AMS1

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Author:
Anonymous
ID:
163105
Filename:
AMS1
Updated:
2012-07-19 12:08:28
Tags:
AMS1T1 Heart Failure
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Description:
Heart Failure
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  1. What is heart failure?
    (formerly “CHF”)
    • Characteristics:
    • Impaired ventricular pumping
    • Reduced exercise tolerance. May present like COPD because both result in  v O2 sat.
    • Diminished QOL
    • Shortened life expectancy
  2. Systolic failure
    • Left Ventricular pump failure
    • Impaired contractility due to weakened heart muscle.
    • Decreased EF (ejection force)
    • Increased afterload
    • Cardiomyopathy
    • Mechanical problems
    • More common than diastolic failure
  3. Diastolic Failure
    • Impaired ventricular filling  
    •  
    • High filling pressures
    • Venous engorgement
    • Pulmonary congestion
    • Pulmonary HTN
    • Normal EF
  4. Compensatory Mechanisms
    • SNS Activation
    • --increased HR, contractility, vasoconstriction
    • Dilation of muscle tissue, not vasodilation.
    • --Muscle fibers stretch to increase contractility
    • Hypertrophy (cardiac remodling)
    • --Overwork causes increased muscle mass of ventricular walls
    • --Can be stopped and to some degree reversed with ACE inhibitors if diagnosed early.
    • Neurohormonal Response
    • --Kidneys respond with renin + angiotensin-->angiotensin 1 system.
  5. Right vs. Left sided failures of the heart.
  6. SnSs of of Acute HF
    Pulmonary Edema (swelling of lungs)
    • Agitated
    • Pale
    • Cyanotic?
    • Cool & clammy
    • Tachypnea/Dyspnea
    • Adventitious BS 
    • ^HR & BP changes
    • Pink and Frothy discharge
  7. SnSs of Chronic Heart Failure
    • Fatigue
    • Dyspnea
    • Tachycardia
    • Edema
    • Nocturia
    • Skin changes
    • Behavioral Changes
    • Chest Pain
    • Weight Changes (good indicator of fluid retension or fluid loss)
  8. Complications of HG
    • Pleural effusion
    • Hepatomegaly (blood pooling in liver-->enlarged liver)
    • Renal failure
    • Arrhythmia (afibrillation most common)
    • Left Ventricular thrombosis
  9. Diagnostis for HG
    • H & P
    • Lab studies (BNP)
    • CXR
    • Hemodynamic monitoring
    • ECG (electrocardogram. Not to be confused with echocardiogram).
    • Echocardiogram
    • Stress testing
    • Cardiac Catheterization

    Goal is to determine root cause.
  10. Nursing intervensions for pt w/HF
    • Tx underlying cause
    • Position (High Fowler)
    • O2
    • Cardiac monitor & oximetry (VS)
    • Daily weights
    • Rest
    • Sodium-restricted diet
    • Medications:
    • ACE inhibitors, to prevent remodeling
    • Inotropics, to improve "squeeze.
    • Diuretics, to clear excess fluid buildup.
    • Vasodilators
    • Antiarrhythmics
    • Beta-blockers, for high HR
    • Human B-type natriuretic peptide (BNP)
    • Anxiolytics
    • et al...
  11. Cardiomyopathy
    A group of heart muscle diseases that affect the structural or functional ability of myocardium

    • Know how it might present in various forms of HF.
    • Can be...
    • dilated: chambers are too large.
    • hypertrophic: heart wall is abnormally thick, overdeeloped.
    • restrictive: Heart wall is "stiff."

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