Chaper 20 Study Cards
Chaper 20 Study Cards
Chaper 20 Study Cards
• Chapter 20:
Heart Failure
• Heart Failure
• New York Heart Association (NYHA) Functional Classification
• Measures the effect that symptoms (fatigue and dyspnea) of heart failure have on physical activities:
– Class I: No limitation of activities
– Class II: Slight limitation of activities, no symptoms at rest
– Class III: Marked limitation of activities, symptoms at rest
– Class IV: Not able to do any activities without symptoms; symptoms at rest
• The ACC/AHA Guidelines for Stages of Heart Failure
• Four stages enhance the NYHA Functional Classification system
• Used to outline the prevention, diagnosis, clinical management, and prognosis of patients with heart
failure
• Only stages C and D correlate with the NYHA Functional Classification system
• Compensatory Mechanisms in Heart Failure
B. Act as a vasodilator
C. Control blood pressure
D. Increase renal perfusion
• Answer
B. Act as a vasodilator
Rationale: Nesiritide is a BNP approved by the FDA for its ability to vasodilate (reduce afterload). Caution
should be used if the systolic blood pressure is <90 mm Hg. The medication does not increase renal perfusion,
improve diuresis, or decrease preload. Dopamine is the drug that can be used to increase renal perfusion and
improve diuresis. Nitrates can be used to reduce preload. Nesiritide is very expensive and is not used to
control blood pressure. Hydralazine is used for blood pressure control and helps reduce afterload.
• Strategies to Manage Heart Failure to Decrease Incidence of Rehospitalization
• Educate client on sodium restriction and importance of label reading.
• Explain why the client should avoid alcohol.
• Explain how walking 15 to 20 minutes/day will improve energy level.
• Explain importance of taking daily weights and taking prompt action to resolve fluid retention.
• Educate on a system to ensure medications are taken and recorded.
• Oxygenation/Ventilation Outcomes
• Hgb 10 g/dL or greater
• Pulse oximetry 90% or greater
• No dyspnea at rest
• NYHA class at baseline or better
• BNP within normal range
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• Circulation/Perfusion Outcomes
• Cardiac index >2.0
• Weight at baseline or better
• Urine output >30 mL/hr
• Mental status at baseline
• Vital signs normal
• Peripheral pulses intact
• Fluid/Electrolyte Outcomes
• Baseline BUN and serum creatinine and GFR
• Electrolytes within normal range
• Baseline weight or better
• No edema present
• No ascites present
• Mucous membranes moist and intact
• Teaching/Discharge Planning Outcomes
• Adequate verbal understanding of care and follow-up
– States ways to meet sodium restriction
– States process to weigh self daily to ensure accuracy
– States what to do if weight is 3 to 5 lb over baseline
– States will abstain from smoking and alcohol
– States realistic plan for exercise
– States plan to ensure medication compliance
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