Chapter 29: Management of Patients With Complications From Heart Disease

The nurse is caring for a client with heart failure who is receiving torsemide. What implementation will help the nurse evaluate the client's response of the medication? You Selected:

measuring intake and output

A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? You Selected:

nausea and vomiting

A client has had an echocardiogram to measure ejection fraction. The nurse explains that ejection fraction is the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects? You Selected:

55%

Heart Failure Poor Perfusion/Low Cardiac Output

Decreased exercise tolerance Muscle wasting or weakness Anorexia or nausea Unexplained weight loss Lightheadedness or dizziness Unexplained confusion or altered mental status Resting tachycardia Daytime oliguria with recumbent nocturia Cool or vasoconstricted extremities Pallor or cyanosis

New York Heart Association Classification of Heart Failure III

Marked limitation of physical activity Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.

New York Heart Association Classification of Heart Failure II

Slight limitation of physical activity Comfortable at rest, but ordinary physical activity causes fatigue, palpitation, or dyspnea.

When the right ventricle fails,

congestion in the peripheral tissues and the viscera predominates.

Digoxin increases the force of myocardial contraction and slows conduction through the atrioventricular node. It improves

contractility, increasing left ventricular output.

Sodium bicarbonate (NaHCO3)—

corrects metabolic acidosis

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? You Selected:

The development of left-sided heart failure

Valvular heart disease is also a cause of HF. The valves ensure that blood flows in one direction. With valvular dysfunction, it becomes

increasingly difficult for blood to move forward, increasing pressure within the heart and increasing cardiac workload, leading to HF.

Milrinone

is a phosphodiesterase inhibitor that leads to an increase in intracellular calcium within myocardial cells, increasing their contractility

Pulmonary edema

is the abnormal accumulation of fluid in the interstitial spaces and alveoli of the lungs.

Pulmonary edema is an acute event that results from

left ventricular failure.

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? You Selected:

"I sleep on three pillows each night."

Nitrates

(e.g., isosorbide dinitrate) cause venous dilation, which reduces the amount of blood return to the heart and lowers preload.

A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be? You Selected:

30%

normal ejection fraction (EF)

55% to 65% of the ventricular volume

Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? You Selected:

IV

The client with cardiac failure is taught to report which symptom to the physician or clinic immediately? You Selected:

Persistent cough

The nurse recognizes which symptom as a classic sign of cardiogenic shock? You Selected:

Restlessness and confusion

New York Heart Association Classification of Heart Failure IV

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 is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? You Selected: Measuring and recording fluid intake and output Correct response:

Weighing the client daily at the same time each day

Atropine—

blocks parasympathetic action; increases SA node automaticity and AV conduction

A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid: You Selected:

canned peas.

High levels of BNP are a sign of

high cardiac filling pressure and can aid in the diagnosis of HF.

The EF is normal in diastolic HF; therefore, this condition is referred to as heart failure with preserved EF. Approximately

one third of HF patients have systolic dysfunction, one third have diastolic dysfunction, and one third have both

Approximately 25% of patients discharged after treatment for HF are

readmitted to the hospital within 30 days

Norepinephrine—

vasopressor given to increase BP Given for hypotension and shock

Dopamine—

vasopressor given to increase BP and contractility

Epinephrine—

vasopressor used to optimize BP and cardiac output; improves perfusion and myocardial contractility

A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity? You Selected:

visual disturbances.

Fluid overload and decreased tissue perfusion result

when the heart cannot generate cardiac output (CO) sufficient to meet the body's demands for oxygen and nutrients.

The nurse is teaching a client with heart failure about digoxin. What statements by the client indicate the teaching is effective? Select all that apply. You Selected:

"I will watch my urine output to be sure that the medication is not affecting my kidneys." "If I take my digoxin I should have limited episodes of shortness of breath."

A client in the emergency room is in cardiac arrest and exhibiting pulseless electrical activity (PEA) on the cardiac monitor. What will be the nurse's next action? You Selected:

Administer epinephrine.

Which is a key diagnostic indicator of heart failure? You Selected:

Brain natriuretic peptide (BNP)

Which diagnostic study is usually performed to confirm the diagnosis of heart failure? You Selected:

Echocardiogram

Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? You Selected:

Increased pulmonary artery diastolic pressure

New York Heart Association Classification of Heart Failure I

No limitation of physical activity Ordinary activity does not cause undue fatigue, palpitation, or dyspnea.

