NUR 2502 Exam 3 Focused Review (Chapters 34, 35, 36, 38, 39, 40)

NUR 2502 Exam 3 Focused Review (Chapters 34, 35, 36, 38, 39, 40) ● Heart failure o causes ▪ A common chronic health problem with acute episodes often causing hospitalization. Acute coronary disease and other structural or functional problems of the heart can lead to acute HF. ▪ Caused by systemic HTN in most cases ▪ Common causes and Risk factors for HF: ● HTN, coronary artery disease, cardiomyopathy, substance abuse, valvular disease, congenital defects, cardiac infections and inflammations, dysrhythmias, DM, smoking/tobacco use, family history, obesity, severe lung disease, sleep apnea, hyperkinetic conditions (hyperthyroidism) o left vs right ▪ Left sided heart (ventricular) failure includes HTN, coronary artery disease, and valvular disease. Decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels indicate left ventricular failure ● Formerly referred to as congestive HF; not all cases of LVF involve fluid accumulation ● May be acute or chronic and mild to severe. ● Two types: o Systolic: heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation o Diastolic: left ventricle cannot relax adequately during diastole- ventricle can not fill with sufficient blood to ensure an adequate cardiac output ▪ Right sided heart (ventricular) failure may be caused by left ventricular failure, right ventricular MI, or pulmonary HTN (cor pulmonale). The right ventricle cannot empty completely. Increased volume and pressure develop in the venous system and peripheral edema results. o diagnosis ▪ Labs: ● Electrolytes - may occur from complications or diuretics ● Hgb and HCT - identify HF resulting from anemia ● BNP - used when dyspnea to r/o HF ● U/A - proteinuria/high specific gravity ● ABGs- respiratory acidosis ▪ B-type natriuretic peptide (BNP) ● is used for diagnosing HF (in particular, diastolic HF), in patients with acute dyspnea ▪ Microalbuminuria ● An early indicator of decreased compliance of the heart and occurs before the BNP rises ▪ CXR ● “early warning detector” that lets HCP know that the heart is experiencing early signs of decreased compliance long before symptoms occur ● Helpful in diagnosing left ventricular failure because the heart is enlarged, representing hypertrophy or dilation