Test Your Knowledge CHF/ Cardiac Inflammation

A: CHF 1. You have taught a patient with CHF about low sodium diets. On return to the clinic, he/ she has gained 6 lb over the last 4 days. The patient insists they are following the diet. What would you do next? State your rationale. 2. What happens to heart chamber pressures in CHF? In the CHF patient, what does JVD represent? chamber pressure increases with CHF, JVD represents increased in right sided atrial pressure 3. What is Lasix and Vastotec? How would using these together benefit the patient with CHF? As the nurse, how would you monitor for effectiveness in these drugs? vasoten (ace inhibitor) can vasodilate, decreases angiotensin and uptake of sodium, approaching fluid balance in 2 different ways. Ask about dyspnea and fatigue to see if they have improved to know if med is working. 4. Review the following medications: Morphine, Valium, Intropin, Tridil. What is the therapeutic use of these drugs in the patient with CHF? Intropin-dopamine , tridil-nitroglycerin. Dopamine increases Bp, usually given to people with severe Hypotension. Don’t give in CHF. Valium is just antianxiety med, do not give for CHF. Morphine reduces preload to reduce workload of heart and anxiety. Give to patient with acute CHF and are anxious about getting enough air. Nitroglycerin vasodilates, no antianxiety properties, can be used in CHF but is not drug of choice. 5. What is Nipride? How is it used in the patient with CHF? What is a major side effect that would be reason for the nurse to titrate the dose? Give rationale. Powerful vasodilator used for management of acute CHF. IV drug. Monitor blood pressure carefully. One of the indications to titrate (adjust dose of) nitride is decrease BP. Systolic has to be 90 or greater and MAP greater than 60 for adequate renal perfusion (risk for ischemic changes) 6. Develop a teaching plan for the patient with CHF. What key things should you teach the patient with CHF? Provide rationale. Daily weights and if you gain more than 3 pounds over 2 days. Weigh same time, same clothes, same scale. Low sodium diet and hidden sources of sodium. A little about the pathology. Meds, activity rest, etc.

Since they already have weak heart. Toxicity? Answer below Instruct to take pulse before they take digoxin. Long term therapy is Captopril. diuretic effect. calcium channel blocker.controls heart rate. The higher the preload the higher the afterload. How does potassium affect Digoxin? IF taking Digoxin. B: Infective/ Inflammatory Heart Disease 1. Decreases blood pressure. Captopril-ace inhibitor. Teach Signs of worsening CHF because this means med isn’t being effective. Dental work can knick patients gum and become a portal for bacteria. 11. If its less than 60 check with doctor before taking it.nausea and comiting.7. So if you can manage preload you can manage afterload. What is Dobutrex. What is preload? What do you want to do to preload in the patent with CHF? State rationale. Cardizem. don’t just not take med without consulting doctor. vasodilates. Any diuretic. 9. Decreased heart rate. What is Coreg? Initially what does this drug do to the symptoms of CHF? What are major side effects of this drug that require immediate notification of the MD? State rationale. . Cardizem and Captopril? Which of these are used in the client with CHF? Which one is for long term therapy? What should you teach the patient regarding these drugs? Dobutrex-decreases preload. What is infective endocarditis? What is the most common cause? What healthcare practices can contribute to the development of this disease? Most common cause is strep. Increased afterload increases workload of heart. when should the patient contact the doctor? What is Hydrodiuril? How does this medication affect potassium? What are some evidences of Dig. If it gets below 90 contact doctor so we can protect renal perfusion. even potassium sparing still makes body loose potassium. Used for management of CHF. Dental. What is Natrecor? How does It work on a physiolgocal basis to improve symptoms of CHF? Used for acute decompensated CHF.decompensation-worsening dyspnea and SOB. What nursing action can you take to accomplish your goal? Amount of stretch heart will do before contraction. seeing yellow hallows. 10. 8. monitor BP. Use dobutrex and captopril the most for CHF. improves flow to kidneys. Ask patient if they have had recent dental work or sore throat. Teach for dig toxicity. Put patient in semi fowlers (45 degrees head of bed).

3. maintain fluid balance.2. nodules. 8. One of the risks of infective endocarditis is embolization to the kidney. purple or red. had as kid but can show signs and symptoms as adult. Contact doctor. Continue to monitor. How would you assess for a pericardial friction rub? Sound like rubbing hands together. 4. James way lesions-flat painless. Your patient with pericarditis has acute pain from inflammation. Signs is polyarthritis. Typically affects valves of heart . 5. give 800 mg. What non collaborative nursing action can you take to reduce the pain? State rationale. Not isolated hypertension (in elderly). Do multiple EKGS. What is rheumatic fever? What is the most common etiology? What musculoskeletal problems can occur with this disorder? Acute inflammatory condition of heart. Position patient in leaning forward or on their left. Less than 10 change between hearing is normal. Puts pressure on heart that can cause cardiac tamponade which is an emergent situation because it is squeezing on heart causing difficulty of blood to get into heart and out. Review use of diaphragm and use of bell. In normal pericarditis there is no squeezing but high pressure can cause the back up of fluid causing cardiac tamponade. Example is cardiac tamponade. greater than 10 is abnormal. Doctor may want BUN and creatinine. Reduce risk by pericardial window to let fluid out which markedly decreases cardiac tamponade. do? Sudden onset of flank pain. You are caring for a patient with pericarditis. small lesions found on toes or fingertips. Any patient with pericarditis one of main goals is to keep patient at rest to conserve oxygen and workload of heart. He asks you why he is getting so many EKG’s What do you plan on telling him? What drug is best to decrease pain from inflammation in the patient with pericarditis? Inflammation of pericardial sack. ecchymosis. 6. JVD you’ll see with increased atrial pressure which means that heart is being squeezed down on so heart cannot fill effectively which can cause cardiac tamponade. 7. as the nurse. Can be latent. you would expect to find generalized changes across EKG. found on palms and soles of feet. What are some assessment findings which are specific to infective endocarditis? Ossler’s nodes-painful. do multiple EKG’s to see if problem is resolving. Motrin is best to decrease pain and inflammation. What is pulsus paradoxus? How do you assess for this disorder? What is the “ normal” level for pulsus paradoxus and and what level is it considered abnormal according to your book? What is the significance of JVD in the patient with pearicarditis? Decreased or absence systolic BP with inspiration. What would be a evidence that this is happening? What should you.

