Heart Failure and Blood Pressure

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Questions and Answers

What is the normal systolic and diastolic pressure?

Normal systolic pressure is around 120 mm Hg, and normal diastolic pressure is around 80 mm Hg.

What is the hallmark of heart failure with reduced ejection fraction (HFrEF)?

Decrease in diastolic pressure

Decrease in systolic pressure

Decrease in left ventricular ejection fraction (LVEF) (correct)

Increase in LVEF

Vasogenic cerebral edema results from disruption of the blood-brain barrier.

True

The normal cerebral perfusion pressure (CPP) is ___ mm Hg.

60 to 100 Signup and view all the answers

What is the result of disruption of the integrity of cell membranes that leads to cerebral hypoxia or anoxia?

Cytotoxic cerebral edema Signup and view all the answers

What is the most sensitive and reliable indicator of neurologic status?

Level of consciousness (LOC) Signup and view all the answers

Unexpected vomiting not preceded by nausea is called projectile vomiting.

True Signup and view all the answers

____ posture may indicate more serious damage, resulting from disruption of motor fibers in the midbrain and brainstem.

Decerebrate Signup and view all the answers

Match the following CNs with their associated ocular signs:

CN III (oculomotor nerve) = Pupil dilation, inability to move eye upward and adduct CN IV (trochlear) = Blurred vision, changes in extraocular eye movements CN VI (abducens) = Diplopia, changes in extraocular eye movements Signup and view all the answers

What are the potential complications associated with scalp lacerations?

Hypovolemia and meningitis Signup and view all the answers

A concussion typically involves a brief disruption in loss of consciousness (LOC).

True Signup and view all the answers

What syndrome may develop in some patients following a head injury, with manifestations including persistent headache and changes in intellectual ability?

post-concussion syndrome Signup and view all the answers

The leaking fluid from the nose or ear can be tested for glucose using a ________ to determine if cerebrospinal fluid (CSF) is present.

Dextrostix or Test-Tape strip Signup and view all the answers

Match the type of skull fracture with its description and cause:

Comminuted = Multiple linear fractures with fragmentation of bone into many pieces, caused by direct high momentum impact Compound = Depressed skull fracture and scalp laceration with communicating pathway to intracranial cavity, caused by severe head injury Linear = Break in continuity of bone without change of relationship of parts, caused by low velocity injuries Depressed = Inward indentation of skull, caused by a powerful blow Signup and view all the answers

Study Notes

Heart Failure

Heart failure can be classified into two main types: systolic heart failure and diastolic heart failure
Systolic heart failure (HFrEF) results from an inability of the heart to pump blood effectively, with a decreased left ventricular ejection fraction (LVEF) of less than 40%
Diastolic heart failure (HFpEF) occurs when the heart has a normal LVEF but has impaired relaxation and filling of the ventricles

Right-Sided Heart Failure

Caused by left-sided heart failure, pulmonary hypertension, COPD, and sleep apnea
Symptoms include weight gain, pitting edema, jugular venous distension, abdominal ascites, and no chest pain unless arteries are clogged
Medications used to treat right-sided heart failure include ACE inhibitors and diuretics

Left-Sided Heart Failure

Causes include ischemic heart disease, long-standing hypertension, and cardiomyopathy
Symptoms include fatigue, MI, and S3, S4 heard on auscultation
Biventricular failure includes both LV and RV dysfunction, leading to decreased cardiac output and fluid buildup

Acute Decompensated Heart Failure (ADHF)

Manifests as pulmonary edema, with symptoms including dyspnea, orthopnea, and paroxysmal nocturnal dyspnea
Diagnosis is based on clinical findings, including crackles and wheezes on auscultation, and X-ray or CT scan showing pulmonary edema
Treatment includes diuretics, vasodilators, and inotropes

Medications Used in Heart Failure

ACE inhibitors (e.g., lisinopril) to dilate blood vessels and decrease fluid buildup
Diuretics (e.g., furosemide) to reduce fluid buildup and sodium levels
Beta-blockers to decrease heart rate and blood pressure
Aldosterone antagonists (e.g., spironolactone) to reduce fluid buildup and potassium levels

Hemodynamic Monitoring

Central venous pressure (CVP) measures the pressure in the right atrium
Pulmonary artery wedge pressure (PAWP) measures the pressure in the left atrium
Cardiac output (CO) is the product of heart rate and stroke volume

