NURSING 302 CHF Simulation: Preparation Questions 2022.

NURSING 302 CHF Simulation: Preparation Questions 2022. 1. List the risk factors for chronic left-sided heart failure related to coronary artery disease. The risk factors are hypertension, diabetes, elevated lipids, tobacco use, and obesity. 2. Explain the cause of the compensations for chronic heart failure. Question is confusing and the answer based on the words written is chronic heart failure. Chronic heart failure causes decreases in blood flow or ineffective blood flow mechanisms. These situations cause the body to compensate to maintain homeostasis which the body is built to do. 1. Frank –Starling mechanism: Increases contractile force leading to increased CO 2. Neuroendocrine responses including activation of the sympathetic nervous system and renin-angiotensin system: a) Decreased CO stimulates the sympathetic nervous system and catecholamine release. Increased HR, BP, contractility, vascular resistance, venous return. b) Decreased CO and decreased renal perfusion stimulate renin-angiotensin system. Vasoconstriction and increased BP c) Angiotensin stimulates aldosterone release from adrenal cortex. Salt and water retention by kidneys, increased vascular volume. d) ADH is released from posterior pituitary. Water excretion inhibited. e) Atrial natriuretic peptide and brain natriuretic peptide are released. Increased sodium excretion, Diuresis, Vasodilation. f) Blow flow is redistributed to vital organs (heart/brain). Decreased perfusion of other organ systems. Decreased perfusion of skin and muscles. 3. Myocardial hypertrophy: Increased cardiac work load causes myocardial muscle to hypertrophy and ventricles to dilate. Increased contractile forced to maintain CO. 3. Describe the manifestations and effects of right-sided and left-sided heart failure.  Manifestations of right-sided heart failure are RV heaves, murmurs, jugular venous distention, edema, weight gain, increased heart rate, ascites, anasarca, and hepatomegaly. The effects are fatigue, anxiety, depression, depended bilateral edema, right upper quadrant pain, anorexia and GI bloating, and nausea.  Manifestations of left-sided heart failure are L V heaves, pulsus alternans, increased heart rate, PMI displaced inferiorly and posteriorly decreased PaO2, slight increase PaCO2, crackles, S3 and S4 heart sounds, pleural effusion, changes in mental status, restlessness, and confusion. The effects are weakness, fatigue, anxiety, depression, dyspnea, shallow respirations up to 32 -40/min, paroxysmal nocturnal dyspnea, orthopnea, dry hacking cough, nocturia, and frothy pink-tinged sputum. 4. List the goals in the interdisciplinary care of a patient with chronic heart failure. This study source was downloaded by from CourseH on :37:33 GMT -05:00 Main goals and treatment of chronic heart failure or to treat the underlying cause and contributing factors, maximize CO, provide treatment to alleviate symptoms, improve ventricular function, improve quality of life, preserve target organ function, and improve mortality and morbidity risks. a. List the two hormones released by the heart muscle in response to changes in blood volume. Atrial natriuretic peptide B-type natriuretic peptide 5. Explain the nursing implications for the client receiving echocardiography with Doppler flow studies. Before the Procedure 1) Obtain and document the patient's history of drug allergies, surgeries, bleeding disorders and medicine uses. 2) Address any anxieties and fears that the patient may have about the procedure. 3) Verify the patient's understanding of the procedure and obtain informed consent. 4) Review lab values as ordered and report any variances to the physician such as CBC and coagulation studies. 5) apply electrographic electrodes if not already in place. 6) Help the patient remove and store any jewelry, denture; appliance and clothes. 7) Establish and assess adequate Intravenous access if needed for any drugs to be used such as for sedation. During the Procedure 1) Establish a low flow of oxygen by nasal cannula. 2) Initiate continuous oxygen saturation monitoring. 3) Assist the patient in a recumbent left lateral position. 4) Assist in positioning patient's head in flexed position if needed. 5) Keep patient comfortable and warm. 6) Assess cardiac rhythm, vital signs, and oxygen saturation at 1-3 min intervals. 7) Assess the patient for discomfort. 8) administer the right drug dosage for procedural sedation if needed and as specified by the doctor. 8) Ensure that the patient fasts for 4-6 hrs before the procedure as directed by doctor.