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PN2 Exam 2 study guide
Chapter 25
Heart Failure and Inflammatory Dysfunction
Terms:
Hypertrophy – abnormal enlargement; increase in size and mass of a body part or organ.
Contractility – capability of muscle fibers to shrink
Cardiomyopathy – heart muscle disease
Carditis – inflammation of heart muscle
Prophylactic – preventing or contributing to prevention of disease
Idiopathic – disease state that arises from unknown cause
Endocarditis – inflammation of endocardium (inner heart muscle layer)
Myocarditis – inflammation of myocardium (middle heart muscle layer)
Pericarditis – inflammation of pericardium (thin membrane surrounding whole heart)
Inner to outermost – Endo myo pericardium
Myectomy – removal of offending muscle
Sequla – any abnormality resulting from disease
Valvular regurgitation –backward flow of blood through heart valve
Valvular stenosis – narrowing or constricting of the diameter of a bodily passage or orifice
Petechiae – small pin point hemorrhages
Valvuloplasty –plastic surgery performed to repair a valve in
body Mitral facies – florid appearance with cyanosed cheeks
Heart Failure – when the heart cannot pump enough blood effectively throughout the body.
Two categories – systolic & diastolic.
Systolic – inability of ventricles to contract and pump blood adequate. Diastolic-
decrease in ventricular filling and impaired diastolic filling of left ventricle. Both
lead to decreased amount of blood being circulated to the body.
Most common in 40-75 yo males. Affects both genders equally after 75 yo
Assessment & findings – health history and physical exam focusing on cardio
and
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pulmonary system. Hh findings - patient needing increased number of pillows to sleep,
paroxysmal nocturnal dyspnea (wake up at night from shortness of breath d/t fluid in lungs), ask
about shortness of breath and what makes symptoms worse and better?, ask about coping and
family dynamics. Assessment findings – possible increase in bp and rapid hr, auscultated s3,
decreased level of consciousness, extremities cool, pale, cyanotic, edema and poor healing
wounds. R sided HF: swelling of feet and ankles, frequent nocturnal urination, pronounced neck
veins, palpitations, irregular or rapid hr, fatigue, weakness, faintness, palpable dysrhythmias,
weight gain, distended neck vein, enlarged liver, ankle edema. L sided HF: sob, paroxysmal
nocturnal dyspnea, palpitations, tachycardia, cough with frothy blood tinged mucus, fatigue,
weakness, syncope, weight gain, oliguria, fluid retention, heart murmur, extra heart sounds,
dysrhythmic heart rate, lung crackles, decreased basilar lung sounds.
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Diagnostic tests – ECG, chest xray, stress tests (exercise test), cbc, Potassium, sodium
and calcium imbalances, fluids and electrolyte levels, cardiac catheterization to see degree of
HF, MRI
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, anxiety
Interventions – control volume overload by monitoring sodium and fluid intake, restrict
salt intake and fluids if needed, rx: morphine, diuretics, respiratory support: oxygen in
nonrebreather mas, PEEP intubation and mechanical ventilation, monitor oxygen and ABGs,
position patient for maximum cardio function (dangle legs and elevate head of bed, reassure
patient to reduce anxiety and extra workload on heart. Nurse needs to motivate pt toward healthy
behaviors by reflective listening, expressing acceptance and affirmation, monitor pt readiness to
change, ensure not jumping ahead of pt.
Rx- ACE inhibitors to decrease the pressure of the heart (captopril, enalapril),
ARBs reduce pressure and work overload (bisoprolol, carvedilol), vasodilators,
nitrates, beta blockers, diuretics (furosemide, torsemide), hormones, digitalis, and
aspirin.
Surgery for severe heart failure – heart valve replacement, implant of cardiac
defibrillator, coronary artery bypass grafting. Done under general anesthesia.
Dilated cardiomyopathy – heart muscle results in dilated heart chamber. Leads to weakened,
thin heart muscle wall that is unable to pump blood efficiently throughout body causing HF.
Assessment findings – monitor pt for sob, tiredness, palpitations, syncope, chest pain.
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, pain.
Interventions – assess pt family and support, anxiety and depression.
Rx- ace inhibitors, beta blockers, diuretics, anticoagulants, antiarrhythmics.
Surgery – cardioversion, heart transplantation, pacemaker, implant defibrillator.
Hypertrophic cardiomyopathy – increase in size and thickness of heart muscle. Genetic and/or
idiopathic.
Assessment findings – sob, chest pain, palpitations, light headedness, black outs, physical
exam reveals palpable forceful apical pulse and heart murmur. Abnormal ECG
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, pain
Interventions – educate pt about physical activity recommendations, weight reduction for
obese pt, moderate alcohol intake, flu vaccine recommended. Avoid overexertion, acute loss of
body fluid volume, fainting situations, hot showers, rx that drop bp quick. Report sudden loss of
consciousness, rapid palpitation, chest pain, sob.
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Rx – calcium channel blockers to reduce stiffness of myocardium. Receive
antibiotic prophylaxis before dental procedure.
Surgery – myectomy (removing muscle), heart transplantation.
Arrhythmogenic right ventricular cardiomyopathy – disease where heart muscle is replaced
by fibrous scar and fatty tissue. Genetic link.
Assessment – palpitations, light headedness, fatigue, fainting, syncope. ECG test.
Interventions – lifestyle advice, refrain from over exertion, and activities that increase
heart work overload, encourage and educate obese pt in weight loss, moderate alcohol intake, flu
vaccine. Report symptoms of palpitations, chest pain, changes in consciousness, sob.
