (shortness of breath) is a common symptom of left-sided HF and is related to the pulmonary congestion that impairs gas exchange. Cyanosis is a symptom of left-sided HF and is the bluish appearance of skin and mucous membranes due to the lack of oxygenation to the peripheral tissues from decreased cardiac output. Decreased cardiac output due to left-sided HF also leads to a decreased amount of oxygen delivered to the brain, which causes confusion.
A patient with hypertension (HTN) asks why medication is needed. Which response by the nurse is acurate? "Hypertension decreases with age, decreasing the risk factor for heart failure." "Uncontrolled hypertension increases the risk of development of heart failure." "Mild hypertension does not have a relationship as a risk factor for heart failure." "Hypertension results in a myocardial infarction, which is the greatest risk factor for heart failure."
"Uncontrolled hypertension increases the risk of development of heart failure." Of the risks for developing heart failure (HF), studies have identified that HTN has the greatest impact. Risk for heart failure with myocardial infarction is also high, but not high as with hypertension. HTN increases with age. Decreasing HTN, even mild HTN, is the best prevention of HF.
A patient with heart failure (HF) asks why daily weight needs to be measured at home. Which response should the nurse make to this patient? "Heart failure patients often lose too much weight due to fluid volume issues, and so it must be monitored." "Weight is a good indicator of oxygenation and needs to be monitored." "Weight is used to guide the amount of medications that need to be taken daily. Medications may only be needed if weight gain is noticed." "Weight gain can be a sign of worsening heart failure and should be monitored and reported to your healthcare provider."
"Weight gain can be a sign of worsening heart failure and should be monitored and reported to your healthcare provider." Weight gain can be a sign of worsening heart failure (HF) and should be monitored frequently. Weight changes should be reported to the healthcare provider. HF patients tend to have issues with fluid retention that cause weight gain. Weight gain is not a good indicator of oxygenation. Medications may be adjusted based on weight gain or loss, but they should be taken daily as prescribed, not just with weight changes.
A patient with heart failure (HF) asks why urine output has increased since starting on a new medication. Which response should the nurse make to this patient? "You are prescribed a beta blocker that works to increase cardiac output and better perfuse the kidneys." "You are prescribed a nitrate that helps to lower fluid volume in the body." "You are prescribed a diuretic that works to encourage the kidneys to excrete sodium and water out of the body." "You are prescribed a vasodilator that works to increase preload returning to the heart to better perfuse the kidneys."
"You are prescribed a diuretic that works to encourage the kidneys to excrete sodium and water out of the body." Diuretics work to reduce sodium resorption in the kidneys, promoting diuresis and relieving symptoms related to congestion in the body. Vasodilators, such as nitrates, directly relax vascular smooth muscle, leading to vasodilation. Nitrates affect the venous system, reducing preload. Beta blockers work to reduce vasoconstriction and heart rates, reducing blood pressure and allowing more time for ventricular filling, but do not work on the kidneys.
Which is the 5-year survival rate for patients with heart failure (HF)? 38% 50% 13% 63%
50% Mortality for heart failure is high, with 50% of individuals succumbing to this condition within 5 years of diagnosis, so 50% survive for at least 5 years. Statistics about heart failure: Lifetime risk of developing heart failure in a 40-year-old individual is 20%. Risk increases with age. Annual rate per 1,000 population of new heart failure events for a Caucasian man is 15.2%. Rate of heart failure increases to 31.7% for ages 75-84. Rate of heart failure increases to 65.2% for people age 85 and older.
The nurse prepares teaching material for a patient with heart failure (HF). Which information should the nurse include? Decrease alcohol consumption to avoid adverse reactions with medications. Increased fluid intake will help maintain cardiac output. Avoid exercise to reduce increased stress on the heart. A low-sodium diet will lessen fluid retention in the body.
A low-sodium diet will lessen fluid retention in the body. Patients with heart failure (HF) are expected to follow a low-sodium diet, avoid all alcohol, and limit their fluid intake to avoid fluid overload. Exercise is also advised for HF patients.
