Medsurg: Cardiovascular: Congestive Heart Failure

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What are the common chronic causes of CHF? (9): 1. Coronary artery disease
2. Hypertensive heart disease
3. Rheumatic heart disease
4. Congenital heart disease
5. Cor pulmonale
6. Cardiomyopathy
7. Anemia
8. Bacterial endocarditis
9. Valvular disorders
What are the common acute causes of CHF? (8): 1. Acute myocardial infarction
2. Arrhythmias
3. Pulmonary emboli
4. Thyrotoxicosis
5. Hypertensive crisis
6. Rupture of papillary muscle
7. Ventricular septal defect
8. Myocarditis
What are the precipitating causes of congestive heart failure?: 1. Anemia
2. Infection
3. Thyrotoxicosis
4. Hypothyroidism
5. Arrhythmias
6. Bacterial endocarditis
7. Pulmonary emboli
8. Pulmonary disease
9. Pagetâ€™s disease
10. Nutritional deficiencies
11. Hypervolemia
How is anemia the precipitating cause of congestive heart failure?: Anemia decrease oxygen-carrying capacity of the blood stimulating the increase in CO to meet tissue demands. This increases the workload of the ventricles, causing a decompensated condition that leads to decreased myocardial function.
How is infection the precipitating cause of congestive heart failure?: Infection increases oxygen demand of tissue, stimulating increase cardiac output. This increases the workload of the ventricles, causing a decompensated condition that leads to decreased myocardial function.
How is thyrotoxicosis the precipitating cause of congestive heart failure?: Thyrotoxicosis create changes in the tissue metabolic rate and in turn, increases heart rate and workload of the heart. This increases the workload of the ventricles, causing a decompensated condition that leads to decreased myocardial function.
How is hypothyroidism the precipitating cause of congestive heart failure?: Hypothyroidism indirectly predisposes the heart to increase atherosclerosis; severe hypothyroidism decreases myocardial contractility.
How are arrhythmias the precipitating causes of congestive heart failure?: Arrhythmias may increase cardiac output and increase workload and oxygen requirements of myocardial tissue.
How is bacterial endocarditis the precipitating cause of congestive heart failure?: Bacterial endocarditis: infection increases metabolic demands and oxygen requirement; Valvular dysfunction causes stenosis and regurgitation.
How is bacterial pulmonary embolism the precipitating cause of congestive heart failure?: Pulmonary embolism increases pulmonary pressure and exerts pressure on the RV, leading to RV hypertrophy and failure.
How is pulmonary disease the precipitating cause of congestive heart failure?: Pulmonary disease increases pulmonary pressure and exerts a pressure load on the RV, leading to hypertrophy and failure
How is Pagetâ€™s disease the precipitating cause of congestive heart failure?: Pagetâ€™s disease increases the workload of the heart by increase vascular bed in the skeletal muscle.
How are nutritional deficiencies the precipitating cause of congestive heart failure?: Nutritional deficiencies may decrease cardiac function by decrease myocardial muscle mass and myocardial contractility.
How is hypervolemia the precipitating cause of congestive heart failure?: Hypervolemia increases preload and causes volume load on the right ventricle.
What are the signs of right-sided heart failure? (11): 1. RV heaves
2. Murmurs
3. Peripheral edema
4. Weight gain
5. Increase HR
6. Dependent edema
7. Ascites
8. Anasarca
9. Jugular venous distension
10. Hepatomegaly
11. Right-sided pleural effusion
What are the symptoms of right-sided heart failure? (6): 1. Fatigue
2. Dependent edema
3. Right upper quadrant pain
4. Anorexia
5. GI bleeding
6. Nausea
What are the signs of left-sided heart failure? (8): 1. LV heaves
2. Cheyne-strokes respiration
3. Pulsus alternans
4. Increase HR
5. PMI displaced inferiorly and posteriorly
6. Decrease PaO2, slightly increase PaCO2
7. Crackles
8. S3 and S4 heart sounds
What are the symptoms of left-sided heart failure? (8): 1. Fatigue
2. Dyspnea
3. Shallow respiration up to 32-40/min
4. Orthopnea
5. Dry, hacking cough
6. Pulmonary edema
7. Nocturia
8. Paroxysmal noctural dyspnea
According to the New York Heart Association: Functional Classification of person with cardiac disease, how would class 1 be described?: No limitation of physical activity.
