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What is the definition of heart failure?

The inability of ventricles to pump enough blood for body's needs; weakness of heart muscles due to aging or disease.

What diseases are associated with heart failure?

Mitral stenosis, mycoardial infarction, chronic hypertension, coronary artery disease, and diabetes mellitus.

What is it called when myocardial fibers are stretched prior to contraction?

Preload

What is the pressure in the aorta that must be overcome before blood is ejected from the left ventricle?

Afterload

Blood pressure is also called what?

Peripheral Vascular resistance

What side failure occurs when the ventricle enlarges and blood backs up into the lungs which can cause cough and shortness of breath?

Left side heart failure

What side failure occurs when blood backs up into the veins and causes peripheral edema, JVD, and organ enlargement (Hepatomegally)?

Right side heart failure

What is the role of the nurse for a patient with heart failure?

Obtain a health history, assess VS, urinary and cardiac output.

What drugs can cure heart failure?

None, heart failure cannot be cured, medications only treat symptoms.

What 3 things do medications do in patients with heart failure

Slow heart rate, increase contractility**, and reduce heart workload.

What are the signs and symptoms of heart failure?

Pink frothy sputum (pulmonary edema), perpheral edema, ascites, decreased spo2, drooling, JVD

What is hypertrophy and what causes it?

When the ventricle is abnomally large due to continuous stretching.***saggy panyhose :)

Where would you expect to find the PMI in a patient with hypertrophy?

6th intercostal space, midclavicular line

What is the drug of choice for heart failure?

ACE inhibitors

How does ACE inhibitors work for patients with HF?

Reduces afterload, enhances excretion of sodium and water, and increases cardiac output.

How does enhancing the excretion of sodium and water help the patient?

It lowers the peripheral resistance and reduces the blood volume.

What is the prototype drug for ACE inhibitors?

Lisinopril (Prinivil, Zestril)

What are other ACE inhibitors?

Captopril (Capoten), and Enalapril (Vasotec)

What are the adverse effects of ACE inhibitors?

First dose hypotension, cough, hyperkalemia, renal failure, and angio-edema

When should the first dose of ACE inhibitors be given, why?

At night time due to first dose hypotension.

What is the nurse's role for patients taking ACE inhibitors?

Monitor CBC (decreased WBC), assess for hypotension, I/O, BUN, creatinine, and daily weights. Monitor for impaired kidney function, hyperkalemia, and autoimmune disease.

What is the theraputic response time for ACE inhibitors?

Weeks or months.

What type of restrictions would a patient on ACE inhibitors be on?

Sodium and Potassium

Ace inhibitors shouldn't be taken with what?

Other medications, OTCs, herbals, and vitamins.

What mechanism of action do diuretics have?

Increases urine flow, reduces blood volume and cardiac workload, and reduces pulmonary congestion and edema.

What is prototype for diuretics?

Furosemide (Lasix)

What are the adverse effects of Lasix?

Dehydration, electrolyte imbalance (esp. K+), hypotension, and ototoxicity**

A patient taking Lasix should also be taking what?

Potassium supplements

What are the loop diuretics?

Bumetanide (Bumex) and Furosemide (Lasix)

What are the thiazide diuretics?

Chlorothiazide (Diuril) and hydrochlorothiazide (HCTZ)

What is the potassium-sparing diuretic?

Spironolactone (Aldactone)

Chlorothiazide is used to treat what?

HTN and fluid retention

When should Chlorothiazide be administered?

In the morning

What is the goal of therapy using diuretics?

Diuresis

What can be assess to see if diuretic is working?

I/O, daily weights

Chlorothiazide can exacerbate what condition?

Gout

How should Spirolactone be taken?

Taken with food

What teaching should occur with patients taking spirolactone?

Do not take potassium supplements, avoid food with high potassium, and avoid direct sunlight. Report weight loss or gain of more than 2 lbs in one day, fatigue and muscle cramps, and change position slowly to avoid falls.

Why should patients taking spirolactone be cautious about using salt substitutes?

Because some contain potassium and should be avoided.

What should be monitored in patients taking spirolactone?

Renal function, electrolytes, I/O, VS, weight, blood glucose, and BUN

What type of drug should be taken to reduce symptoms of heart failure and slow progression of the disease?

