Heart Failure Insights from ATI Flashcards

Heart Failure Overview

• Heart failure is a complex clinical syndrome leading to inadequate blood supply and oxygen to tissues.
• Results in decreased cardiac output and tissue perfusion.

Types of Heart Failure

• HFREF (Heart Failure with Reduced Ejection Fraction): Involves a defect in ventricular systolic function, indicating poor left ventricle (LV) contraction.
• HFPEF (Heart Failure with Preserved Ejection Fraction): Involves a defect in ventricular diastolic function, affecting filling; primarily caused by hypertension.

Left vs Right Sided Heart Failure

• Left Sided Heart Failure: Most common form; results in inability of LV to empty or fill adequately, causing blood to back up into the left atrium.
• Right Sided Heart Failure: Ineffective RV pumping leads to fluid backing up into the venous system and tissues; often secondary to left-sided heart failure or conditions like RV infarction and pulmonary problems.

Acute Decompensated Heart Failure

• Characterized by worsening symptoms requiring rapid escalation of therapy.
• Early signs include increased pulmonary venous pressure and mild respiratory rate increase; later signs include interstitial and alveolar edema.

Heart Failure Classifications

• NYHA functional classification ranges from Class I (no manifestations with activity) to Class IV (manifestations at rest) to gauge severity.
• ACC/AHA stages categorize patients based on structural heart disease presence, ranging from high risk (Stage A) to refractory end-stage heart failure (Stage D).

Risk Factors

• Left-sided failure: hypertension, coronary artery disease, valvular disease.
• Right-sided failure: left-sided failure, RV infarction, pulmonary issues.
• High-output failure linked to increased metabolic needs, infections, anemia, and hyperthyroidism.
• Cardiomyopathy risk factors include coronary artery disease and prolonged alcohol use.

Expected Findings

• Left-sided failure: Symptoms like dyspnea, orthopnea, pulmonary congestion, fatigue, and altered mental status.
• Right-sided failure: Symptoms include jugular vein distention, peripheral edema, and ascites.

Cardiomyopathy

• Four types: dilated (most common), hypertrophic, arrhythmogenic right ventricular, restrictive.
• Manifestations include fatigue, heart failure signs, dysrhythmias, and cardiomegaly.

Laboratory Tests

• Elevated Human B-type natriuretic peptides (hBNP) help diagnose heart failure versus respiratory issues; levels guide treatment intensity.
• Hemodynamic monitoring typically shows increased pressures and decreased cardiac output.

Diagnostic Procedures

• Echocardiograms assess heart function and ejection fractions.
• Chest x-ray reveals cardiomegaly and fluid accumulation.

Nursing Care

• Daily monitoring of weight and intake/output; assess for shortness of breath, administer oxygen as needed.
• Educate clients about diet restrictions, particularly sodium and fluid intake.

Medications

• Diuretics: Reduce preload; monitor for hypokalemia and administer potassium if needed.
• Afterload-reducing agents: ACE inhibitors (enalapril), ARBs (losartan); important nursing considerations include monitoring blood pressure and potassium levels.
• Inotropic agents: Increase contractility; monitor for signs of digoxin toxicity.
• Beta Blockers: Useful for chronic heart failure; involve daily blood pressure monitoring and weight checks.
• Vasodilators: Effective for controlling blood pressure; cause orthostatic hypotension.
• Anticoagulants: Prescribed for clients with a history of thrombus; monitor bleeding times.

Advanced Therapies

• Ventricular Assist Device (VAD): Supports severely compromised heart function; used while awaiting transplant.
• Heart transplantation: Treatment of choice for severe dilated cardiomyopathy; requires postoperative immunosuppressant therapy.### Transplant Eligibility Factors
• Transplant eligibility considers life expectancy, age, psychosocial status, and absence of substance use disorders.

Heart Transplantation Nursing Actions

• Prepare client for the procedure: maintain NPO status and obtain informed consent.
• Monitor vital signs, SaO2, incision drainage, and manage pain postoperatively.
• Watch for complications such as infection, thrombosis, and organ rejection in transplant recipients.

Heart Transplantation Client Education

• Take diuretics in the early morning and afternoon to manage fluid balance.
• Follow fluid and sodium restriction as per medical instructions.
• Regulate potassium intake to prevent imbalances.
• Consult a dietitian for menu planning.
• Weigh daily and notify the provider if weight gain exceeds 2 lbs in 24 hours or 5 lbs in a week.
• Schedule regular follow-up visits with healthcare providers.
• Obtain pneumococcal and yearly influenza vaccines to prevent infections.

Complications: Acute Pulmonary Edema

• Acute pulmonary edema is a life-threatening emergency requiring immediate intervention.
• Key interventions include diuresis to monitor fluid output, alleviate respiratory distress, improve lung sounds, and ensure adequate oxygenation.

Acute Pulmonary Edema Expected Findings

• Symptoms include anxiety, tachycardia, acute respiratory distress, dyspnea at rest, altered consciousness, and ascending fluid levels in lungs evidenced by crackles and frothy, blood-tinged sputum.

Acute Pulmonary Edema Nursing Actions

• Position client in high-Fowler's position to enhance breathing.
• Administer oxygen and consider positive airway pressure, intubation, and mechanical ventilation as necessary.
• Provide IV morphine to reduce anxiety and respirational distress, and decrease venous return.
• Administer rapid-acting loop diuretics, such as furosemide, via IV for fluid management.
• Give prescribed medications to improve cardiac output.
• Educate clients on techniques to balance activity and rest to improve tolerance to daily activities.

This quiz covers essential concepts related to heart failure, as outlined in PowerPoint presentations and ATI flashcards. Test your understanding of definitions, implications of decreased cardiac output, and the importance of ejection fraction. Perfect for nursing students and those studying cardiovascular health.