The nurse reviews medications prescribed for a patient with heart failure (HF). Which classes of medications should the nurse identify that are used to block the renin-angiotensin-aldosterone system (RAAS)? Nitrates and diuretics Nitrates and beta blockers Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers Angiotensin-converting-enzyme (ACE) inhibitors and vasodilators
Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers To block the renin-angiotensin-aldosterone system (RAAS), angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers are used. ACE inhibitors block the conversion of angiotensin I to angiotensin II, decreasing vasoconstriction and reducing afterload. ACE inhibitors also block release of aldosterone to promote sodium and water excretion from the body. Nitrates, beta blockers, diuretics, and vasodilators do not interact with the RAAS system.
The nurse reviews the dinner menu selected by a patient with heart failure (HF). Which dinner choice should the nurse question? Baked chicken and bell peppers Baked potato with sour cream and butter Spinach salad with no dressing Baked salmon with lemon
Baked potato with sour cream and butter Patients with heart failure (HF) are expected to follow a low-sodium diet, and they may be instructed to limit their fluid intake. Baked chicken, salmon, and spinach are good choices for the patient. Baked potatoes with sour cream and butter are not low in sodium, and are not healthy choices for a patient with HF.
A patient is being treated for systolic heart failure. Which finding should the nurse expect when caring for this patient? Increased contractility Bradycardia Preserved ejection fraction Decreased ejection fraction
Decreased ejection fraction This is identified as heart failure (HF) with reduced ejection fraction because the primary deficit in these patients is associated with a reduced ejection fraction. HF is usually associated with tachycardia and decreased contractility. Preserved ejection fraction is related to diastolic heart failure.
The public health nurse is providing heart failure prevention education at a community health fair. Which information should the nurse include during this presentation? Advanced age is the greatest risk factor for heart failure. Hypertension is the greatest risk factor for heart failure. Female gender is the greatest risk factor for heart failure. Heart attack is the greatest risk factor for heart failure.
Hypertension is the greatest risk factor for heart failure. Although gender differences exist in the risks for developing heart failure (HF), studies have identified that hypertension has the greatest impact. Risk for heart failure with myocardial infarction (MI) is also high, but not high as with hypertension. Heart failure is the most common reason for hospitalization in those older than 65 years, but decreasing hypertension is the best prevention of HF.
The nurse assesses hypotension and dyspnea in a patient with sepsis. Which related complication should the nurse anticipate developing in this patient? Increased systemic vascular resistance (SVR) Hypervolemia Cool, clammy skin Decreased cardiac output (CO)
Hypervolemia High-output HF is marked by an unusually low systemic vascular resistance (SVR) and an elevated cardiac output. Sepsis, which is a systemic inflammatory response to an infection, can lead to high-output heart failure (HF). Sepsis produces profound vasodilation which leads to low blood pressure and neurohormonal effects. In sepsis, the systemic vascular resistance is decreased, cardiac output is increased, and skin remains warm.
A patient is admitted for symptoms related to a heart problem. During assessment, which finding should lead the nurse to suspect right-sided heart failure? Increased ascites Pulmonary edema Increased dyspnea Cyanosis in the extremities
Increased ascites Ascites is a result of the backward effects of right-sided heart failure due to congestion in the systemic venous system. Dyspnea (shortness of breath) is a common symptom of left-sided heart failure and is related to the pulmonary congestion that impairs gas exchange. Cyanosis is a symptom of left-sided heart failure and is the bluish appearance of skin and mucous membranes due to the lack of oxygenation to the peripheral tissues from decreased cardiac output. Pulmonary edema is related to left-sided heart failure as fluid backs up into the lungs.
The nurse assesses a patient who has been sitting up in a chair for several hours.Which finding should the nurse recognize as being related to right-sided heart failure? Increased rales in the lung bases Increased edema in the feet and ankles Poor peripheral perfusion Pulmonary edema with pink frothy sputum
Increased edema in the feet and ankles Peripheral edema, as evidenced by increased ankle and foot edema, is a clinical manifestation of right-sided heart failure (HF). Increased rales, pulmonary edema, and poor peripheral perfusion are all manifestations of left-sided heart failure. Right-sided heart failure (HF) occurs when the right side of the heart is unable to pump blood sufficient to meet the needs of the body. There is a lack of forward flow of blood through the lungs to the left ventricle, which leads to decreased left ventricular preload and reduced cardiac output. There is a backup of blood through the venous circulation to the liver, the mesentery, and the periphery.
