chapter 28
The nurse is reviewing the medication administration record of a client diagnosed with systolic heart failure. What medication should the nurse anticipate administering to this client?
A beta-adrenergic blocker
The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status?
ABG (Arterial blood gases)
The triage nurse in the ED is assessing a client with chronic heart failure who has presented with worsening symptoms. In reviewing the client's medical history, what is a potential primary cause of the client's heart failure?
Atherosclerosis
Beta-type natriuretic peptide (BNP)
BNP is cardioprotective. Its function is to decrease BP by increasing the excretion of sodium and water and promoting arterial dilation. It achieves its effects by counteracting renin, angiotensin, and aldosterone.
The nurse is caring for a client who is receiving a loop diuretic for the treatment of heart failure. What assessment should the nurse prioritize?
BP
A nurse has performed an assessment of a patient and subsequently administered the patient's scheduled dose of ramipril, an angiotensin-converting enzyme (ACE) inhibitor prescribed for the treatment of the patient's longstanding heart failure (HF). The nurse understands that this drug will aid in the treatment of the patient's disease by:
Causing vasodilation and decreasing the heart's workload
left sided failure s/s
Cynosis Hypoxia Elvated pulmonary capillary weadge pressure Fatigue S3 heart sound Cough w/pink, frothy sputum Crakles Orthopnea Paroxysmal nocural dyspea
The diagnosis of heart failure is usually confirmed by which of the following?
Echocardiogram
Aldosterone
Hormone that stimulates the kidney to retain sodium ions and water
The nurse is caring for a client with severe left ventricular dysfunction who has been identified as being at risk for sudden cardiac death. What medical intervention can be performed that may extend the survival of the client?
Insertion of an implantable cardioverter defibrillator (ICD)
Class III (Moderate) Heart Failure
Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.
The nurse is caring for a client with severe compensated heart failure. What human brain natriuretic peptide (BNP) medication may be used in a critical care unit with hemodynamic monitoring?
Natrecor
The nurse notes that a client has developed a cough productive for mucoid sputum, is short of breath, has cyanotic hands, and has noisy, moist-sounding, rapid breathing. These symptoms and signs are suggestive of what health problem?
Pulmonary edema
A patient in cardiogenic shock after a myocardial infarction is placed on an intra-aortic balloon pump (IABP). What does the nurse understand is the mechanism of action of the balloon pump?
The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart.
Class II (Mild) Heart Failure
The client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea.
What is the main difference between Class I and Class II heart failure as defined by the New York Heart Association (NYHA)?
The level of physical activity each allows
Class IV (Severe) Heart Failure
Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.
A client taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the client no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the health care provider ordering?
Valsartan
right sided failure
Weakness Ascites vomiting Elevated central venous pressure Arrhythmias Weight gain Nausea
Which nursing intervention should the nurse perform when a client with valvular disorder of the heart has a heart rate less than 60 beats/min before administering beta-blockers?
Withhold the drug and inform the primary health care provider.
ventricular remodeling
a condition in which there are changes in the size, shape, structure, and physiology of the heart after myocardial injury.
Cardiac resynchronization therapy (CRT)
a treatment for heart failure in which a device paces both ventricles to synchronize contractions
Intra-aortic balloon pump (IABP)
acts as a secondary mechanical circulatory pump to temporarily supplement the ineffectual contraction of the left ventricle. It is inserted as a catheter into the left femoral artery and threaded up to the descending aortic arch
A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, what actions should the nurse perform? Select all that apply.
administer oxygen place the client in an upright position
myocardial oxygen demand
amount of oxygen the heart needs to perform its work
Ventricular assist device (VAD)
an auxiliary heart pump that supplements the heart's ability to eject blood (1) a bridge to recovery, (2) a bridge to transplant, or (3) destination therapy (mechanical circulatory support when there is no option for a heart transplant).
pulmonary vascular bed
capillary network surrounding the alveoli
right sided heart failure
causes swelling in extremities occurs when the right ventricle fails to eject its diastolic filling volume into the pulmonary artery, causing congestion of blood in the venous vascular system.
Chronic Heart Failure (CHF)
condition in which the heart is unable to pump sufficient blood to the tissues of the body
Surgical ventricular restoration (SVR)
decreases the size of the heart to a near normal size and shape by removing dysfunctional heart muscle that does not contract properly.
The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse titrate to improve blood flow to vital organs?
dopamine
Inotropic medications
drugs that improve myocardial contractility
The nurse is interviewing a client during an initial visit at a cardiologist's office. What symptom will the nurse expect to find as an early symptom of chronic heart failure?
fatigue
total artificial heart (TAH)
few patients have ever received this is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles.
congestive heart failure (CHF)
heart is unable to pump its required amount of blood describes the accumulation of blood and fluid in organs and tissues from impaired circulation
acute pulmonary edema
impairs oxygen diffusion into the pulmonary capillaries
Significance of BNP Levels >300 to 599 pg/mL
indicates mild heart failure
Significance of BNP Levels >600 to 899 pg/mL
indicates moderate heart failure
Significance of BNP Levels <100 pg/mL
indicates no heart failure
Significance of BNP Levels ≥900 pg/mL
indicates severe heart failure
The nurse is receiving a client from the emergency in cardiogenic shock. What mechanical device does the nurse anticipate will be inserted into the client?
intra-aortic balloon pump
heart failure (HF)
is the inability of the heart to pump sufficient blood to meet the body's metabolic needs
cardiogenic pulmonary edema
left ventricle becomes incapable of maintaining sufficient output of blood with each contraction.
The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival?
lisinopril
A client has been rushed to the ED with pulmonary edema and is going to need oxygen immediately. Which oxygen delivery system should be used first?
mask
Class I (Mild) Heart Failure
ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. the client does not experience any limitations of physical acivity.
Ejection Fraction (EF)
percentage of blood volume in the ventricles at the end of diastole that is ejected during systole; a measurement of contractility
Left sided heart failure
pulmonary edema results from various conditions that impair the left ventricle's ability to eject blood into the aorta
Refractory heart failure
refers to symptoms of heart failure that persist despite maximum medical therapy with proven efficacy for managing heart failure.
cor pulmonale
right ventricular hypertrophy and heart failure due to pulmonary hypertension is a condition in which the heart (cor) is affected secondarily by lung damage (pulmonale).
multiple gated acquisition (MUGA)
scan, also called a gated blood pool scan, measures a decrease in the ejection fraction.
The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with ordinary physical activity. Under what classification does the nurse understand this patient would be categorized?
stage II
acute heart failure
sudden change in the heart's ability to contract
Significance of BNP Levels 100 to 300 pg/mL
suggests heart failure is present
cardiomyoplasty
surgical procedure in which the client's own chest muscle (latissimus dorsi) is grafted to the aorta and wrapped around the heart.ventricular remodeling, a condition in which there are changes in the size, shape, structure, and physiology of the heart after myocardial injury.
Afterload
the amount of resistance to ejection of blood from the ventricle , the force that the ventricle must overcome to empty its diastolic volume, increases with arterial hypertension, aortic stenosis, pulmonary hypertension, or excessive blood volume from renal failure.
Preload
volume of blood in ventricles at end of diastole
