Jenna Cohen Exam 1 Study Guide Congestive Heart Failure major diagnosis that brings people into the hospital enlarged heart with heart failure decompensated very symptomatic compensated no symptoms Cardiac and Peripheral Perfusion Structural Functional Mechanical and Electrical Conduction o Decreased Cardiac Output or perfusion that the person is getting Congestive Heart Failure Cardiomyopathy Valvular Disease Cardiogenic Shock Congenital Defects Atrial Septal Defect ASD Ventricular Septal Defect VSD Coarctation of the Aorta Tetralogy of Fallot CHF Physiology Concept Perfusion Inadequate levels of oxygen in the blood from complications of pumping action of the heart loss or dysfunction of the cardiac muscle not carrying as much O2 to the body when heart not pumping effectively Etiology o Hypertension coronary artery disease and dilated cardiomyopathies having a heart attack can lead to a CHF a lot of time renal problems r t CHF cardiomyopathies care for CHF is pretty much the same Physiology CHF Stroke Volume volume of blood ejected with each ventricular contraction X Heart Rate amount of volume the Cardiac Output CO volume of blood heart pumps each minute blood pumping out with each contraction stroke volume when someone has decreased co that is saying the HR is really slow if the pumping of the heart is normal that is good perfusion if hr fast the perfusion co is really low high heart rate or low hear rate will impact cardiac output Preload o Stretch of the ventricular myocardial fibers at the end of diastole before ventricular contraction end of ventricular contraction o Refer to volume of blood in venous system o High Preload fluid in lungs ascites edema too much fluid on board Afterload o Force that the left ventricle must develop during systole in order to eject the stroke volume the blood into the circulation o Afterload is increased by hypertension pulmonary or aortic stenosis peripheral vascular resistance if vessels are constricted heart works harder htn more pressure heart trying to work against arteries if narrowed and resistance has to work harder more fluid the heart has to work harder more volume to pump not enough fluid works harder hypovolemia HR goes up o High Afterload Heart has to work harder to get blood to body and vital organs Physiology CHF Impaired Pumping Ability Decrease in Oxygen Delivered Left sided Heart Failure o Blood backs into L atrium and pulmonary circulation left lungs blood is backed up into pulmonary circulation lungs symptoms assessments listen to lung sounds cyanosis if no oxygenation shortness of breath O2 sat respiratory rate all about the lungs all about how you assess oxygenation Right sided Heart Failure edema edema can go to the periphery abdomen jugular vein distention extra fluid everywhere except lungs bounding pulses too much fluid looking at color of extremities r rest of the body having trouble coming back up assess for o Blood backs into R Atrium and systemic venous circulation Biventricular Failure Combined Failure with severe CHF you can have r and l sided heart failure would see both sets of sx Left sided Heart Failure Lungs o Increased RR dyspnea orthopnea and nocturnal o Increased pulse palpitations o Increased adventitious lung sounds crackles and audible wheezing o Increased cough often hacky pink tinged sputum leads to pulmonary edema classic sign of pulmonary edema we don t want anyone to get this may have normal cough and hacking bc of extra fluid pink is what we pay attention to o Decreased O2 sats decreased activity intolerance Rest of body Right sided Heart Failure o Increased weight gain o Increased edema of lower extremities o Increased hepatomegaly o Increased distended neck veins o Increased ascites N V o Increased nocturia Ausculation of S3 Confusion with elderly often with heart failure s3 heart failure 3 syllables s4 htn 4 syllables everything is going up with elderly they may have confusion going on may have other sx but might not just be themselves Assessment Potential Complication Pulmonary Edema Life Threatening an emergency recognize as Assessments o Increased anxiety early sign can t sit still super anxious o Increased RR RESPIRATORY DISTRESS decreased O2 sat o Increased pulse palpitations o Increased adventitious lung sounds crackles and audible wheezing o Increased cough with frothy pink tinged sputum Interventions o Position High Fowlers o Give O2 may need intubation o Notify HCP STAT o IV Morphine helps relax them and decreases the preload in the heart morphine is for pain but it calms down the heart and settles them down has vasodilating properties increases o2 to the heart o IV Lasix need Lasix to take the fluid out Analysis Concepts for CHF Perfusion cardiac and peripheral Oxygenation Fluid Volume Balance Excess the edema extra fluid in lungs if kidney problem renal perfusion down so fluid being held onto lots of lifestyle changes same as htn Health Promotion Risk for o Infection fluid in lungs have a medium for potential infection whenever extra fluid and a lot of times have diabetes copd also is temp going up is WBC going up o Cardiogenic Shock basically heart has shut down no longer working different than the others don t want to give fluid bc increases the workload other shocks you do give fluids Teaching Moment During a cardiac assessment where should the nurse place the stethoscope to accurately evaluate the aortic heart sound A The second intercostal space right of the sternum B The second intercostal space left of the sternum C The fifth intercostal space at the left midclavicular line PMI often with CHF it can be shifted some to the left bc the heart is enlarged may have to shift a little to the left to hear it D The third intercostal space right of the sternum System Specific Etiology Risk Factors for CHF at is that you can live a healthy lifestyle but if it s in you re history there are some things you can t do you can push it off though with lifestyle changes same as HTN most important thing to look Major Non modifiable Risk o Family History o Age o Gender o Genetics Major Modifiable Risk Factors people can t deal with it all at once if they re really sick down the road when going home we can give them their education give referrals to special doctors all about health promotion o Smoking Alcohol Illicit drug use o Hypertension o Hyperlipidemia o Metabolic Syndrome o Sedentary lifestyle o Obesity o Diabetes o Valvular abnormalities they may be able to have surgery Labs CHF