children's ch 22

Medications for HF

ACE inhibitors, ARB's, Diuretics, Digoxin, Beta Blockers

Medical Treatment for HF

AICD, LVAD, Transplant, Cardiac Rehab

A patient with coronary artery disease is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies valvular function and measures the size of the cardiac chambers? a. 12-lead electrocardiogram b. Cardiac catheterization c. Echocardiogram d. Electrophysiology study

Echocardiogram

Single most important test to evaluate patients with HF

Echocardiogram

Tachycardia

Left sided HF

Increase peripheral venous pressure

Right sided HF

Swelling in hands & feet

Right sided HF

Enlarged liver & spleen

Right sided Heart Failure

Medical Management of Mitral Regurgitation

Serial Echos, Prophylactic antibiotics, Valvuloplasty, Valve Replacement

The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? a. "Do you have a history of a heart attack?" b. "Is there a family history of endocarditis?" c. "Have you had any recent immunizations?" d. "Have you had dental work done recently?"

"Have you had dental work done recently?"

Backflow of blood from aorta into left ventricle

Aortic Regurgitation

Narrowing of opening between left ventricle and aorta

Aortic Stenosis

Diagnostic test that is a specific indicator for HF

BNP

Primary underlying cause of Heart Failure

Coronary Artery Disease

Nursing Management for HF

Daily weights, Strict I&Os, Prevent complications, control anxiety, Monitor S/S

The patient has been in chronic heart failure for the past 10 years. He has been treated with beta-blockers and angiotensin-converting enzyme inhibitors as well as diuretics. His symptoms have recently worsened, and he presents to the ED with severe shortness of breath and crackles throughout his lung fields. His respirations are labored and arterial blood gases show that he is at risk for respiratory failure. Which of the following therapies may be used for acute, short-term management of the patient? (Select all that apply). a. Dobutamine b. Intraaortic balloon pump c. Nesiritide (Natrecor) d. Ventricular assist device

Dobutamine, Intraaortic balloon pump, Nesiritide (Natrecor)

The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find? a. Dependent edema b. Distended neck veins c. Dyspnea and crackles d. Nausea and vomiting

Dyspnea and crackles

Clinical Manifestations Mitral Valve Prolapse

Fatigue, dizziness, SOB, syncope, palpitations, chest pain, anxiety

Which clinical manifestations are indicative of right ventricular failure? (Select all that apply.) a. Jugular venous distention b. Peripheral edema c. Crackles audible in the lungs d. Weak peripheral pulses

Jugular venous distention, Peripheral edema

Blood tinged sputum

Left sided HF

Cough, Crackles, Wheezes

Left sided HF

Cyanosis

Left sided HF

Orthopnea

Left sided HF

Paroxysmal Nocturnal Dyspnea

Left sided HF

Restlessness and Confusion

Left sided HF

A patient was admitted in terminal heart failure and is not eligible for transplant. The family wants everything possible done to maintain life. Which procedure might be offered to the patient for this condition to increase the patient's quality of life? a. Intraaortic balloon pump (IABP) b. Left ventricular assist device (LVAD) c. Nothing, because the patient is in terminal heart failure d. Nothing additional; medical management is the only option

Left ventricular assist device (LVAD)

Abnormal reversal of blood flow from left ventricle to the left atrium during systole.

Mitral Regurgitation

Stenotic valve restricts blood flow from left atrium to left ventricle

Mitral Stenosis

Improper closure of the valve between the heart's upper & lower left chambers

Mitral Valve Prolapse

Mitral Valve Prolapse Assessment & Diagnostics

Mitral click on auscultation, murmur, doppler echocardiogram

Anorexia & Complaints of GI distress

Right sided HF

Dependent edema

Right sided HF

Distended Jugular Veins

Right sided HF

Fatigue and Ascites

Right sided HF

Medical Management of Mitral Valve Prolapse

Smoking Cessation, limit alcohol and caffeine, CCBs or BBs

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on which assessment finding(s)? a. Fever, chills, and diaphoresis b. Urine output less than 30 mL/hr c. Petechiae on the inside of the mouth and conjunctiva d. Increase in heart rate of 15 beats/minute with walking

Urine output less than 30 mL/hr

During the assessment of a 25-year-old patient with infective endocarditis (IE), the nurse would expect to find a. substernal chest pressure. b. a new regurgitant murmur. c. a pruritic rash on the chest. d. involuntary muscle movement.

a new regurgitant murmur

A drug the nurse would most likely expect to be prescribed to the patient with valvular heart disease is: a. oral nitrates b. anticoagulants c. antidysrhythmics d. Beta blockers

anticoagulants

patient hospitalized for 1 week with subacute infective endocarditis is afebrile and has no signsof heart damage. Discharge with outpatient antibiotic therapy is planned. During discharge planning with the patient, what is it most important for the nurse to do? a. Plan how his needs will be met while he continues on bed rest. b. Encourage the use of diversional activities to relieve boredom and restlessness. c. Teach the patient to avoid crowds and exposure to upper respiratory infections. d. Assess the patient's home environment in terms of family assistance and hospital access.

assess the patient's home environment in terms of family assistance and hospital access

Mitral Regurgitation may be caused by

calcification, ischemia

An essential aspect of teaching that may prevent recurrence of heart failure is: a.notifying the physician if a 2-lb weight gain occurs in 24 hours. b. compliance with diuretic therapy. c. taking nitroglycerin if chest pain occurs. d. assessment of an apical pulse.

compliance with diuretic therapy

Lifestyle modifications for HF

decreased sodium intake, fluid restriction, daily weights, regular exercise, smoking cessation, decrease alcohol intake, compression stockings

Causes of heart failure

hypertension, cardiomyopathy, valvular disease, MI, cardiac dysrhythmias

Valvular heart disease can be initially identified on physical examination by the presence of ...

murmur

Mitral Valve Prolapse occurs more often in

women