Med surg week 8 Cardiac (HF)

s/s of congestive HF

1. fatigue* 2. dyspnea 3. orthopnea 4. Tachycardia 5. edema 6. nocturia 7. dizziness, near syncope, confusion, restlessness 8. weight changes 9. chronic, non productive cough

HF treatments / Self Care

1. low sodium diet (DASH) 2. fluid restriction ~monitor daily weight 3. smoking cessation 4. physical activity 5. CPAP

ACE inhibitors

1. reduce afterload** 2. s/s: cough

Ejection fraction

1. the % of blood the left ventricle pumps out during systole 2. normal = 50-70% 3. HF = <40%

Goal of HF diagnostics

Find the underlying cause of HF and treat it (2 types of HF)

what is the most common cause of pulmonary edema?

left sided congestive heart failure

Valve stenosis

narrowing of the valves (forward flow is impaired)

heart murmurs

**hallmark of valvular disease (more common to have valve issues with left side of heart - mitral and aortic valves)

Beta blockers

1. decrease HR, can increase EF

Diuretics

1. decrease preload** 2. decreases edema and pulmonary venous pressure 3. carefully monitor for dehydration and electrolyte imbalances 4. *recommended to take in the morning to avoid nocturia

s/s of pulmonary edema

1. dyspnea 2. PND (paroxysmal nocturnal dyspnea) 3. coughing 4. pink, frothy sputum 5. tachypnea 6. accessory muscle use 7. crackles, wheezes 8. tachycardia 9. S3 or S4

cardiac output (CO)

= the amount of blood the heart pumps in 1 minute [ CO = HR(heart rate) x SV(stroke volume) ]

valve regurgitation

incomplete closure of the valves (causes backward flow)

heart failure medications

1. ACE inhibitors (-pril) 2. ARBs ( -sartan) 3. Beta Blockers ( -lol) 4. Diuretics 5. Nitrates, Digoxin, Hydralazine

HF risk factors

1. HTN 2. CAD (coronary artery disease) 3. MI (myocardial infarction) 4. DM 5. increased age 6. Tobacco use / lifestyle choices 7. Vascular diseases

Mitral valve regurgitation

1. caused by rheumatic heart disease, MI, mitral valve prolapse 2. LV and LA need to work harder to maintain CO 3. chronic = can be asymptomatic for years, weakness, fatigue, dyspnea, loud systolic murmur with S3 (due to increased volume in LV)

compensatory mechanisms of HF

1. enlargement of heart chambers 2. increase in muscle mass (thickness of walls) 3. ventricular remodeling 4. pumping faster

HF exacerbation

1. known as "acute decompensated heart failure (ADHF) 2. sudden increase and onset of s/s r/t HF (typically see increased RR and SOB) 3. increase sodium and fluid accumulation LEADS TO pulmonary congestion and volume overload 4. treatment/management = ~supplemental O2 ~high fowler's position (decreases venous return and therefore pulmonary congestion) ~diuretics (gets excess fluid off)

Right sided HF (rest of body)

1. leads to fluid backup in the rest of the body causing peripheral edema 2. s/s = weight gain, edema, ascites, congestion of abdominal organs

Left sided HF (lungs)

1. leads to pulmonary congestion and edema **Most common HF 2. (inability of LV to empty adequately, so blood backs up into lungs and fluids leak causing congestion) 3. s/s = cough, crackles, tachypnea (bc decreased CO), may hear s3 or s4, paroxysmal nocturnal dyspnea

mitral valve stenosis

1. most common cause = rheumatic heart disease (caused by rheumatic fever from strep throat) 2. higher risk for AFib and Stroke 3. s/s = dyspnea, loud S1, diastolic murmur

aortic valve stenosis

1. narrowing of aortic valve (one of the most common and serious valve disorders) 2. increases O2 demand, reduced CO 3. affects older adults bc of scarring and Ca buildup over the years

Which action should the nurse take first when caring for a client with heart failure that just had an episode of paroxysmal nocturnal dyspnea (PND)? a. assess the client's O2 saturation level b. assist the client to sit on the edge of the bed c. ask whether the client is experiencing chest discomfort d. offer the client an explanation about the cause of the PND

b. assist the client to sit on the edge of the bed (if pt is having trouble lying down, have pt sit up to get fluid off of their chest)

when obtaining a health history for a client with mitral valve stenosis, which question will be most relevant to ask? a. do you frequently get UTI's? b. have you had a recent episode of pneumonia? c. do you have a family history of heart attack/MI? - (ask for mitral valve regurgitation) d. did you ever have strep throat during childhood?

d. did you ever have strep throat during childhood?

What is heart failure?

inability of the heart to pump enough blood to meet the body's needs for oxygen and blood (compensatory mechanisms develop)