Heart Failure Exam Questions With 100% Verified Solutions

Heart Failure Exam Questions With 100% Verified Solutions What imaging assessments are used for HF - ANSWER- A) Chest x-rays →Useful in diagnosing left ventricular failure because the heart will be enlarged *B) Echocardiogram* →Considered the best tool for diagnosing heart failure →Can be used to diagnose valvular changes, pericardial effusion, chamber enlargement, ventricular hypertrophy, and to determine ejection fraction *What are the priority problems for pt with heart failure?* - ANSWER- 1. Impaired gas exchange 2. Decreased cardiac output 3. Fatigue/weakness 4. Potential for pulmonary edema Nursing interventions to improve gas exchange - ANSWER- -Pt may need ventilation assistance -Monitor respiratory rate, rhythm, and quality q1-4 hours -Auscultate breath sounds q4-8 hours -Maintain O2 saturation at 90% or higher. *-If pt has dyspnea, place pt in fowlers position w/pillows under each arm* *→Reposition and perform cough and deep breathing exercises q2hr* When focusing on improving cardiac output, the goal is: - ANSWER- To have increased cardiac output by improving stroke volume, and heart rate. Types of interventions to improve cardiac output are classified as____ and ____ - ANSWER- Nonsurgical Surgical Nonsurgical interventions to improve cardiac output generally rely on ___ measures, and their goal is to: - ANSWER- -Pharmacological -To improve stroke volume by reducing after load, reducing preload, and improve cardiac muscle contractility Medications that reduce afterload - ANSWER- -These medications are arterial vasodilators that will will relax the arterioles, effectively reducing the resistance to left ventricular ejection (aka afterload) -ACE inhibitors and ARBs *→One or the other is always given, however ACE inhibitors are usually the first choice* -Human B-type Natriuretic Peptides ACE inhibitors - ANSWER- -These meds prevent the conversion of angiotensin I to angiotensin II, thus decreasing the release of aldosterone -They increase kinin levels, so they have a favorable effect on cardiac remodeling Causes: a) *Arteriolar dilation* which will reduce afterload, increases stroke volume and cardiac output →Improves blood flow in the kidney, which will promote excretion of Na and water b) *Venous dilation* which will reduce venous pressure. This will reduce pulmonary congestion, peripheral edema, preload, and cardiac dilation c) *Supression of aldosterone release* increases the release of Na and water, while retaining K≈ Examples of ACE inhibitors - ANSWER- *They end in "-pril"* -Lisinopril/Zestril, Prinivil -Enalapril/Vasotec Captopril/Capoten -Quinapril/Accupril Adverse effects of ACE inhibitors - ANSWER- -Hypotension -Hyperkalemia -Nagging, dry cough -Angioedema Nursing considerations for ACE inhibitors and ARBs - ANSWER- -Can be used alone in treatment of heart failure, but they are usually given in combination with a beta blocker and a diuretic *-If cough develops bc of ACE, medication should be discontinued and pt should be started on ARB* -Teach pt to move slowly when changing positions -Caution to pt taking K supplements or K sparing diuretics *-Should not be given to pt with systolic BP 100* -Caution to pt w/Na level 135 ARBs - ANSWER- -Effects are similar to those of ACE inhibitors -Main clinical difference is that ARBs do not increase levels of kinins, so their effects on cardiac remodeling are less favorable than ACE *-ARBs are usually used when pt is intolerant of ACE inhibitors (usually noted by the cough)* Examples of ARBs - ANSWER- *They end in "-sartan"* -Losartan/Cozaar -Candesartan/Atacand -Valsartan/Diovan Nursing interventions for pt who is taking ACE inhibitors or ARBs - ANSWER- -Assess for hyperkalemia, orthostatic hypotension, acute confusion, poor peripheral perfusion, and reduced urine output -Monitor serum K, and creatinine levels to determine renal dysfunction -Monitor BP q1hr for several hours after the initial dose and each time the dose is increased *→Immediately report systolic BP 90* *→→If this occurs, place pt flat to increase cerebral perfusion* When are interventions to reduce preload appropriate? - ANSWER- Appropriate when HF is accompanied by congestion with total body Na and water overload Interventions to reduce preload - ANSWER- A)*Nutrition Therapy* →Na intake restriction →Eliminate table salt, ham, bacon, pickles from diet →Avoid milk and milk products, and use a few canned or prepared foods as possible B) Weigh pt daily, using same scale every morning before breakfast C) *Drug Therapy* →Diuretics →*Morphine sulfate is given to pt w/acute HF to reduce anxiety, decrease preload and afterload, slow respirations, and reduce pain associated w/MI* →Nitrates Diuretics considerations - ANSWER- -Added when diet and fluid restrictions have not been effective in managing HF symptoms -First line drug of choice in older adults with HF and fluid overload -Loop, thiazide, and k sparing are used depending on severity Diuretic teaching points - ANSWER- -Encourage to take them in the morning -Get weight each morning at the same time. Loop diuretic considerations - ANSWER- -Older pt are at increased risk of dehydration, monitor for: →Acute confusion →Decreased Urine →Dizziness -They will be at risk for falls