Ordinary physical activity does not cause fatigue, dyspnea, palpitation, or anginal pain.
According to the New York Heart Association: Functional Classification of person with cardiac disease, how would class 2 be described?: Slight limitation of physical activity.
No symptom at rest.
Ordinary physical activity results in fatigue, dyspnea, palpitation, or anginal pain.
According to the New York Heart Association: Functional Classification of person with cardiac disease, how would class 3 be described?: Marked limitation of physical activity.
Usually comfortable at rest.
Ordinary physical activity results in fatigue, dyspnea, palpitation, or anginal pain.
According to the New York Heart Association: Functional Classification of person with cardiac disease, how would class 4 be described?: Inability to carry in any physical activity without discomfort.
Symptoms of cardiac insufficiency or of angina may be present even at rest.
If any physical activity is undertaken, discomfort is increased.
What are the diagnostic tests for acute CHF and Pulmonary edema? (8): 1. History and physical examination
2. ABGs, serum chemistries, liver function test
3. Chest X-ray
4. Hemodynamic monitoring
5. Twelve-lead ECG
6. Echocardiogram
7. Nuclear imaging studies
8. Cardiac catherization
What are the collaborative therapies for acute CHF and Pulmonary edema? (9): 1. Treatment of the underlying cause
2. High Fowler position
3. Oxygen by mask or nasal catheter
4. Cardiac monitor and oximetry
5. Drug therapy
6. BP, HR, RR, PAWP, Urinary output at least q1hr.
7. Daily weights
8. Possible cardioversion
9. Endotracheal intubation and mechanical ventilation
What are the drug therapies for acute CHF and Pulmonary edema? (7): 1. Morphine IV
2. Diuretic IV
3. Digitalis IV
4. Nitroglycerine IV
5. Nitroprusside IV
6. Inotropic therapy
7. Nesiritide (Natricor)
What are the diagnostic tests for Chronic CHF? (10): 1. History and Physical examination
2. Determination of underlying cause
3. Serum chemistries, liver function test
4. Chest x-ray
5. Echocardiogram
6. Echocardiography
7. Exercise-stress testing
8. Nuclear imaging studies
9. Hemodynamic monitoring
10. Cardiac catherization
What are the collaborative therapies for Pt. with Chronic CHF? (10): 1. Treatment of the underlying cause
2. Oxygen therapy at 2-6 L/min
3. Rest
4. Drug therapy
5. Daily weight
6. Sodium-restricted diet
7. Intraaortic balloon pump
8. Ventricular assist device
9. Cardiac resynchonization therapy
10. Cardiac transplant
What are the drugs used in the treatment of CHF? (7): 1. ACE inhibitors
2. Diuretics
3. Inotropic drugs
4. Vasodilator drug
5. Antiarrhythmic drugs
6. Beta-Adrenergic blockers
7. Human B-type natriuretic peptide
What are some examples of inotropic drugs? (4): 1. Digitalis preparations: Digoxin (Lanoxin)
2. Beta-Adrenergic agonists: Dopamine, Dobutamine
3. Phosphoesterase inhibitors: milrinone (Primacor)
4. Calcium-sensitizing agent: levodimendan (Simdax)
What are manifestations of digitalis toxicity in the cardiovascular system? (3): 1. Bradycardia or tachycardia
2. Pulse deficit
3. Arrhythmias
- premature ventricular contraction
- first-degree atrioventricular blocks
- atrial fibrillation
- junctional rhythms
What are manifestations of digitalis toxicity in the gastrointestinal system? (5): 1. Anorexia
2. Nausea
3. Vomiting
4. Diarrhea
5. Abdominal pain
What are manifestations of digitalis toxicity in the neurologic system? (5): 1. Headache
2. Drowsiness
3. Confusion
4. Insomnia
5. Muscle weakness
What are manifestations of digitalis toxicity in the visual system? (4): 1. Double vision
2. Blurred vision
3. Colored vision (green or yellow)
4. Visual halos

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Number of cards 33