A pregnant patient with a history of hypertension is experiencing shortness of breath, weight gain, and peripheral edema. For which potential complication of pregnancy should the nurse assess this patient? Peripartum cardiomyopathy from a congenital heart defect Postpartum cardiomyopathy that has led to heart failure Peripartum cardiomyopathy from hypertension Peripartum cardiomyopathy from a myocardial infarction (MI)
Peripartum cardiomyopathy from hypertension Peripartum cardiomyopathy is a type of pregnancy-related heart failure that usually develops during the last month of pregnancy and can occur up to 6 months after the end of pregnancy. Since the patient is still pregnant, it is not postpartum. The patient has no history of a myocardial infarction (MI) or congenital heart defect that could lead to heart failure.
Which condition is related to right-sided heart failure? Peripheral edema Poor peripheral perfusion Cor pulmonale Pulmonary edema
Peripheral edema Peripheral edema is a clinical manifestation of right-sided heart failure (HF). Cor pulmonale, pulmonary edema, and poor peripheral perfusion are all manifestations of left-sided heart failure.
A patient with a history of diabetes is 1 month postpartum and begins to experience shortness of breath and ascites. Which complication of pregnancy should the nurse suspect is occurring? Peripartum cardiomyopathy that has resulted in heart failure Peripartum cardiomyopathy related to hypertension (HTN) Peripartum cardiomyopathy related to a myocardial infarction (MI) Postpartum cardiomyopathy related to diabetes
Postpartum cardiomyopathy related to diabetes Pregnancy cardiomyopathy is a type of pregnancy-related heart failure (HF) that usually develops during the last month of pregnancy and can occur up to 6 months after the end of pregnancy. Since the patient is not pregnant, it is not peripartum. The patient has no history of a myocardial infarction (MI) or hypertension (HTN) that could lead to HF.
A patient is diagnosed with a decreased ejection fraction. For which health problem should the nurse plan care for in this patient? Diastolic heart failure Tachycardia Bradycardia Systolic heart failure
Systolic heart failure This is identified as heart failure with reduced ejection fraction, because the characteristic HF in such patients is associated with a reduced ejection fraction. HF is usually associated with tachycardia and decreased afterload. Preserved ejection fraction is related to diastolic heart failure.
A patient with left-sided heart failure is diagnosed with hepatomegaly. The nurse should conclude that which cause resulted in the change to patient's liver? The left side of the heart is pumping too much blood to the body. The patient developed a pulmonary embolism, resulting in right-sided heart failure (HF). The patient is now experiencing decreased right-sided afterload. The left-sided heart failure (HF) now has caused right-sided HF.
The left-sided heart failure (HF) now has caused right-sided HF. Right-sided heart failure (HF) can be caused by many conditions but is typically caused by left-sided HF. Hepatomegaly is a sign of right-sided HF as fluid backs up into the body. Hepatomegaly is not a forward effect of left-sided HF. Right-sided afterload is increased in HF. The patient had left-sided HF as a cause, not a pulmonary embolism.
The nurse notes ascites while assessing a patient with left-sided heart failure (HF). Which conclusion should the nurse make about this finding? The patient is now experiencing decreased right-sided preload. The patient is now experiencing signs of right-sided heart failure (HF). The patient now has primary pulmonary hypertension. The left side of the heart is not pumping enough blood to the body.
The patient is now experiencing signs of right-sided heart failure (HF). Right-sided heart failure can be caused by many conditions but is most typically caused by left-sided heart failure (HF). Ascites is a sign of right-sided HF, because fluid backs up into the body. Ascites is not a forward effect of left-sided HF. Right-sided preload is increased in HF. The patient's left-sided HF, not primary pulmonary hypertension (HTN), is most likely the cause of the patient's right-sided heart failure.
The nurse manager is determining the appropriate nursing staff ratio for patients with heart failure. Which statement should the nurse consider? "Lower nurse staffing ratios are associated with decreased 30-day readmission rates for patients with heart failure." "Nurse staffing ratios have not been shown to affect the 30-day readmission rates for patients with heart failure." "Higher nurse staffing ratios are associated with increased 30-day readmission rates for patients with heart failure." "Higher nurse staffing ratios are associated with decreased 30-day readmission rates for patients with heart failure."
"Higher nurse staffing ratios are associated with decreased 30-day readmission rates for patients with heart failure." With heart failure, higher nurse staffing is associated with decreased 30-day readmission rates. Although this study did not examine the specific reasons for the lower readmission rates, it is possible that increased nurse staffing ratios enable nurses to facilitate better discharge planning, provide more discharge education, and/or better involve family and significant others in the education, provide more complete patient assessments, and contribute more overall to the team management of heart failure.
