NURSING 302 CHF Simulation: Preparation Questions.

NURSING 302 CHF Simulation: Preparation Questions. 1. List the risk factors for chronic left-sided heart failure related to coronary artery disease. Non-modifiable risk factors include increasing age, gender (men more than women until age 65), ethnicity, genetic predisposition and family history of heart disease. Modifiable risk factors are hypertension, elevated serum lipids, tobacco use, physical inactivity, psychologic state, obesity, diabetes. 2. Explain the cause of the compensations for chronic heart failure. HF can occur quickly with the onset from acute MI and rapid A-fib, or it can be an insidious process from slow, progressive changes. The overloaded heart will resort to compensatory mechanisms trying to maintain adequate CO. The main compensatory mechanisms include: Sympathetic Nervous System Activation: ● First mechanism triggered is low CO states (least effective). ● In response to inadequate stroke volume and CO, there is increased the release of catecholamines (epinephrine and norepinephrine) to increase HR which increases myocardial contractility and peripheral vasoconstriction. Neurohormonal response: ● As CO decreases, the blood flow to the kidneys decreases.The kidneys respond by releasing rennin, which helps change angiotensinogen to angiotensin I. It then is subsequently converted to angiotensin II. Angiotensin II stimulates the release of aldosterone, thus resulting in retention of sodium and water, and vasoconstriction. Thus causing increase BP. The activation of the SNS and the neurohormonal response causes an increased cardiac workload , myocardial dysfunction, ventricular remodeling (ventricles becomes larger and less effective pumps) Dilation results in enlargement of chambers of the heart. It starts as an adaptive mechanism to cope with increasing blood volume. Eventually this mechanism becomes inadequate and can no longer contract effectively thereby decreasing the CO. Hypertrophy increases the muscle mass and cardiac wall thickness in response to overwork and strain. Hypertrophic heart muscles have poor contractility and requires more oxygen to perform work. Also poor coronary artery circulation and are prone to dysrhythmias. 3. Describe the manifestations and effects of right-sided and left-sided heart failure. Right-sided HF Left-sided HF - Right ventricle heaves - Murmurs - JVD - Edema (pedal, scrotum, sacrum) - Weight gain - Increased HR - Left Ventricle heaves - Pulsus alternans (Alternating pulses, strong, weak) - Increased HR - Point of maximum displaced inferiorly and posteriorly ( LV hypertrophy) This study source was downloaded by from CourseH on :36:27 GMT -05:00 - Ascites - Anarsaca ( Massive generalizd body edema) - Hepatomegaly (liver enlargement) - Fatigue - Anxiety and depression - Dependent, bilateral edema - Right upper quadrant pain - Anorexia and GI bloating - Nausea - Decreased PaO2, slight increase PaO2 (poor O2 exchange) - crackles (pulmonary edema) - S3 and S4 heart sound - pleural effusion - Change in mental status - Restlessness, confusion - Weakness, fatigue - Anxiety, depression - Shallow respirations up to 32-40/min - Paroxysmal nocturnal dyspea - Orthopnea ( SOB in recumbent position) - dry, hacking cough - nocturia - frothy, pink-tinged sputum ( advanced pulmonary edema).