American College of Cardiology and American Heart Association Classification of Heart Failure Stage A

Patients at high risk for developing left ventricular dysfunction but without structural heart disease or symptoms of HF

American College of Cardiology and American Heart Association Classification of Heart Failure Stage D

Patients with refractory end-stage HF requiring specialized interventions

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? You Selected:

Withhold the drug and inform the primary health care provider.

pulseless electrical activity (PEA)

a condition in which the heart's electrical rhythm remains relatively normal, yet the mechanical pumping activity fails to follow the electrical activity, causing cardiac arrest

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). How should the nurse document this sound? You Selected:

a third heart sound (S3).

Diuretics

are prescribed to remove excess extracellular fluid by increasing the rate of urine produced in patients with signs and symptoms of fluid overload.

The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? You Selected:

decreased left ventricular pumping

The clinical manifestations of pulmonary congestion include

dyspnea, cough, pulmonary crackles, and low oxygen saturation levels.

The patient, nearly suffocated by the blood-tinged, frothy fluid filling the alveoli, is literally drowning in secretions. The situation demands

emergent action.

When the left ventricle begins to fail, blood backs up into the pulmonary circulation, causing pulmonary interstitial edema. This may occur quickly in some patients, a condition sometimes called

flash pulmonary edema

The fluid within the alveoli mixes with air, producing the classic sign of pulmonary edema—

frothy pink (blood-tinged) sputum.

Cardiogenic shock occurs when decreased CO leads to inadequate tissue perfusion and initiation of the shock syndrome. Cardiogenic shock is a life-threatening condition with a

high mortality rate.

Vasopressin—

increases systemic vascular resistance and BP

Loop diuretics, such as furosemide (Lasix),

inhibit sodium and chloride reabsorption mainly in the ascending loop of Henle.

Heart failure (HF)

is a clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to fill or eject blood

Both of these classes of diuretics increase potassium excretion; therefore, patients treated with these medications must have their

serum potassium levels closely monitored.

Thiazide diuretics, such as metolazone (Zaroxolyn), inhibit sodium and chloride reabsorption in the

early distal tubules.

More than 40% of patients with chronic HF have

impaired renal function.

The most common type is an alteration in ventricular contraction called

systolic heart failure, which is characterized by a weakened heart muscle.

Aldosterone antagonists such as spironolactone (Aldactone) are potassium-sparing diuretics

that block the effects of aldosterone in the distal tubule and collecting duct

A total artificial heart (TAH) 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. What makes it different from an LVAD? You Selected:

An LVAD only supports a failing left ventricle.

A client is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this client? You Selected:

Digoxin immune FAB

Heart Failure Congestion

Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Cough (recumbent or exertional) Pulmonary crackles that do not clear with cough Weight gain (rapid) Dependent edema Abdominal bloating or discomfort Jugular venous distention Sleep disturbance (anxiety or air hunger) Fatigue

Which feature is the hallmark of systolic heart failure? You Selected: Pulmonary congestion Correct response:

Low ejection fraction (EF)

The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders? You Selected:

Older adults are at increased risk for toxicity.

American College of Cardiology and American Heart Association Classification of Heart Failure Stage B

Patients with left ventricular dysfunction or structural heart disease who have not developed symptoms of HF

American College of Cardiology and American Heart Association Classification of Heart Failure Stage C

Patients with left ventricular dysfunction or structural heart disease with current or prior symptoms of heart disease

An extra heart sound, the S3, or "ventricular gallop," may be detected on auscultation. It is caused by

abnormal ventricular filling

Amiodarone—

acts on sodium-potassium and calcium channels to prolong action potential and refractory period

A client asks the nurse if systolic heart failure will affect any other body function. What body system response correlates with systolic heart failure (HF)? You Selected:

decrease in renal perfusion

A hacking cough, fatigue, weight gain, increased edema, and decreased activity tolerance may be early indicators of

developing pulmonary edema.

Magnesium sulfate—

promotes adequate functioning of cellular sodium—potassium pump

The blood volume and pressure build up in the left atrium, decreasing flow through the pulmonary veins into the left atrium. Pulmonary venous blood volume and pressure increase in the lungs, forcing fluid from the pulmonary capillaries into the pulmonary tissues and alveoli, causing

pulmonary interstitial edema and impaired gas exchange.

The signs and symptoms of HF can also be related to the ventricle that is most affected. Left-sided heart failure (left ventricular failure) causes different manifestations than right-sided heart failure (right ventricular failure). In chronic HF, patients may have

signs and symptoms of both left and right ventricular failure.

A second type is diastolic heart failure, which is characterized by a

stiff and noncompliant heart muscle, making it difficult for the ventricle to fill.