A patient with systolic heart failure (HF) asks why medications are prescribed to help with the pumping action of the heart. Which response by the nurse is correct? "Decreased systemic vascular resistance is making it harder for the heart to pump blood to the body." "Increased blood pressure and fluid volume make it difficult for the heart to pump blood to the body." "Increased preload and perfusion to the body's organs are causing too much fluid to build up in the body." "Increased blood flow through the lungs is making it harder for the heart to pump blood."
"Increased blood pressure and fluid volume make it difficult for the heart to pump blood to the body." Increased blood pressure, afterload, fluid volume, and preload make it difficult for the heart to pump blood to the body. Increasing perfusion is not associated with heart failure (HF). Increased systemic vascular resistance (SVR) increases afterload and makes it harder for the heart to pump. Decreased blood flow through the lungs occurs in HF due to congestion. SVR is increased in heart failure.
A patient with a history of cocaine use is scheduled for cardiac function tests. Which should the nurse include when explaining the purpose of these tests to the patient? "Cocaine is an idiopathic cause of heart failure." "Cocaine causes bradycardia and decreases cardiac output, so heart function needs to be monitored." "Systolic heart failure can be caused by cocaine increasing pressure in the lungs." "Systolic heart failure can be caused by toxins affecting the function of the heart."
"Systolic heart failure can be caused by toxins affecting the function of the heart." Systolic heart failure may be due to the effect of toxins such as cocaine on the heart, which results in tachycardia. Cocaine does not increase pressure in the lungs to cause heart failure. Since cocaine is an identifiable cause, it is not idiopathic.
A patient with a history of myocardial infarction (MI) asks why breathing becomes difficult at night. Which response by the nurse is accurate? "The MI has caused the heart to have a compromised pumping ability and cannot oxygenate the body, making breathing difficult." "The MI caused cardiac output to increase and is putting too much workload on the heart, making it difficult to breath." "Due to the MI, the heart is unable to pump blood to the lungs, so it has become difficult to breath." "The MI caused the heart to lose some ability to pump blood out of the heart, and blood is backing up into the lungs making it difficult to breath."
"The MI caused the heart to lose some ability to pump blood out of the heart, and blood is backing up into the lungs making it difficult to breath." The myocardial infarction (MI) caused damage to the heart resulting in the loss of some ability to pump blood, so the blood is backing up into the lungs and making it difficult to breathe. Left-sided heart failure (HF) occurs when the left side of the heart is unable to pump blood sufficient to meet the needs of the body. In this type of heart failure there is a lack of forward flow of blood to the aorta and the systemic circulation causing a decrease in cardiac output. There is also increased venous congestion in the lungs as blood begins to back up into the pulmonary vessels. Oxygenation is an issue in HF, but the assessment finding relates to left-sided HF. The difficulty breathing is due to pulmonary congestion. The right side delivers blood to the lungs and does not cause pulmonary congestion.
A patient with systolic heart failure (HF) is prescribed new medications to help control the symptoms. Which statement by the nurse explains the goal of treatment for this patient? "The goal of these medications is to reduce blood flow through the lungs." "The goal of these medications is to increase systemic vascular resistance and make it easier for the heart to pump blood to the body." "The goal of these medications is to increase preload and perfusion to the body's organs." "The goal of these medications is to make it easier for your heart to pump blood to the body."
"The goal of these medications is to make it easier for your heart to pump blood to the body." Targeted medication therapies such as increasing diuresis or afterload reduction may be advised to help the symptoms of heart failure (HF) and make it easier for the heart to pump blood to the body. Increasing preload can overwhelm the heart with too much fluid. Increased systemic vascular resistance (SVR) increases afterload and makes it harder for the heart to pump. The goal is not to reduce blood flow through the lungs, but to make it easier for the heart to pump blood forward.
The nurse notes that a patient who developed left-sided heart failure after a myocardial infarction has jugular vein distention. Which statement represents what the nurse should conclude about this finding? "The patient developed right-sided heart failure (HF) due to decreased afterload in the pulmonary system." "The patient is now experiencing decreased right-sided preload." "The left side of the heart is pumping too much blood into the body." "The left-sided heart failure (HF) increased pulmonary pressure and caused right-sided heart failure."
