AACN Notes For PCCN Exam Questions With Accurate
Answers.
Cardiac output equation - accurate answers-CO = HR x SV
Stroke volume equation - accurate answers-end diastolic volume - end systolic
volume
also = preload + afterload + contractility
Mechanism of failure: initial adaptation to low CO - accurate answers-drop in
CO-->drop in EF-->increased EDV (end-diastolic volume)-->fiber stretch--
>increased contractility-->activation of neurohormonal system
activation of neurohormonal system in HF - accurate answers-adrenergic
system
renin-angiotensin-aldosterone system (RAAS)
hypothalamic-neurohypophyseal system
endothelium activated mediators
influence of activation of neurohormonal system in HF - accurate answers-
Goal: increased CO and BP
increased HR and contractility-->vasoconstriction--?Na and H2o retention
progressive HF mechanism of failure - accurate answers-1. continued
activation of sympathetic nervous system (SNS) and RAAS-->increased
afterload
2. release of atrial natriuretic peptide (ANP) and brain natriuretic peptide
(BNP)
3. release of cytokines
4. cardiac hypertrophy and remodeling
5. reflex response of baroreceptors and stretch receptors
6. increased demand and decreased function-->increased progressive failure
hepatojugular reflux (HJR) - accurate answers-used to test fluid retention:
(JVD >3cm) when pressing liver
S4 - accurate answers-the resistance of filling
,paroxysmal nocturnal dyspnea (PND) - accurate answers-pulmonary s/s of HF
classifications of HF - accurate answers-1. systolic vs. diastolic
2. R vs. L
3. high-output vs. low-output
4. compensated vs. decompensated
the primary cause of RHF: - accurate answers-LHF
HFrEF - accurate answers-EF<=40%
HFpEF - accurate answers-ef>=50%
the only class of meds to treat cause of coronary artery disease: - accurate
answers-statins
Diuretics for HF management - accurate answers--Aldosterone antagonist
(AKA potassium-sparing)
-thiazide
-loop
vasodilators for HF management - accurate answers--ACE inhibitors
(angiotensin-converting enzyme)-->reducing vasoconstriction-->helps to
dilate the vessels
-ARBs (angiotensin-receptor blockers)-->reducing vasoconstriction-->helps to
dilate the vessels
-hydralazine: often recommended for African American patients
-nitroglycerin (NTG): sometimes for decompensated HF
-CCB: for dysthymias, but not recommended as standard therapies for HF
patients, because they further decrease contractility. normally used for HR
although it can decrease BP as well
-ARNI: new; promotes increased levels of BNP, which promotes diuresis and
dilation.
positive inotropes: reserved for decompensated HF - accurate answers-they
don't improve heart functions, or length of life
-digoxin:
-dobutamine:
, -milrinone: not specifically listed under PCCN test guideline, but dobutamine
is
negative inotropes: - accurate answers--beta-blockers: works best to stop the
compensatory negative spiral, and reduce the activation of the SNS
maintaining BP is important as long as patient can tolerate beta- blockers
dose (as high as possible)
decrease demands for HF management: three ways - accurate answers-1.
intraaortic balloon pump (IABP)
2. impella
3. ventricular assist device (VAD)
decrease ectopy or maintain electrical stability for HF patients - accurate
answers--approximately half of HF deaths that occur outside the hospital are
from dysrhythmia
-oral antidysrhythmic agents
-pacemakers
-implantable cardioverter defibrillator (ICD): for dilated cardiac myopathy if
EF <35% after 3 months on optimal medical therapy
goal of HF therapy - accurate answers-1. cardiac transplantation: only cure for
HF
2. focus on quality of life
cardiomyopathy - accurate answers-1. dilated: most common type; causes
in/c ischemia such as MI, alcohol, postpartum myopathy, viruses, myocarditis,
stress induced dilated cardiomyopathy (takotsubo cardiomyopathy--the only
one that can heel in time)
2. hypertrophic: only thick inside the heart; familiar with genetic issues
3. septal hypertrophy: septum can become a large part of the heart--?obstruct
the outflow of the ventricles, especially if the patient becomes dehydrated (e.g.
young athletes)
4. restrictive: the heart becomes tight; it can't relax to fill well; can be caused
by connective tissue diseases (e.g. amyloid)
dilated cardiomyopathy can go into what dysrhythmia? - accurate answers-
atrial fibrillation;
need to prevent thromboembolic events
Answers.
