NUR2502/MDC Exam 3 Focused Review (Chapters 34, 35, 36, 38, 39, 40) Fall 2020
● 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.
�...
NUR2502/MDC Exam 3 Focused Review (Chapters 34, 35, 36, 38, 39,
40) Fall 2020
● 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
, ● “early warning detector” that lets HCP know that the
heart is experiencing early signs of decreased
compliance long before symptoms occur
▪ CXR
Helpful in diagnosing left ventricular failure
●
because the heart is enlarged, representing
hypertrophy or dilation
▪ Echocardiography
● Best tool in diagnosing HF- ejection fraction between 50-70%
● Cardiac valvular changes, pericardial effusion,
chamber enlargement, and ventricular hypertrophy
can be diagnosed with this noninvasive technique
● Can also be used to determine ejection fraction
▪ Hemodynamic Monitoring
● PA catheter allows for assessment of cardiac function and fluid
volume
● PAP (positive airway pressure) /PAWP (pulmonary
artery wedge pressure) elevated with L sided HF
because volumes and pressures are increased in the
left ventricle
●
o
s/s ▪ Left HF:
● Decreased cardiac output:
o Fatigue, weakness, oliguria during the day
(nocturia at night), angina, confusion,
restlessness, dizziness, tachycardia,
palpitations, pallor, weak peripheral pulses,
cool extremities
o Priority problems:
▪ Impaired gas exchange r/t
ventilation/perfusion imbalance
▪ Decreased cardiac output r/t altered
contractility, preload, and afterload
▪ Fatigue/weakness r/t hypoxemia
▪ Potential for pulmonary edema r/t L sided HF
● Pulmonary congestion:
o Hacking cough, worse at night,
dyspnea/breathlessness, crackles or
, w in lungs, frothy, pink-tinged sputum,
h tachypnea, s3 s4 summation gallop
e
e
z
e
s
▪ Right HF:
● jugular neck vein distention, enlarged liver and spleen,
anorexia and nausea, dependent edema (legs and
sacrum), distended abdomen, swollen hands and
fingers, polyuria at night, weight gain, increased BP
from excess volume or decreased BP from failure
o treatment
▪ Drugs:
● ACE inhibitors: increase stroke volume (can cause hyperkalemia)
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller paulhans. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.49. You're not tied to anything after your purchase.