"The left-sided heart failure (HF) increased pulmonary pressure and caused right-sided heart failure." Right-sided heart failure (HF) can be caused by many conditions, but is most typically caused by left-sided HF. Jugular vein distention (JVD) is sign of right-sided HF as fluid backs up into the body. JVD is not a forward effect of left-sided HF. Right-sided afterload and preload is increased in HF. JVD is not from too much blood being pumped to the body by the left side of the heart.
A patient recovering from an acute myocardial infarction (MI) develops heart failure (HF). Which statement should the nurse include when explaining the development of HF in this patient? "The myocardial infarction resulted in disruption in the electrical system of the heart, which led to disorganized contractions." "The myocardial infarction resulted in the heart's decreased ability to pump blood." "The myocardial infarction lead to your heart beating faster because of the systems that control your blood pressure." "The myocardial infarction caused the nervous system to increase the fluid volume in the vascular space."
"The myocardial infarction resulted in the heart's decreased ability to pump blood." Heart failure (HF) is a progressive disorder that begins after an initial injury, such as a myocardial infarction, that damages the myocardium and decreases the pumping ability of the heart muscle. HF is not related to the electrical system being disrupted. The renin-angiotensin-aldosterone system (RAAS) affects vasoconstriction and fluid retention in the body. The sympathetic nervous system (SNS) influences heart rate and vasoconstriction.
A patient with multiple myeloma is demonstrating signs of heart failure, but has a normal ejection fraction. Which statement supports what the nurse should conclude about this patient? "The patient may have systolic heart failure that has not yet affected the ejection fraction (EF)." "The patient has right-sided systolic heart failure (HF)." "The patient may have diastolic heart failure that is related to a preserved or normal ejection fraction (EF)." "The patient does not have heart failure because the ejection fraction (EF) is normal."
"The patient may have diastolic heart failure that is related to a preserved or normal ejection fraction (EF)." A form of heart failure (HF) commonly known as diastolic heart failure is seen in patients with normal contractility of the heart but abnormal relaxation of the heart. This type of HF is called heart failure with preserved ejection fraction (EF), because these patients have HF in the presence of a normal ejection fraction. Obesity, hypertension, metabolic syndrome, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, multiple myeloma, and amyloid heart disease have been linked to diastolic HF. The normal ejection fraction rules out systolic HF.
A patient asks why a transthoracic echocardiogram (TTE) has been scheduled. Which response by the nurse is correct? "This is a test that shows pulmonary congestion in the lung fields." "This is an x-ray procedure that gives a view of the cardiac shadow." "This is an ultrasound of the heart and gives information about the ejection fraction of the heart." "This is a test that allows us to measure blood flow through the lungs."
"This is an ultrasound of the heart and gives information about the ejection fraction of the heart." A transthoracic echocardiogram (TTE) is an ultrasound that typically reveals an ejection fraction (EF) less than 40% with or without ventricular enlargement in heart failure. A chest x-ray may show an enlarged cardiac shadow or evidence of pulmonary vascular congestion. Pulmonary artery catheterization may be helpful in measuring blood flow through the lungs.
The nurse is teaching a patient about heart failure. Which statement should the nurse use to explain the body's compensatory responses to decreased cardiac output (CO)? "Your heart rate will decrease so your body can conserve energy." "Your body will work to release more sodium in your urine." "You will urinate less so your body can retain more water." "Your veins will open up to decrease the amount of blood coming back to the heart."
"You will urinate less so your body can retain more water." In response to decreased cardiac output (CO), the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS) are activated. The RAAS system decreases urine output by increasing sodium and water retention. The SNS causes peripheral vasoconstriction and increases the heart rate. Activation of the neurohormonal system in heart failure: The sympathetic nervous system (SNS) influences the activation of the renin-angiotensin-aldosterone system (RAAS). Kidneys release renin when blood flow to the kidney is reduced. Renin causes the conversion of angiotensinogen to angiotensin I in the liver. Angiotensin-converting enzyme helps convert angiotensin I to angiotensin II in the lungs. Angtiotensinogen II causes peripheral vasoconstriction and causes the release of aldosterone and antidiuretic hormone. Aldosterone from the adrenal glands causes sodium to be reabsorbed leading to increased sodium level and fluid retention. Antidiuretic hormone (vasopressin) released by the pituitary gland causes additional vasoconstriction and water retention.