PN2 Exam 2 study guide
Chapter 25
Heart Failure and Inflammatory Dysfunction
Terms:
Hypertrophy – abnormal enlargement; increase in size and mass of a body part or organ.
Contractility – capability of muscle fibers to shrink
Cardiomyopathy – heart muscle disease
Carditis – inflammation of heart muscle
Prophylactic – preventing or contributing to prevention of disease
Idiopathic – disease state that arises from unknown cause
Endocarditis – inflammation of endocardium (inner heart muscle layer)
Myocarditis – inflammation of myocardium (middle heart muscle layer)
Pericarditis – inflammation of pericardium (thin membrane surrounding whole heart)
Inner to outermost – Endo myo pericardium
Myectomy – removal of offending muscle
Sequla – any abnormality resulting from disease
Valvular regurgitation –backward flow of blood through heart valve
Valvular stenosis – narrowing or constricting of the diameter of a bodily passage or orifice
Petechiae – small pin point hemorrhages
Valvuloplasty –plastic surgery performed to repair a valve in
body Mitral facies – florid appearance with cyanosed cheeks
Heart Failure – when the heart cannot pump enough blood effectively throughout the body.
Two categories – systolic & diastolic.
Systolic – inability of ventricles to contract and pump blood adequate. Diastolic-
decrease in ventricular filling and impaired diastolic filling of left ventricle. Both
lead to decreased amount of blood being circulated to the body.
Most common in 40-75 yo males. Affects both genders equally after 75 yo
Assessment & findings – health history and physical exam focusing on cardio
and
, 1
pulmonary system. Hh findings - patient needing increased number of pillows to sleep,
paroxysmal nocturnal dyspnea (wake up at night from shortness of breath d/t fluid in lungs), ask
about shortness of breath and what makes symptoms worse and better?, ask about coping and
family dynamics. Assessment findings – possible increase in bp and rapid hr, auscultated s3,
decreased level of consciousness, extremities cool, pale, cyanotic, edema and poor healing
wounds. R sided HF: swelling of feet and ankles, frequent nocturnal urination, pronounced neck
veins, palpitations, irregular or rapid hr, fatigue, weakness, faintness, palpable dysrhythmias,
weight gain, distended neck vein, enlarged liver, ankle edema. L sided HF: sob, paroxysmal
nocturnal dyspnea, palpitations, tachycardia, cough with frothy blood tinged mucus, fatigue,
weakness, syncope, weight gain, oliguria, fluid retention, heart murmur, extra heart sounds,
dysrhythmic heart rate, lung crackles, decreased basilar lung sounds.
, 1
Diagnostic tests – ECG, chest xray, stress tests (exercise test), cbc, Potassium, sodium
and calcium imbalances, fluids and electrolyte levels, cardiac catheterization to see degree of
HF, MRI
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, anxiety
Interventions – control volume overload by monitoring sodium and fluid intake, restrict
salt intake and fluids if needed, rx: morphine, diuretics, respiratory support: oxygen in
nonrebreather mas, PEEP intubation and mechanical ventilation, monitor oxygen and ABGs,
position patient for maximum cardio function (dangle legs and elevate head of bed, reassure
patient to reduce anxiety and extra workload on heart. Nurse needs to motivate pt toward healthy
behaviors by reflective listening, expressing acceptance and affirmation, monitor pt readiness to
change, ensure not jumping ahead of pt.
Rx- ACE inhibitors to decrease the pressure of the heart (captopril, enalapril),
ARBs reduce pressure and work overload (bisoprolol, carvedilol), vasodilators,
nitrates, beta blockers, diuretics (furosemide, torsemide), hormones, digitalis, and
aspirin.
Surgery for severe heart failure – heart valve replacement, implant of cardiac
defibrillator, coronary artery bypass grafting. Done under general anesthesia.
Dilated cardiomyopathy – heart muscle results in dilated heart chamber. Leads to weakened,
thin heart muscle wall that is unable to pump blood efficiently throughout body causing HF.
Assessment findings – monitor pt for sob, tiredness, palpitations, syncope, chest pain.
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, pain.
Interventions – assess pt family and support, anxiety and depression.
Rx- ace inhibitors, beta blockers, diuretics, anticoagulants, antiarrhythmics.
Surgery – cardioversion, heart transplantation, pacemaker, implant defibrillator.
Hypertrophic cardiomyopathy – increase in size and thickness of heart muscle. Genetic and/or
idiopathic.
Assessment findings – sob, chest pain, palpitations, light headedness, black outs, physical
exam reveals palpable forceful apical pulse and heart murmur. Abnormal ECG
Nursing diagnosis – activity intolerance, risk for ineffective breathing pattern, pain
Interventions – educate pt about physical activity recommendations, weight reduction for
obese pt, moderate alcohol intake, flu vaccine recommended. Avoid overexertion, acute loss of
body fluid volume, fainting situations, hot showers, rx that drop bp quick. Report sudden loss of
consciousness, rapid palpitation, chest pain, sob.
, 1
Rx – calcium channel blockers to reduce stiffness of myocardium. Receive
antibiotic prophylaxis before dental procedure.
Surgery – myectomy (removing muscle), heart transplantation.
Arrhythmogenic right ventricular cardiomyopathy – disease where heart muscle is replaced
by fibrous scar and fatty tissue. Genetic link.
Assessment – palpitations, light headedness, fatigue, fainting, syncope. ECG test.
Interventions – lifestyle advice, refrain from over exertion, and activities that increase
heart work overload, encourage and educate obese pt in weight loss, moderate alcohol intake, flu
vaccine. Report symptoms of palpitations, chest pain, changes in consciousness, sob.
