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