Heart Failure with A Fib

Heart failure occurs most commonly in clients over the age of 60, and occurs more commonly in males than females. 1. In addition to these two risk factors, which question will provide the nurse the best data about any additional risk factors for heart failure? A) "Do you have any chronic lung disorders?" INCORRECT Lung disorders, such as asthma and chronic bronchitis, are not commonly associated with an increased risk for heart failure. However, they can precipitate heart failure. B) "Have you ever had a heart attack?" CORRECT Myocardial infarction, coronary artery disease, and ischemic heart disease are among the most common underlying causes of heart failure. In fact, the most common cause of heart failure is myocardial infarction. The nurse should also ask Bert if he has hypertension, another primary underlying condition causing heart failure. C) "Do you have varicose veins?" INCORRECT Varicose veins are not associated with an increased risk for heart failure. D) "Have you ever had low blood pressure?" INCORRECT Systemic hypertension increases the work of the heart and is one of the primary underlying conditions causing heart failure. However, hypotension is not considered a contributory risk factor for heart failure. Points Earned: Correct Answer(s): 1.0/1.0 B Clinical Manifestations 2. Which assessment finding would indicate to the nurse that Bert is experiencing right­sided heart failure? A) Dyspnea. INCORRECT Dyspnea and lung crackles are manifestations of left­sided heart failure. Left­sided heart failure results in pulmonary congestion due to the inability of the left ventricle to pump blood out of the heart and into the systemic circulation effectively. B) Tachycardia. INCORRECT Tachycardia is a manifestation of left­sided heart failure as the heart attempts to compensate for diminishing cardiac output. C) Edema. CORRECT Right­sided heart failure results in peripheral congestion due to the inability of the right ventricle to effectively pump blood out of the heart to the lungs, causing edema, JVD, an enlarged liver, abdominal ascites, and weight gain. D) Fatigue. INCORRECT Fatigue and anxiety are manifestations of left­sided heart failure. As the tissues receive less oxygen to meet oxygenation needs, the client struggles to obtain adequate air. Points Earned: Correct Answer(s): 0.0/1.0 C Cardiac Dysrhythmias Remember: Left­sided heart failure results in pulmonary fluid overload, and right­sided heart failure results in peripheral fluid overload. Left­sided heart failure usually occurs first, and can trigger right­sided heart failure. Upon admission to the Cardiac Nursing Unit, Bert's dyspnea continues. He reports fatigue, but denies chest pain. The nurse places Bert on oxygen via a nasal cannula at 3 L/min and a cardiac telemetry monitor. The ECG recording shows no discernible P waves, and a rapid, irregular ventricular response (QRS complexes). This corresponds with Bert's pulse rate, which is 136 and irregular.