age of the client and therapeutic management requirements of each. 14. Review the other valves. Tricuspid stenosis 12. 10. 11. What are they? What changes occur in the heart with each? Which one is associated with sudden cardiac death? Which one is the patient most likely to be recommended for a cardiac transplant? See turbulent flow that puts as major risk for clotting. Related to infection. There are three types of cardiomyopathies.develop fibers in muscle. Pigskin valve doesn’t last as long Metal valve is long term. What is the long term management regime for a patient with rheumatic fever? Long term antibiotics for 4 to 5 years. 13. but have to be on anticoagulant (Coumadin) for rest of life. Dilated. blood flows forward but not enough and regurgitation is weak and open valves where blood can flow backward. Restrictive. Not considered cardiac tamponade yet.9. What is the difference between a biological (pigskin) valve and a mechanical valve? Consider life of the valve. In valve disorders. 16. can do surgery to remove part of muscle mass and relieve pressure off heart but it is considered major surgery. what associated disorder is common in all three types of cardiomyopathies? What do you plan on teaching the client regarding this associated disorder? Structural changes in heart. Hypertrophic. restrictive and hypertrophic are three types and all involve some degree of CHF. What type of blood flow do you have with valvular disorders? What first line drug is commonly used in valvular disorders? State rationale. discuss what happens to blood flow and symptoms you should observe for: Mitral stenosis. For the patient with cardiomyopathy. 15. what is stenosis? Regurgitation? What happens to blood flow in each of these? What happens to cardiac output in both of these? What happens to circulating oxygen? What is a common indicator of lack of oxygen to the tissues? Stenosis is stiff valves. For each of these disorders. needs a lot of force to get blood out. Mitral valve stenosis causes blood to back up in left atrium and ultimately the lungs. Dilated-overall decrease pressure. Mitral is typically the most common one involved. If child bearing woman you can’t take Coumadin. What happens to blood flow in patients with cardiomyopathy? What is the therapeutic advantage to the use of heparin in patients with cardiomyopathy? . Do blood cultures always before antibiotics if both are offered. Aortic stenosis.increase in muscle mass that starts to invade chamber. Do CHF teaching.

normal is 4 or 5. lasix and potassium sparing. Ischemic pain in heart (pain due to decreased oxygenation). Right sided most common cause is pulmonary hypertension (increased pressure in lungs. Lasix use cautiously in known renal disease. Digitalis increases contractile force of heart. . EKG-ventricular hypertrophy. Remodeling (alteration in the way the heart looks as tissue is replaced with scar tissue) occurs and you start to see enlargement in area and decrease in function.believe patient (if patient is gaining weight but says he is following diet start checking patient knowledge or hidden levels of sodium in canned foods. just not as much (spiralactone). -Assessment. most common cause is stiffening in lungs caused by damage from smoking or asthma). Eventually patient develops CHF. ask ADL’s. Assess ability to do ADL’s -Signs of left sided. dyspnea when they are sleeping (patients start increasing pillows to keep head up to help with breathing-pillow orthopnea).diuretic. K sparing-still loose potassium. Make it applicable to them (watch words like “may” because its not concrete).BNP. Put patient on medications like vasodilators to decrease workload of heart so the whole remodeling process is minimized to help reduce CHF. enlarged heart is 6 or 7). leg edema (not only a symptom of right sided failure so pick JVD for right failure over leg edema). fatigue. cardiac cath-change in pressure. but over time one will lead to the other and you’ll have both. increased voiding. -Patient teaching. decreases lung expansion which decreases oxygen intake). teach patient to rinse off canned vegetables). decrease in ejection fraction. As tissue dies from MI. -Labs for heart failure. -MEDS. decreased appetite and nausea (gut is engorged with blood causing decreased motility). it is replaced with scar tissue. -Signs of right sided failure-jugular vein distention (caused by right side atrial increased presuure). pleural effusion (fluid in pleural space.-Know key lab values in CHF -CHF-heart is unable to pump adequately.hear PMI (apical pulse) lower (around ribcage. You can have right sided or left sided failure. echo increased chamber pressure. Lasix causes potassium to drop (enhances digoxin). SOB with activity or rest.Pulmonary congestion. etc. Make it on level that patient can understand (5 th grade level). Chest x-ray-cardiac enlargement. Left sided failure most common is Hypertension (the silent killer) and myocardial infraction (left side is more susceptible to MI’s).

. Ask about dyspnea and fatigue to see if they have improved to know if med is working. JVD represents increased in right sided atrial pressure #3-vasoten (ace inhibitor) can vasodilate. start talking with them about label reading and maybe ask to bring in canned foods. decreases angiotensin and uptake of sodium.it is what you see that is actual (don’t put at risk for?) #1.assess sodium.-Nursing diagnosis. -do blood cultures before starting antibiotics. talk about hidden sodium #2.chamber pressure increases with CHF. approaching fluid balance in 2 different ways.

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