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N105 Cardiac Ch 37
N105 Interventions for Clients with Cardiac Problems
46
Nursing
Undergraduate 1
03/31/2012

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Cards

Term
Considerations for Cardiac Catheterization
Definition
general bed rest from 6, 8 to 12 hours
Extremity Kept Straight
****ASSESS INSERTION SITE (MOST IMPORTANT)***
2nd assess distal to intertion site.
Term
What can a ECG identify
Definition
dysrhythmias, escemia, sites of a MI, hypotrophy
Term
Facts of Heart Disease
Definition
More people die from it than next 7 leading causes, 1 in 5 with Heart failure will die within a year of diagnosis
Term
Indications of Pump Failure
Definition
insufficient Cardiac Output
decreased profusion to tissues
hypoxia, lack of nutrients, accumulation of waste products causing more damage around the body
Term
Key Features of Left Side Heart Failure from decreased Cardiac Output
Definition
Fatigue, Weakness, oliguria during day, noctuuria at night, angina, confusion, restlessness, dizziness, tachycardia, palpitations, pallor, weak peripheral pulses, cool extremities
Term
Key Features of Left Side Heart Failure from Pulmonary Congestion
Definition
Hacking cough that is worse at night, dyspnea/breathlessness, crackles or wheezing in lungs, frothy pink tinged sputum, tachypnea, S3/S4 summation gallop
Term
Key Features of Right Sided Heart Failure from Systemic Congestion
Definition
Jugular Vein Distention, Enlarged Liver and Spleen, Anorexia, Nausea, Dependent Edema in legs and sacrum, Distended Abd, Swollen hands & fingers, Polyuria at night, Weight Gain, Increased B/P from excess volume or decreased b/p from failure
Term
25% of heart failure begins on

75% of heart failure begins on
Definition
Right Side

Left Side
Term
Right side failure can result from Left Side failure or Pulmonary Congestion
Definition
Term
Type of Heart Failure usually from increased metabolism such as raging fever, tachycardia, thyroid disease
Definition
High Output Heart Failure
Term
Classification of Heart Failure STRUCTURAL damage of heart from past MI causing necrosis of muscle.
Definition
Class A - no damage but risk for it.
Class B thru D increases with amount of damage to the muscle
Term
FUNCTIONAL Classification of Heart disease according to the ability to do things (ADLs)
Definition
+1 - minimal symptoms risk for increasing
+4 - client is sedentary b/c of breathlessness
Term
Patients with heart failure experience decreased cardiac output - the ________ mechanism will occur (what is it also)
Definition
Hormonal/Compensatory Mechanism - Activation SNS - speeds up heart rate.
Term
Explain what the SNS does to increase heart rate
Definition
increase HR
Activate ReninAngiotensin System - produces a hormone that causes vassoconstriction to make a smaller amount of blood go further,
Manipulates ADH conserving fluid - increasing circulating volume
Term
Myocardial Hypotrophy occurs when
Definition
heart works harder and starts to enlarge to keep up with increased workload. It requires more oxygen
Term
____ failure revolve around systemic congestion b/c blood comes from Vena Cava backs up = congestion
Definition
Right Side Heart Failure
Term
How does right side heart failure usuaslly manifest first?
Definition
GI symptoms
Term
Right Sided Heart Failure Results
Definition
Enlarged Liver/Spleen, Anorexia, Nausea, Vomiting, Distended Abd, Dependent Edema, Enlarged Scrotum, increased B/P
Term
Causes of Right Side Heart Failure
Definition
Hypertension = 75% of time
Myocardia Infarction - 1/3rd of time structural Heart Changes = Valvular Dysfunction b/c of pressure or volume overload (MV Damage)
Term
Left Side heart Failure effects
Definition
Impaired Tissue profusion b/c systemic and decreased cardiac output,
Excessive Fatigue - b/c decreased Cardiac Output and poor O2, Fluid in lungs - b/c of pressure in lungs forcing fluid in perpheral supporting lung tissues
Term
Complaints of LS Heart Failure
Definition
Activity intolerence - b/c of imbalanced O2 needed and available (IT HAS NOTHING TO DO WITH MUSCLE ABILITY), SOB, Tachycardia, palpitations, dysrhythmias, cough - usually at night, Orthopnea
Term
Right Side Heart Failure Results in

