MDC3 Final Study Guide

MDC3 Final Study Guide  Left Sided Heart Failure (left side: backs up into the lungs) Left atrium, Left ventricle, mitral valve, or aortic valve o Ejection fraction needed to dx LHF <40 o Causes: HTN, Coronary artery disease (CAD), valvular disease o Education: restrict sodium, and possible fluid restriction, daily weight (report 2lb in 1 night or 3-5lb in 1-week weight gain), report sleep sitting up, use pillows to prop themselves up, notify provider is increase swelling, and decreased activity tolerance, med compliance (no skipping Lasik’s) o Signs and symptoms: increased BP and pooling of blood, pink frothy sputum, dyspnea and night, crackles, fatigue, pulmonary congestion, crackles, wheezing o The main goal is to prevent exacerbation in chronic conditions o Diagnosis: Ejection fraction (echocardiogram), Lab: BNP (fluid overload), Chest Xray, ECG o Interventions: Oxygen, position, assess lung sounds, assess VS, cough, and deep breath o Tx: DASH Diet,  Medications: Overall goal is to manage fluid volume and help the heart to control the fluid volume that is there.  Diuretics---- Enhance selective excretion of various electrolytes & water o Loop: furosemide: monitor potassium and electrolytes, dehydration (monitor daily weight and I&O, skin turgor, MOITOR BP before giving). If IV push give slowly. Adverse effects: Tinnitus (chronic) o Thiazide: monitor potassium, possible supplements o Potassium Sparing- Spironolactone: Monitor POSTASSIUM – This is potassium sparing.  Ace inhibitors (-pril)  Arbs  Beta Blockers (-olol): lowers HR  Digoxin----Enhance Contractility, reduce HR, inhibit sodium potassium o Complications: Fluid overload (Pulmonary Edema)  Heart Failure in General o Education: monitor daily weight, stay active, low sodium diet, possible fluid restrictions, Med adherence, avoid NSAID (can lead to sodium and fluid retention) o What labs do you monitor for HF: BNP (if elevated anticipation that diuretic because it is showing that the heart is stressed, and it shows that more fluid is on the heart) o Best tool for dx of HF in general- Echocardiogram. This looks at the blood flow o Difference between Left and Right HF: Left backs up into lungs, right backs up into the rest of you. Right side of heart is systemic edema. Left side is pulmonary edema and the left will lead to the right. Know the signs and symptoms of each and the differences between them o What else leads to heart failure in general: HTN, valve disorders, cor pulmonal, smoking, DM, A Fib, MI. o PRIORITY IS ALWAYS YOUR ABC’s. o End stage heart failure, the last treatment would be a transplant. They will also be on the LVAD. Education post-transplant: immunosuppressant (avoid large crows, infection, do not eat raw fish or meat, no fresh flowers hand washing, lab and med adherence, watch for low grade fever), confusion o Hypertension with right sided HF, Hypotension with left sided HF  Right sided heart Failure o RF: Left sided HF (left ventricular failure), Right ventricular MI, Lung disease, Pulmonary Hypertension, pulmonary fibrosis Right atrium Tricuspid Valve Right ventricle Pulmonary valve o Signs and symptoms: abdominal ascites, peripheral edema, JVD, weight gain, fatigue, nocturia o Diagnosis: Echocardiogram, Lab: BNP (best lab), electrolytes, H&H o Manifestations: Positive JVD, increased ascites (and girth), hepatomegaly (congestive liver), Nausea, Vomiting, peripheral edema, malaise, enlarged liver and spleen, anorexia, dependent edema, distended jugular veins, o Tx: Same as Left sided HF, unless the cause is dt lung disease, then we will be tx lung disease. o CHF has an S3 gallop (this can be normal in athletes)  Mitral Valve Prolapse o This is on the left side of our heart, between the left atrium and ventricle. o If this prolapses it means the valve leaflets are going to fall back into left atrium o Usually benign, it can progress to mitral valve regurgitation o You will hear this as a murmur in the heart Causes  Marfan syndrome  Congenital heart disease  Genetics  Valve Stenosis o Narrowing of the valve causing a decrease in amount of blood that can flow through. Blood then backs up into lungs. o This can lead to left sided heart failure o The valves become stiff, which can narrow the valvular opening