Reducing Readmissions for Heart Failure Post test

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What is your name? (Last, first) *

Identify this as your post test *

Post test

Which is NOT a risk factor related to readmission to the hospital? *

Lengthy hospital stay

Older age

Elevated troponin

Elevated creatinine or BUN

How is heart failure diagnosed?

Lab values such as elevated creatinine, echocardiogram showing decreased Ejection Fraction (EF)

Elevated BNP, Echocardiogram showing systolic or diastolic dysfunction

Elevated BUN, creatinine and BP and ECG showing left ventricular hypertrophy

Echocardiogram showing decreased Ejection Fraction or diastolic dysfunction and elevated liver function tests

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Your patient presents with a history of heart failure, recent discharge from the hospital with HF and is currently at home with marked limitations in function due to dypnea on exertion. This patient would be diagnosed as: *

NYHA Class IV heart failure or Class D

NYHA Class III heart failure or Class C

NYHA Class II heart failure or Class B

NYHA Class I heart failure or Class A

Choose the BEST answer. Define the difference between compensated and uncompensated heart failure *

Uncompensated heart failure means the patient needs to be put on IV inotropic agents like dobutamine and compensated heart failure means patient doesn't need any more inotropic medications

Compensated heart failure means the patient's Ejection Fraction is now above 30% whereas uncompensated heart failure means the patient's Ejection Fraction is below 30%

uncompensated heart failure means a patient is symptomatic at rest and unable to perform ADLs or any activity; compensated heart failure means the patient is not symptomatic at rest although they may be on medications to control their heart failure.

Uncompensated heart failure means a patient needs to be in IV las

Signs/Symptoms of right heart failure include *

Chest xray with interstitial edema, poor left ventricular ejection fraction, elevated BUN and elevated creatinine

LE edema, CXR with interstital edema, dyspnea, elevated creatinine

CXR with pulmonary edema, Shortness of breath, paroxysmal nocturnal dyspnea, elevated BUN

LE edema, jugular venous distention (JVD), dyspnea and possibly ascites

What are the two major causes of left heart failure? *

hypertension and myocardial infarction

diabetes and COPD

chemotherapy/radiation to chest and diabetes

viral cardiomyopathy and coronary artery disease

Signs/symptoms that are diagnostic of left heart failure include: *

CXR showing edema, elevated creatinine

Inability to lay flat, CXR with edema, weight gain > 2 lbs in 24 hours

Shortness of breath with activity, swollen liver, wt gain > 2 lbs in 24 hours

CXR showing edema, elevated bilirubin

Your patient is a classic "repeat readmission" patient. Some of the techniques for self management of the disease to prevent readmission include (check all that apply): *

monitoring urine output and fluid intake daily as they do in the hospital

reminding patients to take their medications daily

doubling lasix every other day

daily weighing of patient and daily monitoring of perceived exertion or dyspnea with activity

Required

What are the three most common medications used in the medical treatment for heart failure? *

diuretics, beta blockers and ACE inhibitors

Inotropes like dobutamine, ACE inhibitors like lisinopril, diuretics like lasix

Beta blockers, calcium channel blockers and diuretics\

Inotropes like dobutamine, ARBs like valsartan, diuretics like dyazide

Which days following discharge appear to be most common for readmission? *

day 1

within 7-10 days

15-30 days

days 12,13,14

Patients with a diagnosis of heart failure and a history of pulmonary edema but who have a preserved ejection fraction (EF 50% or greater) often have a diagnosis of *

Diastolic dysfunction and need to monitor fluid intake, changes in dyspnea with sleeping and with activity and often take diuretics regularly

Systolic dysfunction and need to monitor fluid intake, changes in dyspnea with sleeping and with activity and often take diuretics regularly

Right heart failure as there is pulmonary edema

Right heart dysfunction as there is backup into the lungs with the pulmonary edema but a preserved ejection fraction

What diagnostic test would you want to review the results (and is noninvasive) to determine if an individual has diastolic versus systolic heart failure? *

chest xray

echocardiogram

12 lead ECG

cardiac catheterization

Which is NOT a clinical indicator of poor outcomes and higher re-hospitalization? *

physical frailty

chronic kidney dysfunction

diastolic heart failure

smoking history

The Short Physical Performance Battery is an outcome measure with three components. Which is NOT a component of the battery? *

6 meter walk speed test

Modified rhomberg balance

Six minute walk test

Multiple chair rise

Patients who present to the ER in decompensated heart failure are often admitted. The following are signs/symptoms of decompensated heart failure that one should be aware of in the post hospitalization setting. Which is NOT one that is a sign of decompensated heart failure? *

Dyspnea at rest with resting tachycardia

Hypotension

Altered mentation with dyspnea at rest

Occasional PVCs (or occasional skips in the pulse) at rest

All of the following EXCEPT one are Readmission risk factors post hospitalization that have significant impact on readmission. Which one is NOT a risk factor? *

Age < 65

Hospital length of stay

Medical complexity

Impaired physical function

Role of physical and occupational therapy with heart failure EXCEPT: *

Managing diuretic intake and urine output

Early assessment

Education on activity and signs/symptoms of decompensation

Monitoring all activities

Key components of an initial evaluation in a patient with HF include all EXCEPT: *

Auscultation of lung sounds

Assessment of LE and peripheral edema

Assessment of vital signs with activity

Assessment of diaphragmatic excursion

What are key interventions for patients with heart failure to prevent rehospitalization? *

Limit exercise whenever a patient develops dyspnea

Sit to stand and endurance with walking exercises

Coordination activities, stair climbing training and instruction on dyspnea monitoring

Balance and upper extremity endurance activities

One of the patients you have been seeing for a few visits presents today reporting greater shortness of breath, and noticeably at rest, with more than normal dyspnea on exertion. You palpate the pulse and notice it is very fast, and very irregular. You take the resting vital signs and HR is 120 irregular irregular, and BP is lower than normal for this patient. Your plan of action would be: *

tell the patient to rest for the remainder of the day

contact the patient's MD or PA/NP and explain the new symptoms/signs and request action

Call 911 and have patient referred to hospital

Call the patient's family or spouse and make them aware patient not feeling well today

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