WEEK 3 QUIZ – CH 116, 188-122, 126 AND 211 Primary care a collaborative practice
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NR 603 WK 3 FOCUS QUIZ TOPICS
WEEK 3 QUIZ – CH 116, 188-122, 126 AND 211 Primary care a collaborative practice
Heart Failure (ch 121)
Congestive heart failure (CHF) risks
- HTN - MI, CAD - DM - Metabolic syndrome
- Drug Abuse - PVD - Valvular heart disease. - Cardiomyopathies
CHF typical presentation
- Fatigue - decrease in exercise tolerance - SOB - Cough, rales
- JVD/edema - Palpitations - Anorexia, early satiety
- Wt gain >2 lb in 1 day >5 lb in 1 wk
- AMS (elderly) - S3
NYHA Classification of CHF
* Class I*********Cardiac disease without resulting limitation of physical activity
* Class II*******Slight limitation of physical activity - comfortable at rest, but ordinary physical activity results
in fatigue, palpitation, dyspnea, or anginal pain
* Class III******Marked limitations in physical activity - comfortable at rest, but less than ordinary
physical activity causes fatigue, palpitation, dyspnea, or anginal pain
* Class IV******Inability to carry on any physical activity without discomfort - or symptoms at rest
AHA/ACC 2009 - staging system of heart
HFrEF stands for
- Heart failure with reduced ejection fraction (EF < 40%) - Systolic failure
HFpEF stands for
- Heart failure with preserved ejection fraction - Varying definitions: EF > 40, 45, 50, or 55%. - Diastolic failure
HFmrEF stands for
- Heart failure with mid-range ejection fraction - EF 40-49%
CHF Diagnosis orders
* CXR. * CBC, CMP, UA. * Lipid profile. * TSH
* BNP (B-type natriuretic peptide)
- 200-400 pg/ml - likely moderate CHF - > 400 pg/ml - likely moderate to severe CHF - poorer prognosis
- Not part of routine OP eval
- Useful in acute dyspnea to r/o CHF
* Cardiac enzymes * EKG * Echo/TEE
CHF treatment & management
* Meds - start w at least two
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