Heart Failure with Atrial Fibrillation case study-NU 475 – Flashcards

Previous MI, HTN, CAD, cardiomyopathy, alcohol/drug/tobacco use, valvular disease, congenital defects, cardiac infections & inflammations, dysrhythmias, DM, fam hx, obesity, severe lung disease, sleep apnea, hyperkinetic conditions (Ex: hyperthyroidism), age, male

Peripheral fluid overload--congestion/edema, JVD, enlarged liver, abdominal ascites, weight gain

1+ --2mm 2+ --4mm 3+ --6mm 4+ --8mm Brawny edema--0mm, firm or hard, tissue cannot be dispalaced

pulmonary fluid overload--dyspnea, crackles

multiple areas in atria initiate rapid, irregular electrical stimuli-->inability to see clear P waves and can cause irregular QRS complexes if one escapes through

administer prescribed dose of Digoxin (slows HR and increases force of contraction) -Monitor apical pulse

Allows measurement of the pressures within the right atrium and pulmonary artery. Used in management of acutely ill clients in CC setting.

Useful in the dx of HF since an enlarged heart and pleural effusions can be visualized.

Beneficial in detection of cardiac valvular defects, chamber enlargement, or pericardial effusions

Valuable in determining underlying myocardial ischemia or damage, as well as associated dysrhythmias. Not useful in dx existence or extent of HF

Lowers BP (reduces afterload) and workload on heart is reduced. Shown to prolong survival in pt with HF. Dilates vessels, improves renal blood flow, decreases fluid volume, promotes reverse remodeling, decreases morbidity and mortality -Monitor BP; adverse effect: angioedema (s/s: facial, perioral, epiglottal and/or extremity swelling, intestinal pain, difficulty breathing)

Used to prevent constipation and straining at stool. Pt. with HF should avoid Valsalva maneuver to prevent vagal stimulation which can result in bradycardia -Assess bowel sounds and activity daily

Used to prevent retention of excess body fluid. Decreases fluid volume, decreases preload, decreases pulmonary venous pressure, relieves edema

Therapeutic level is 0.5-2.0 ng/mL -Greater than 2.4 is toxic

ACE-I, ARBs Diuretics-High-ceiling, potassium-sparing Human B-type natriutetic peptides Nitrates Beta-adrenergic blockers Inotropics: Beta-adrenergic agonists, phosphodiesterase inhibitors, calcium sensitizers, Digoxin (Lanoxin)

Reduces cardiac afterload, leading to increased CO; dilates arterioles of kidneys, leadign to increased renal perfusion and fluid loss; decreases BP; decreases preload; relieves dyspnea

Promotes reverse remodeling; decreases afterload; inhibits SNS; decreases morbidity and mortatlity Adverse effects: orthostatic hypotension

Increases contractility (+inotropic); increases CO; increases HR (+chronotropic); produces mild vasodilation; increases stroke volume and CO; promotes vasodilation

decreases anxiety; decreases preload and afterload

Hypokalemia-contributes to digitalis toxicity Ginseng may falsely elevate digoxin levels. St. John's wort decreases the absorption of digoxin and thus decreases the serum digoxin level. Psyllium (Metamucil) may decreases digoxin absorption. Hawthorn may increase the effect of digoxin. Licorice can potentiate the effect of digoxin. It promotes potassium loss (hypokalemia), which increases the effect of digoxin. It may cause digitalis toxicity. Aloe may increase the risk of digitalis toxicity. It increases potassium loss, which increases the effect of digoxin. Ma-huang or ephedra increases the risk of digitalis toxicity. Goldenseal may decrease the effects of cardiac glycosides and increase the effects of antidysrhythmics.

-anorexia & N/V/D (early signs), confusion, fatigue, diplopia & halo of light around objects (late signs), irregular pulse, tachycardia -check for potassium <3.0 mEq/L Tx: Digibind

Ca++ binds with digitalis to decrease effects of digitalis. Hypercalcemia can cause depressed cardiac activity, dysrhythmias, cardiac arrest. Hypomagnesemia is contributing factor to digitalis toxicity; can cause dysrhythmias, hypotension and tachycardia.

Life-threatening complication of HF is result of increasing pressure in the left ventricle causing fluid to leak across pulmonary capillary membranes. S/S: crackles in lung bases, frothy & blood-tinged sputum, cyanosis, cold & clammy skin, anxiety, severe dyspnea