NUR 405 Exam 7 - 1. fluid due to impaired cardiac pump 2. damage...

NUR 405 Exam 7

• chronic heart failure

• fluid due to impaired cardiac pump

• damage to ventricles-> ventricles start to have scar tissue-> hypertrophy due to infarction

(MI)-> L ventricle starts to enlarge (remodeling)-> floppy heart beat

• normal EF (ejection fraction)

• should be above 60%

amt of blood pumped through L ventricle going to aorta each time heart beats

• not diseased, starting to enlarge, floppy thin w L ventricle (systole)-> EF 35% (heart failure)

brain not getting enough blood

• kidneys filter blood, get 20-25% of cardiac output, kidneys are not able to filter fluid out into

urine cause not receiving it-> fluid building up in ankles causing edema-> put legs up at night and go into lungs causing SOB -brain also needs 20-25% -vital organs suffer the most w heart failure

• chronic as long as take meds (lasix) can still be out in community, stable
• acute is in ER, 3-4 plus pitting edema, frothy sputum, life threatening

• heart failure

• Complex clinical syndrome resulting in insufficient blood sup- ply/oxygen to tissues and

organs 1 / 4

-major health problem in US -most common reason for hospital admission in adults over 65, placing sig economic burden on health care system -The complex, progressive nature of HF often results in poor outcomes, the most costly being hospital readmissions.-Approximately 25% of patients discharged with a primary diagnosis of HF are readmitted within 30 days. The total cost of HF care in the United States exceeds $40 billion annually, with over half of these costs spent on hospitalizations.

• An abnormal condition involving impaired cardiac pumping
• Heart failure (HF) is not a disease but a "*complex clinical syndrome*"
• The most common reason for hospitalization in adults >65 years old

• Primary Risk Factors

*HTN & CAD*

-also MI -cardiac viruses (rare) -uncontrolled HTN or not properly controlled (not taking meds consistently) 140/50 over 90 -CKD also (chronic kidney disease)-> end up retaining fluid, affecting pumping of heart

• A defect in either ventricular filling (diastolic dysfunction) or ventricular ejection (systolic

dysfunction) are the key manifestations of HF.

• The amount of blood pumped by the left ventricle with each heart beat is called the ejection

fraction (EF).The American Academy of Cardiology Foundation (ACCF)

has adopted the terms heart failure with reduced EF (HFrEF) and heart failure with preserved EF (HFpEF) to describe systolic and diastolic HF.

• classification of heart failure

• *Left-sided HF*- most common form of HF

-results either from (1) the inability of the left ventricle (LV) to empty adequately during systole or (2) fill adequately during diastole 2 / 4

-systole pumping

-diastole

relaxing and filling of blood

-asynchonous

no synchrony

-point of maximal impulse

mid clavicular 5th intercostal space-> LV moves toward axilla, PMI toward axilla

• Risk Factors- HTN, CAD, MI, etc

-Hypertension is a modifiable risk factor that should be aggressively treated and managed.*Long-term treatment of hypertension reduces the incidence of HF by 50%* -Other co-morbidities, such as diabetes, metabolic syndrome, advanced age, tobac- co use, and vascular disease also contribute to the development of HF.

• Results from inability of LV to

-Empty adequately during systole -Fill adequately during diastole

• Weakened *dilated enlarged heart muscle* cannot generate adequate stroke volume, which “

CO

• Left-Sided Heart Failure 3 / 4

• Blood backs up into left atrium and pulmonary veins

-Left-sided HF results from left ventricular dysfunction.

• *Increased pulmonary pressure* causes fluid leakage ’ pulmonary congestion (crackles) and

pulmonary edema -fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli.

• Further classified as

-*Systolic HF* -*Diastolic HF* -*Mixed systolic and diastolic HF*

• frothy white sputum, eventually pink (RBC coming through)-> emergency

-want to catch when just little crackles -ordered IV lasix to start diuresing pt

• systolic HF

• *HFrEF* - HF with reduced EF

• Inability to pump blood forward
• Caused by

-Impaired contractile function (MI, only part of muscle damaged) -Increased afterload (hypertension)

-Cardiomyopathy (something happened to muscles, maybe virus) -Mechanical abnormalities (valvular heart disease)

• Decreased LV ejection fraction (“EF< 60%)

-hallmark of systolic failure -Normal EF is >60%. Patients with HFrEF generally have an EF less than 45%. It can be as low as 5% to 10% (end-stage HF) -EF at rest-> however during fight or flight response would get 100%

• The LV in systolic failure loses its ability to generate enough pressure to eject blood forward

through the aorta. Over time, the LV becomes dilated and hypertrophied.

• The weakened heart muscle cannot generate adequate stroke volume, which affects CO.

Because the LV cannot effectively push blood forward, end diastolic volumes and pressures in the LV increase.

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