resulting in
Definition
Systemic Congestion and Fluid Retention

Dependent Edema in legs, feet, hands
Term
Pitting Edema is a Result of

Non Pitting Edema is usually a result of
Definition
Right Side Heart Failure

kidney overload - general fluid overload
Term
Urination problems with Right side heart failure are
Definition
Oliguria during day, and polyuria at night
Term
Most reliable indicator of fluid status b/c of dependent edema
Definition
weight gain - daily weights
Term
What Lab Test is for Heart Failure?
Definition
There are no lab assessments for heart failure. You will begin to see alterations in values b/c liver not functioning as effectively, kidneys wont be either b/c of fluid imbalances,
Term
Tests for Heart Failure
Definition
Chest X-Ray - shows cardiac enlargement
Term
A cough only at night could indicate

what causes this
Definition
Left Side Heart Failure

Paroxysmal Noctural Dyspnea (PND)

lay down and fluid returns causing more back up in heart results in PND
Term
No pain but 6 mo later development of heart failure b/c they weren't treated for
Definition
Silent Heart Attack
Term
How could you diagnose a silent heart attack?
Definition
ECG would show previous damage
Term
Pulmonary Artery Catheter measures
Definition
pressures in heart
Term
If heart failure is present what would a pulmonary artery catheterization show
Definition
Elevated in Pulmonary VEIN as Right Side of heart pumps to lungs that are congested and it will be decreased in Pulmonary ARTERY where it returns to left side of heart
Term
Nursing Diagnosis for Heart Failure
and why with each
Definition
*Impaired Gas Exchange b/c lungs filling with fluid ventilation profusion imbalance patient still breathing air but profusion of blood to lungs has decreased *Decreased Cardiac Output r/t contractility, preload & afterload, *Activity Intolerence r/t imbalance of O2 suppy and demand
Term
Nursing Diagnosis
IMPAIRED GAS EXCHANGE for Heart Failure
interventions
Definition
Evaluate respiratory status, Titrate O2, High Fowlers, Coughing, Turning, Deep Breathing (to expand alveoli)
Term
Nursing Diagnosis for Heart Failure
DECREASED CARDIAC OUTPUT
interventions
Definition
medications - reduce afterload, reduce preload and improve contractility
Term
The goal of Decreased Cardiac Output is: And how do you do that?
Definition
Optimize Cardiac Output
interupt poor circulation by regulating amount of blood coming into the heart, regulating blood leaving the heart and the workload of the heart. Optimize the Stroke Volume
Term
Stroke Volume is dependeent on the __
Definition
Preload, afterload and contractility
Term
Amount of blood coming into the heart
Definition
Preload
Term
How does drugs that decrease preload work to help heart failure
Definition
optimize the ventricular muscle stretch and ability of heart to contract by not over filling
Term
Interventions for Heart Failure
Definition
Low Sodium Diet
Fluid Restriction
Diuretics
Venous Vassodilators
Term
What is the amount for a low sodium diet? What foods?
Definition
< 5 g daily
cooking from scratch, no processed or canned foods
Term
What is the fluid restriction for heart failure
Definition
1500 mL day
Term
Diuretic works to improve heart failure how?
Definition
reduce the preload
Term
What are the venous vassodilators for heart failure
Definition
Nitrates - Nitroglycerin
Term
What is an education for Nitrates?
Definition
Don't wear patch at night because of tolerance build up
Term
Heart Failure - when to contact dr?
Definition
weight gain of 1 to 2 pounds overnight or 3 to 5 pounds a week
decrease exertion tolerance, cough, increased edema
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