NR 324 EXAM 2 MEDICAL SURGICAL STUDY GUIDE

HEART FAILURE Assessment of left and right CAD: Left Sided Heart Failure ( • Most common • Prevents normal forward flowing blood • Blood backs up into the left atrium, and then to the pulmonary vein o Pressure increases, fluid leaks from the pulmonary capillary bed into the interstitium and then the alveoli o Results in pulmonary congestion and edema • Signs o LV heaves o Alternating pulses (strong, weak): o Increased HR o Decreased PaO2, slight increase PaCO2 (result poor oxygen exchange) o Crackles (pulmonary edema) o S3/S4 sounds o Pleural effusion o Changes in mental status, restlessness, confusion o Orthopnea, shallow respirations, dry hacking cough o Nocturia o **Frothy, pink-tinged sputum (advanced pulmonary edema) Right Sided Heart Failure • RV fails to contract effectively • Backup of blood into the right atrium, and then venous circulation • Venous congestion in systemic circulation results in o JVD o Hepatomegaly o Splenomegaly o Vascular congestion of GI tract o Peripheral edema: blood returning is blocked/backed up • Can result from acute conditions such as RIGHT VENTRICULAR INFARCTION or P.E. • CorPulmonale: right ventricular dilation and hypertrophy caused by pulmonary disease • Primary cause: Left-sided HF o Left side HF results in pulmonary congestion, increased pressure in the blood vessels of lungs (pulmonary HTN) o Chronic pulmonary HTN puts increased right ventricular afterload and results in right-sided hypertrophy and HF • Signs/Symptoms o RV heaves, murmurs