Cardiac 2 Study Guide

Congestive Heart Failure Other text books call it systolic failure/diastolic failure Definition: the heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body’s tissues - HF decreases the pt’s quality of life / Poor prognosis / terminal illness - implement measures to make the heart pump more effectively  Causes:  Coronary Artery Disease (CAD ) cause ischemia (reduced blood flow) to the heart (tissue death) > loses elasticity (scar tissue) > losses ability to pump  Hypertension (HTN) > hypertrophy related to an increase in SVR/afterload > losses ability to pump  Myocardial Infarction (MI) cause ischemia to the heart (tissue death) > losses elasticity (scar tissue) > loses ability to pump  Mitral valve stenosis > muscle needs to work hard to push the blood through  Mitral valve regurgitation Pts can have left sided HF or right sided HF / Pts can have both right & left sided HF Left Ventricular Failure  Left ventricle loses the ability to pump  Decreased cardiac output > S/S: hypotension, pallor, decreased peripheral pulses, confusion, altered mental status,  Blood “backs up” into the lungs  Eventual symptoms of pulmonary congestion & pulmonary edema  When you listen to a patient’s lung you will hear fine crackles (cardiac crackles / rales)  S/S: paroxysmal nocturnal dyspnea (sudden awakening with shortness of breath), cough, orthopnea (difficulty breathing when lying flat), exertional dyspnea (shortness of breath due to minimal to moderate activity), pale, cyanosis (bluish or grayish color of the skin, nails, lips or around the eyes), blood tinged sputum, elevated pulmonary capillary wedge pressure  Symptoms are in the lungs  Pulmonary Edema: is a manifestation of severe HF but it can also occur when the left ventricle stops working due to acute ischemia – if the left ventricle can’t pump or contract, blood can back up to the lungs causing pulmonary edema – can happen more gradually if someone is in HF – the fluid leaks from the alveoli into the pulmonary tissue  S/S PE: extreme anxiety, tachypnea (fast breathing), air hunger (the use of accessory muscles to breath – neck & abdominal muscles), frothy pink tinged sputum, pt will be cold & diaphoretic with an elevated CVP (Central Venous Pressure)  Treatment for PE: IV diuretics, we can give Lasix 40 mg over 1 to 2 minutes & we can repeat the dose, This study source was downloaded by 100000780339733 from CourseHero.com on 05-09-2022 01:48:11 GMT -05:00 https://www.coursehero.com/file/64995588/Cardiac-2-Study-Guide-docx/  When pt’s go into PE: one of the first things to do is sit them way up in fowler’s position, put them on oxygen, get their oxygen saturation, sometimes we need to draw their blood gases & we can also give morphine 2mg to 5 mg IV push (decreases afterload but especial preload – dilates arteries & veins)  We can cause venous dilation, so less blood is going to the right side of the heart, b/c when it’s done with the right side it goes to the lungs  Keep in mind that pts with PE: may need to be intubated