Heart failure is a Cardiac output problem (Medical management (Lifestyle…
Heart failure is a Cardiac output problem
CAD, HTN, Renal disease, valvular dysfunctions, diabetes, atherosclerosis,
Decreased blood ejected from the ventricles
Baroreceptors sense it
Sympathetic nervous system is activated
release of epinephrine and norepinephrine
Increase heart rate and contractility
SNS: causes vasoconstriction in skin, GI and kidneys
Decrease renal perfussion causes release of renin
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RIGHT SIDED HEART FAILURE
congestion in the tissues and viscera. Heart cant accommodate all the blood that returns to it from the venous circulation
Jugular venous distention
hepatomegaly (venous engorgement in the liver)
Gastrointestinal distress because of pressure
pressure on diaphragm (respiratory distress)
Anorexia, nausea and abdominal pain
YOu can see right sided HF on the body
LEFT SIDED HEART FAILURE
Left ventricle cant pump blood out into aorta -blood volume builds up in left atrium - pulmonary blood volume increase in the lungs - forces fluid into capillaries, tissues and alveoli - pulmopnary edema and impaired gas exchange
paroxysmal nocturnal dyspnea
Low o2 sats
Dizzines, confusion, anxiety (low perfusion to the brain)
Weak peripheral pulses and tachycardia
YOU can hear Left sided HF
they can be violent due to confusion form lack of O2, Give O2, start IV, and start 80-100 IV push Lasix over 5 mins
Col pulmanale is not right sided HF, it just looks exactly like it. It is caused by COPD
Usually HF patients are not hospitalized, unless they become decompensated usually caused by diet. EX: patient goes to get chinese food and sodium caused fluid retention.
If you work night shift you weigh patient anyway even if morning did weighing. We need to make sure we catch weight fluctuations. CNA should not be taking weights
CBC, BNP(KEY DIAGNOSTIC)
PO and IV meds
Low sodium, no smoking, limit fluids, weight reduction and exercise
O2: if huffing and puffing give 100% cuz he is about to die, if can talk and calm start at 2L
Implantable cardioverter defibrillator
Cardiac resynchronization therapy (CRT)
Goal is to treat cardiac symptoms before respiratory because they cause it.
Promote vasodilation and diuresis - decrease pre and after load. Promote excretio of sodium and retain potassium.
If angioedema occurs: stop immediately
Block adverse effects of SNS. Relax blood vessels, decrease BP and decrease pre and afterload. Decrease cardiac workload.
Remove excess extracellular fluid by increasing the rate of urine
(Hyperkalemia and Hyponatremia with Spirolactone)
Make sure not allergic to sulfites for lasix. Monitor for K+ levels
Block vasoconstricting effect of angiotensin II at receptors
Hydralazine and Isosorbide Dinitrate
Dilates blood vessels. Decreases BP and afterload
Increases force of myocardial contraction and slows conduction on AV node. Improves contractility and increases left ventricular output.
Bradycardia and Digitalis toxicity
Digitalis toxicity: anorexia, nausea, visual disturbances, confusion and bradycardia
Always check Apical pulse. EVen at 60 you give it. 59 hold it and return 30 mins later and reassess to see if HR went up. Make sure K+ is normal and not hypokalemic. Assess what they ate for breakfast or how much of it did they eat. If they didnt eat, its a sign of anorexia, N/V, halos.
Normal level is 0.5-1.5 ish basically after 2.0 they are toxic.
watch for orthostatic hypoT
Do not mix with ED drugs
If you gain more than 3lbs in 48hours or 5lbs in a week. or if you see a trend of weight going up steadily then most likely decompensation. If gained 5lbs in 5 days you report.