Treatment of Heart Failure

Lifestyle modifications: low-sodium diet, fluid restriction, and exercise
Medications: ACE inhibitors, beta-blockers, diuretics, and aldosterone antagonists
Device therapy: implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT)

Cerebral Edema

Types of cerebral edema:
- Vasogenic edema: disruption of the blood-brain barrier, causing fluid to leak into the brain
- Cytotoxic edema: disruption of cell membranes, causing fluid to shift into cells
- Interstitial edema: increase in cerebrospinal fluid (CSF) production or decreased reabsorption
Symptoms: headache, vomiting, and decreased level of consciousness
Diagnosis: CT or MRI scan, lumbar puncture, and neurological examination
Treatment: osmotic diuretics (e.g., mannitol), corticosteroids, and maintenance of adequate cerebral perfusion pressure (CPP)### Nursing Management: Increased Intracranial Pressure
If the patient cannot maintain adequate oral intake, start alternative nutrition methods such as enteral feedings or parenteral nutrition.
Continuously monitor I&O to ensure it matches the volume of fluids being given.

Glasgow Coma Scale (GCS)

A quick, practical, and standard system for assessing the level of consciousness (LOC).

Pupillary Check

The oculomotor nerve (CN III) is compressed, causing the pupil on the affected side to become larger and eventually fully dilate if ICP continues to increase.
Both pupils dilate if ICP increases further.

Oculocephalic Reflex (Doll's Eye Reflex)

Test by turning the patient's head briskly to the left or right while holding the eyelids open.
A normal response is movement of the eyes across the midline in the direction opposite that of the turning.

Oculovestibular Reflex (Cold Caloric)

Test by positioning the patient with the head of the bed elevated and instilling ice-cold water into the external auditory ear canal.
Assess the patient's eyes for a total of 1 minute.
The absence of eye movement or response indicates severe neurologic demise.

Motor Response

Test strength by assessing spontaneous movement or applying a pain stimulus.
Note any asymmetry in strength or movement.

Altered Breathing

Be alert to altered breathing in patients with increased ICP.
Snoring sounds indicate obstruction and require immediate intervention.
Maintain a patent airway to prevent airway obstruction.
Limit suctioning to 2 passes per suction procedure to prevent lower CPP.

Fluid and Electrolyte Balance

Monitor urine output to detect problems related to diabetes insipidus and SIADH.
Closely monitor IV fluids using an accurate IV infusion control device or pump.
Monitor serum electrolytes, especially glucose, sodium, potassium, magnesium, and osmolality.
Discuss abnormal values with the healthcare provider (HCP).

Body Position

Maintain the patient in the head-up position to promote drainage from the head and decrease vascular congestion.
Avoid extreme neck flexion and keep the head in a midline position.

Protection from Injury

Use restraints carefully in the agitated patient to prevent injury.
Place the patient with or at risk for seizures on seizure precautions.

Types of Head Injuries

Scalp Lacerations: profuse bleeding, risk of blood loss and infection.
Skull Fractures: basilar, frontal, orbital, parietal, posterior fossa, and temporal types.
Types of Skull Fractures: comminuted, compound, depressed, linear, and simple.

Post-Concussion Syndrome

Develops in some patients, usually 2 weeks to 2 months after the injury.
Manifestations include persistent headache, lethargy, personality and behavior changes, shortened attention span, and decreased short-term memory.

Concussion

A sudden, transient mechanical head injury with disruption of neural activity and a change in LOC.
Typical signs include brief disruption in LOC, amnesia about the event, and headache.

Diffuse Axonal Injury (DAI)

Widespread axonal damage occurring after a mild, moderate, or severe TBI.
Clinical signs vary, including decreased LOC, increased ICP, decortication or decerebration, and global cerebral edema.

Focal Injury

Minor to severe, localized to an area of injury.
Consists of lacerations, contusions, hematomas, and CN injuries.
Surgical repair of the laceration is impossible due to the nature of brain tissue.

Epidural Hematoma

Results from bleeding between the dura and inner surface of the skull.
A neurologic emergency, requiring rapid surgical treatment to evacuate the hematoma and prevent cerebral herniation.

Subacute and Chronic Subdural Hematomas

Subacute: usually occurs within 2 to 14 days of the injury.
Chronic: develops over weeks or months after a seemingly minor head injury.
More common in older adults due to brain atrophy.

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Description

This quiz covers the basics of heart failure, including normal blood pressure ranges and the characteristics of systolic heart failure and heart failure with reduced ejection fraction.