Objective 8 and 9.txt

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Objective 8 and 9.txt
2013-09-02 14:21:08

Objective 8 and 9
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  1. Heart failure
    inability of the heart to pump sufficient blood to meet the needs of the tissues for O2 and nutrients
  2. Heart failure
    chronic or acute; fluid overload; myocardial disease (contraction, systolic or diastolic); some cases are reversible; progressive and lifelong; poor tissue perfusion
  3. Causes of left sided heart failure
    HTN, CAD, valvular disease involving the mitral or aortic valve; pulmonary congestion from increased pressure in pulmonary vessels
  4. Systolic heart failure
    when heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation; preload increases and afterload increases as a result of increased peripheral resistence; ejection fraction drops from 50-70% to below 40%
  5. Systolic HF
    fluid backs up into the pulmonary system
  6. Patients with an ejection fraction of less than 30%
    are candidates for implantable ICD
  7. Diastolic heart failure
    left ventricle cannot relax adequately during diastole; inadequate relaxation or stiffening prevents ventricle from filling with sufficient blood to ensure adequate cardiac output
  8. Right sided heart failure
    caused by left ventricular failure, right ventricular MI or pulmonary HTN; right ventricle cannot empty completely, increased volume and pressure develop in the venous system and peripheral edema results
  9. High-output heart failure
    can occur when CO remains normal or above normal; caused by increased metabolic needs or hyperkinetic conditions like septicemia, high fever anemia and hyperthyroidism
  10. What compensatory mechanisms work to improve cardiac output
    sympathetic nervous system stimulation, renin angiotension system, other chemical responses, myocardial hypertrophy
  11. BNP
    a peptide produced and released by the ventricles when the patient has fluid overload as a result of HF
  12. Signs of left sided HF
    decreased CO, fatigue, weakness, oliguria, angina, confusion, dizziness, tachycardia, pallor, weak peripheral pulses, cool extremities, pulmonary congestion, hacking cough, dyspnea, crackles, wheezing, frothy pink tinged sputum, tachypnea, S3/S4 gallop
  13. Assessment of left HF
    pulse strength and auscultate AP for 1 minute; respiratory-rate, rhythm, character, O2 sats, auscultate lungs, A&O X 3
  14. Signs of right sided HF
    systemic congestion
  15. Assessment of right sided HF
    neck veins, ABD girth, dependent edema
  16. Labs for rt sided HF
    electrolytes, HGB, HCT, BNP, UA, ABGs, echo, chest xray, ECG, pulmonary artery cath
  17. Assessment for HF
    health history, sleep and activity, knowledge and coping, physical exam, assess responses to meds
  18. Problems or complications of HF
    cardiogenic shock, dysrhythmias, thromboembolism, pericardial effusion, cardiac tamponade
  19. Goals for teaching HF
    promote, relieve, decrease, encourage, teach
  20. Activity intolerance for HF
    bed rest, physical activity, exercise, pacing self, wait after eating, conserve energy, avoid weather conditions, positioning of self
  21. How to help with fluid volume excess
    assessment, daily weight, I&O, timing of meds, fluid intake, sodium restructions
  22. Paroxysmal nocturnal dyspnea
    sudden awakening with a feeling of breathlessness 2-5 hours after falling asleep; sitting upright and danging feet usually helps
  23. Crackles
    usually start low in lung and work their way up
  24. Benefits of dig
    increased contractility, reduced HR, slowing of conduction through AV node, inhibit sympat while enhancing parasym
  25. PVCs are most common with
    Dig and potassium levels can cause problems with dig
  26. Classes of HF
    I: no symptoms with activity; II: symptoms with ordinary exertion; III: Symptoms with minimal exertion; IV: symptoms ar rest
  27. What med decreases preload
  28. What meds decrease afterload
    ACE inhibitors (pril), AR II blockers (Cozaar), cal channel blockers (Cardizem), phophop 3 (Primacor)
  29. Inotropic agents
    dig, dopamine used to increase contractility and thereby improve CO
  30. What to watch for with dig
    count pulse before taking med, take at same time of day, don’t take with antacids, toxicity includes fatigue and muscle weakness and confusion and loss of appetite; have dig and K levels checked
  31. Vasodilators can cause
    orthostatic hypotension and headache is common side effect; sit and lie slowly
  32. hBNP cause
    natriureses (loss of Na and vasodilation)
  33. If someone has HF and SOB, give O2 then do what
    put in high fowlers-decrease venous return to the heart (preload) and help decrease lung congestion
  34. Pulmonary artery catheter
    multi-lumen catheter with the capacity to measure right atrial and indirect left atrial pressures or pulmonary artery wedge pressure
  35. Increased RA pressures may occur
    with right ventricular failure whereas low RA pressures usually indicate hypovolemia
  36. Normal PAP is from
    15-26 systolic vs 5-15 diastolic
  37. Transducer needs to be at
    phlebostatic axis (4th intercostal space and 1/2way between front and back)
  38. Central venous catheter
    through vena cava or right atrium; normal CVP is 2-6; lower than 2 is reduced rt ventricular preload caused by hypovolemia, vomiting or overdiuresis and higher than 6 indicates right ventricular preload
  39. Complications of central venous catheter
    blood clot, infection
  40. Pulmonary artery catheter
    assess pulmonary function
  41. Intraarterial BP monitoring
    can use blood from this for ABGs, check pulses (may be tingling, usually in radial area)
  42. Complications with PAC
    pulmonary infarction, air embolism, ventricular dysrhythmias if catheter slips into right ventricle, infection, bleeding
  43. Complications of antraarterial BP monitoring
    air embolism, blood loss, pain, arteriospasm, tingling in arm, hold pressure for 10 minutes (NO PEEKING)