Cardiac output equation - accurate answers-CO = HR x SV
Stroke volume equation - accurate answers-end diastolic volume - end systolic
volume
also = preload + afterload + contractility
Mechanism of failure: initial adaptation to low CO - accurate answers-drop in
CO-->drop in EF-->increased EDV (end-diastolic volume)-->fiber stretch--
>increased contractility-->activation of neurohormonal system
activation of neurohormonal system in HF - accurate answers-adrenergic
system
renin-angiotensin-aldosterone system (RAAS)
hypothalamic-neurohypophyseal system
endothelium activated mediators
influence of activation of neurohormonal system in HF - accurate answers-
Goal: increased CO and BP
increased HR and contractility-->vasoconstriction--?Na and H2o retention
progressive HF mechanism of failure - accurate answers-1. continued
activation of sympathetic nervous system (SNS) and RAAS-->increased
afterload
2. release of atrial natriuretic peptide (ANP) and brain natriuretic peptide
(BNP)
3. release of cytokines
4. cardiac hypertrophy and remodeling
5. reflex response of baroreceptors and stretch receptors
6. increased demand and decreased function-->increased progressive failure
hepatojugular reflux (HJR) - accurate answers-used to test fluid retention:
(JVD >3cm) when pressing liver
S4 - accurate answers-the resistance of filling
,paroxysmal nocturnal dyspnea (PND) - accurate answers-pulmonary s/s of HF
classifications of HF - accurate answers-1. systolic vs. diastolic
2. R vs. L
3. high-output vs. low-output
4. compensated vs. decompensated
the primary cause of RHF: - accurate answers-LHF
HFrEF - accurate answers-EF<=40%
HFpEF - accurate answers-ef>=50%
the only class of meds to treat cause of coronary artery disease: - accurate
answers-statins
Diuretics for HF management - accurate answers--Aldosterone antagonist
(AKA potassium-sparing)
-thiazide
-loop
vasodilators for HF management - accurate answers--ACE inhibitors
(angiotensin-converting enzyme)-->reducing vasoconstriction-->helps to
dilate the vessels
-ARBs (angiotensin-receptor blockers)-->reducing vasoconstriction-->helps to
dilate the vessels
-hydralazine: often recommended for African American patients
-nitroglycerin (NTG): sometimes for decompensated HF
-CCB: for dysthymias, but not recommended as standard therapies for HF
patients, because they further decrease contractility. normally used for HR
although it can decrease BP as well
-ARNI: new; promotes increased levels of BNP, which promotes diuresis and
dilation.
positive inotropes: reserved for decompensated HF - accurate answers-they
don't improve heart functions, or length of life
-digoxin:
-dobutamine:
, -milrinone: not specifically listed under PCCN test guideline, but dobutamine
is
negative inotropes: - accurate answers--beta-blockers: works best to stop the
compensatory negative spiral, and reduce the activation of the SNS
maintaining BP is important as long as patient can tolerate beta- blockers
dose (as high as possible)
decrease demands for HF management: three ways - accurate answers-1.
intraaortic balloon pump (IABP)
2. impella
3. ventricular assist device (VAD)
decrease ectopy or maintain electrical stability for HF patients - accurate
answers--approximately half of HF deaths that occur outside the hospital are
from dysrhythmia
-oral antidysrhythmic agents
-pacemakers
-implantable cardioverter defibrillator (ICD): for dilated cardiac myopathy if
EF <35% after 3 months on optimal medical therapy
goal of HF therapy - accurate answers-1. cardiac transplantation: only cure for
HF
2. focus on quality of life
cardiomyopathy - accurate answers-1. dilated: most common type; causes
in/c ischemia such as MI, alcohol, postpartum myopathy, viruses, myocarditis,
stress induced dilated cardiomyopathy (takotsubo cardiomyopathy--the only
one that can heel in time)
2. hypertrophic: only thick inside the heart; familiar with genetic issues
3. septal hypertrophy: septum can become a large part of the heart--?obstruct
the outflow of the ventricles, especially if the patient becomes dehydrated (e.g.
young athletes)
4. restrictive: the heart becomes tight; it can't relax to fill well; can be caused
by connective tissue diseases (e.g. amyloid)
dilated cardiomyopathy can go into what dysrhythmia? - accurate answers-
atrial fibrillation;
need to prevent thromboembolic events
