Heart Failure Quiz 2

Fundamentals of Heart Failure

• Heart failure (HF) is defined as the heart's inability to pump sufficient blood to meet metabolic demands
• Cardiac output (CO) is calculated by multiplying heart rate (HR) by stroke volume (SV)
• Causes of a low ejection fraction include cardiomyopathy, heart attack, hypertension, and valve stenosis
• An ejection fraction (EF) below 40% suggests reduced systolic function, which is characteristic of systolic heart failure
• Normal EF is typically between 55–70%
• Increased preload can result from volume overload
• Anemia, hypertension, and valve disorders can increase cardiac workload
• Hyperthyroidism increases metabolic demand, potentially leading to heart failure
• Afterload is the resistance the heart must overcome to eject blood
• Systemic hypertension increases systemic resistance, which therefore increases afterload

Systolic vs. Diastolic Heart Failure

• Systolic HF has an impaired contractility, which reduces the amount of blood ejected from the ventricle
• Diastolic HF stems from stiff or non-compliant ventricles that cannot fill properly, despite normal ejection fraction
• Systolic HF involves impaired contractility and reduced EF
• Hypertension contributes to systolic HF by increasing afterload
• A patient with normal EF but complains of fatigue and shortness of breath is suspected to have diastolic HF
• Diastolic HF often presents with preserved EF but decreased ventricular filling, resulting in fatigue/SOB
• Chronic hypertension carries a high risk of diastolic heart failure
• Chronic hypertension causes ventricular hypertrophy, which reduces compliance and impairs filling, which are hallmarks of diastolic HF
• Echocardiogram findings suggesting diastolic dysfunction include an EF of 65%, large stiff left ventricle, and decreased ventricular filling
• Digoxin improves myocardial contractility and is especially useful in systolic HF with low EF
• Cardiac output is reduced because of poor ventricular contraction in systolic HF
• Signs of left-sided systolic HF include pulmonary congestion, fatigue and weakness, decreased urine output, and crackles in lung bases
• Jugular vein distention is more consistent with right-sided failure
• Restrictive cardiomyopathy is more associated with diastolic dysfunction from impaired filling and compliance, not impaired contraction

Left-Sided vs. Right-Sided Heart Failure

• A hallmark symptom of left-sided HF is crackles in the lungs. This is due to pulmonary congestion, evidenced by fluid in the alveoli
• The manifestation associated with right-sided HF is peripheral edema
• Right-sided HF leads to systemic venous congestion, including peripheral edema in the feet and legs
• Symptoms of left-sided HF include dyspnea, orthopnea, and pink-tinged sputum
• Weight gain and hepatomegaly are more typical of right-sided heart failure
• Clinical findings supporting right-sided HF include anasarca, jugular vein distention, ascites, and nocturia
• Crackles are associated with left-sided HF
• In right-sided HF, congestion of GI veins leads to reduced appetite, nausea, and GI discomfort
• Nursing interventions for a client presenting with fatigue, orthopnea, and frothy sputum:
  • Place the client in High Fowler's position
  • Assess oxygen saturation and lung sounds
  • Administer a prescribed diuretic
  • Restrict fluid intake
• These interventions reduce preload, improve oxygenation, and address fluid overload
• Orthopnea caused by pulmonary congestion that worsens when lying flat is a classic left-sided HF symptom caused
• When lying down, fluid previously pooled in the legs returns to circulation. It is then excreted by the kidneys, causing nocturia
• Ankle edema, hepatomegaly, and jugular vein distention are signs of right-sided HF, suggesting progression
• Crackles and S3 gallop are linked to left-sided failure

Acute vs. Chronic HF, Compensatory Mechanisms, & Management

• Acute HF develops rapidly and can result in life-threatening conditions like cardiogenic shock or sudden cardiac arrest
• Chronic HF presents with slowly worsening symptoms like exercise intolerance and fatigue
• Compensatory processes the body uses to try to maintain cardiac output in the face of heart failure:
  • Activation of sympathetic nervous system
  • Ventricular dilation
  • Myocardial hypertrophy
  • Renin-angiotensin-aldosterone system activation
• SNS activation releases norepinephrine to increase HR and contractility, aiming to improve cardiac output
• Ventricular hypertrophy is initially beneficial, but over time, it decreases compliance and contributes to worsening HF
• Pulmonary congestion and decreased perfusion indicate that compensation has failed to maintain adequate cardiac output
• Decreased peripheral edema indicates the effectiveness of taking diuretics, which reduce fluid overload
• ACE inhibitors, beta-blockers, ARBs, and vasodilators, such as nitroglycerin, reduce afterload
• Loop diuretics primarily reduce preload
• Monitor for bradycardia and hold if HR < 60 bpm before administering Digoxin
• Important findings indicating effective HF management are weight loss of 1 kg over 2 days, serum sodium of 136 mEq/L, decreased peripheral edema, and stable blood pressure and HR
• Lung crackles suggest unresolved pulmonary congestion

Nursing Interventions, Patient Education & Evaluation

• High Fowler's improves lung expansion and reduces venous return (preload), helping with dyspnea and oxygenation
• High Fowler's position is used in an acute episode of HF
• Morphine reduces anxiety and oxygen demand, both helpful in managing acute HF with respiratory distress
• Instructions to include when teaching a client about daily weights:
  • Weigh client at the same time every morning
  • Use the same scale each day
  • Wear similar clothing each time
  • Report a gain of 2–3 lbs in 24 hours
• For a client with HF experiencing 2+ pitting edema, SOB, and crackles, fluid volume excess is the priority
• Dietary modifications appropriate for a client with moderate heart failure include limiting sodium to 2g/day, avoiding canned and processed foods, and eating small, frequent meals
• Compression stockings reduce the risk of venous stasis and DVT during periods of immobility
• Heart Failure discharge education includes:
  • Activity guidelines
  • Diet and daily weights
  • Medication adherence
  • Warning signs
• Valsalva maneuver during straining can reduce cardiac output and provoke dysrhythmias in HF patients
• Findings reflecting reduced fluid overload and improved cardiac function, or positive treatment outcomes:
  • Decreased peripheral edema
  • Weight loss of 1.5 kg over 2 days
  • Improved energy levels
  • Decreased nocturnal dyspnea
• Sudden weight gain is a key sign of fluid retention, and clients should know to report this promptly. This statement suggests effective understanding of self-management with heart failure