NURSING 2502 MDC3 Final Study Guide

NURSING 2502 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 (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 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 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 • 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 o Blood will back up and cause hypertrophy of the left ventricle. They will have HF manifestations dt back up of blood. They may also have A. Fib or clots Causes treatment diuretics, blockers, Ca+ blockers o Presents with an S4 gallop • Mitral Valve Regurgitation o The backflow of blood into the left atrium, causing hypertrophy of left atrium and ventricle because not all the blood is leaving the heart. Causes o This can lead to heart failure. Signs and symptoms tachycardia, fatigue, weakness, high pitched murmur, neck pain, pooling of blood that leads to edema and JVD (this is dt it is backing up into the lungs and then further into the right side of the heart causing symptoms of right sided HF) Treatment similar tx for HF; diuretics, low sodium diet, decreased overall volume, surgery to repair or replace valve. o You will hear this as a murmur in the heart. o If manifestations of hf occur, they may discuss procedures to repair valve. o Medications: This can cause R sided HF (VS: HTN, bounding pulses- rt excess fluid, Beta blockers (-olol) will be med to lower HR • Mechanical Valve replacement o INR of 3-4 o Will be on anticoagulants (Warfarin) life long. They can ONLY take warfarin. This is due to the fact that blood has an easier time clotting on the metal/ mechanical equipment. o Will be on abx after dental procedure to prevent Endocarditis. o Adhere to tx plan or HF sx will likely develop. • aortic regurgitation o Back flow of blood from the aortic valve causing left ventricular hypertrophy, manifestations and decreased cardiac output (fainting, SOB, Bounding Pulse, Murmur, May have no Sx. Causes o Overall tx is to improve sx when able. When not able we do a valve replacement. • Endocarditis o Inflammation/ infection of the endocardium. (heart muscle tissue) o If they are confused and have a fever, expect endocarditis o Causes : IV drug users, valve recipients, systemic infections, structural cardiac defects o Manifestations/Assessment: New or changed murmur, embolization (can cause mini strokes), petechiae, fever, chills, night sweats, positive blood cultures. o HF is most common complication of this. o TX: antimicrobials (6 weeks), rest, aseptic technique, assess for SX of HF o Sx: fever, chills, night sweats, malise, fatigue, anorexia, weight loss o Entry ports: oral, rash, lesion, infection. surgery o They will want blood cultures to be negative with no SX present. o They do not use anticoagulants because the emboli are of a vegetative origin, anticoagulants will not have an effect on them because they are not actually a clot. o Dx: Echocardiogram and blood cultures. o Pts with hx of this or with a mechanical valve replacement or other heart issue should have abx after dental procedures to reduce risk of this. o In severe cases they may have to remove an infective valve. • Pericardial effusion o When fluid builds up between the heart muscle and the pericardial sac. o Can be dt infection, cancer, inflammation o Manifestations: Mild to Mod doesn’t cause much of an issue, once significantly enlarged it can cause o This can lead to Cardiac Tamponade (Heart loses ability to pump, the cardiac output suddenly drops and opt will do into cardiac arrest is tx is not done. ▪ TX of this is Pericardiocentesis ▪ This is an emergency o Tx: can drain it, do diuretics or abx depending on cause o SX: SOB, Cough, sharp chest pain, increase resp effort