Beta-adrenergic blockers

What is the prototype drug for beta-adrenergic blockers?

Carvedilol (Coreg)

What is the MOA for Coreg?

To slow heart rate and blood pressure, and reduce the workload of the heart.

What is another example of beta-adrenergic blockers?

Metoprolol extended release (Toprol-XL)

What are the adverse effects of Coreg?

Fluid retention, worsening of heart failure, fatigue, hypotension, bradycardia, and heart block.

Coreg is contraindicated in what patients?

Asthma, Diabetes (because it masks the signs and symptoms of hypoglycemia), and heart block.

What should be monitored in patients taking Coreg?

Liver function for hepatic toxicity, worsening symptoms, blood pressure and pulse.

Patients should report what to their provider?

Pulse below 60 and signs and symptoms of worsening heart failure.

What is one of the most important teaching points for patients taking Coreg?

Do not stop taking abruptly.

What type of drug is used to increase contractility or strength of myocardial contraction?

Cardiac gylcosides

What is the prototype drug for cardiac glycosides?

digoxin (Lanoxin)

What is the MOA of digoxin?

to increase force of heartbeat, slow heart rate, and improve cardiac output

What are the adverse effects of digoxin?

Neutropenia, dysrhythmias**, and digitalis toxicity which can lead to hypokalemia

What is another example of cardiac glycosides?

Digitoxin (Crystodigin)

What should be assessed in patients taking digoxin?

Evaluate for ventricular dysrhythmias, assess renal function and theraputic levels of lab tests, and pulse

When should digoxin be given?

In the morning after taking pulse (above 60)

What medications should be avoided when taking digoxin?

antidiarrheals and antacids

What are the signs and symptoms of digoxin toxicity?

N/V(esp. after IV push), fatigue and halos around lights

Patients taking digoxin should be taught to do what?

Report weight gain and eat foods high in potassium such as bananas, peanut butter, apricots, and potato

What is a loading dose and how should it be given?

The first dose of the medication needed to get the patient at a theraputic level. Usually IV, and patient should be hooked up to the cardiac monitor and assessed for dysrhythmias.

What is the normal digoxin level?

.5-2; will be decreased in patients with hypokalemia

What type of drug is used for short term therapy for heart failure?

Phosphodiesterase inhibitors

What is the prototype drug for phosphodiesterase inhibitors?

Milrinone (Primacor)

What is the MOA for Primacor?

To block the enzyme phosphodiesterase in cardiac and smooth muscles.

What does Primacor do?

increase calcium for myocardial contraction, causes positive inotropic response and vasodilation, increase contractility and decrease afterload.

What setting is Primacor primarily used?

In the hospital for acute, short-term therapy only.

What is the life-threatening dysrhythmia?

Ventricular dysrhythmia

What are the adverse effects of Primacor?

hypokalemia, hypotension, and ventricular dysrhythmias**

What should be assessed and monitored in patients taking Primacor?

Potassium levels, hypotension, renal impairment, and dysrhythmias

If Primacor is given IV, what should be monitored carefully? How is it administered?

Temp, fever of 101 is significant; pain and swelling at the infusion site. Use microdrip tubing for safety.

What patient teaching should be done in patients taking Primacor?

Report irregular or rapid heart rate and report fever over 101 or increased chest pain or angina.

What type of medication is used to lower blood pressure for patients who cannot take ACE inhibitors? Also a minor role in heart failure txt.

Vasodilators

What is the prototype drug for vasodilators?

Isosorbide dinitrate (Isordil)

What is the MOA for Isordil?

to relax and dilate blood vessels

What are the adverse reactions of Isordil?

Reflex tachycardia and orthostatic hypotension

What is another example of vasodilators?

Hydralazine (Apresoline)

What is the main lab test done to determine CHF?

BNP - brain natriuretic peptide

What would the BNP be for someone with CHF?

>100g/mL

What does the BNP indicate?

Increased stretch of the ventricles.

What is the amount of blood pumped by each ventricle per minute?

Cardiac output

What principle says the more the myocardial fibers are stretched, the more forcefully they will contract?

Frank-Sterling law

What is the strength of contraction of the heart?

Contractility

What is a change in contractility of the heart?

inotropic effect

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