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Heart FailureMedical Surgical Nursing

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ACC/AHA stages of heart failure are graded A, B, C, and D. At what stage(s) does a patient have heart failure?
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C and D. The major difference between C and D is that patients classified as D have significant signs/symptoms of heart failure
ACC/AHA stages of heart failure are graded A, B, C, and D. At what stage(s) does a patient have risk factors for heart failure, but don't actually have it?
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A and B, the main difference between the two is that A has a high risk of developing structural heart dysfunction, B actually has a heart dysfunction but no heart failure
What levels of BNP are suggestive of heart failure?
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BNP between 100-500 pg/ml are suggestive, over 500 is highly probable
What is the major difference between the New York Heart Association (NYHA) classification of heart disease and that of the ACC/AHA?
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NYHA: based on activity tolerance ACC/AHA: based on risk of developing heart failure and progresses to severe heart failure
_______ is useful in differentiation whether the cause of dyspnea is heart failure or respiratory in origin.
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BNP
What are the four core measures established by JCAHO for the management of heart failure?
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-Written d/c instructions that includes diet, activity level, meds, weight monitoring, follow-up appointment and symptom management. -Left ventricular function must be documented -ACE inhibitors should be prescribed for patients with systolic dysfunction
________ are the main type of drugs used to decrease intravascular volume
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Diuretics
_________ is a treatment for volume overload that is utilized in patients with heart failure and renal insufficiency. Up to 500 mL of fluid is removed an hour without changing mean arterial pressure.
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Ultrafiltration/aquapheresis
How can venous return be decreased (preload) in a patient with heart failure?
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Placing a patient in high-fowler's with the feet horizontal or dangling bed side, and/or administration of IV nitroglycerin
What medication is administered to reduce afterload in a patient with heart failure?
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IV sodium nitroprusside (Nipride)
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At what point should inotropic agents be integrated into care of a patient with heart failure?
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When they develop abnormal heart rates, dysrhythmias, becomes hypoxic, hypotensive
What is the desired Pulmonary Artery Wedge Pressure (PAWP) to ensure adequate cardiac output?
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14-18 mm Hg
________ is a nonpharmacologic therapy that coordinates right and left ventricle contractility through biventricular pacing. It improves quality of life in heart failure patients by allowing increased exercise capacity and reduction in overall symptoms.
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CRT-cardiac resynchronization therapy
_________ diuretics are typically the first choice in treating symptoms of chronic heart failure because of their convenience, safety, low cost and effectiveness. They inhibit sodium reabsorption in the distal tubule, promoting excretion of sodium and water.
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Thiazide
_______ diuretics act on the ascending loop of Henle to promote sodium, chloride, and water excretion.
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Loop diuretics
What are the s/s of digitalis toxicity that a nurse should monitor for?
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Anorexia, nausea, vomiting, yellow vision or other visual disturbances. Also causes dysrhythmias but this is a late sign
What typically causes digitalis toxicity?
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Hypokalemia from concurrent use of diuretics increases the effect of digitalis
What conditions predispose a patient to digitalis toxicity?
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People that are elderly or have kidney disease, liver disease, or electrolyte imbalances like hypercalcemia, hypokalemia or hypomagnesemia
What is the antidote for a life-threatening case of Digitalis toxicity?
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Digibond
How is edema associated with heart failure treated non-pharmacologically?
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Restriction of sodium in the diet
What is the recommended daily intake of sodium for a patient that has heart failure?
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2.5 g
  
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