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Heart Failure, ReferencesIgnatavicius, D., Workman, L., Rebar, C., &…
Heart Failure
Patient Education
maintain an exercise routine
consume diet low in sodium, and possibly fluid restriction
refrain from smoking
follow medication regimen
ACE inhibitors can cause a dry cough
Notify provider if any substantial weight gain or any increased trouble breathing
Teach the patient how to monitor BP and HR
Education depending on what medications the patient is taking
Pathophysiology
Occurs when the heart muscle is unable to pump effectively, resulting in inadequate cardiac output, myocardial hypertrophy and pulmonary/systemic congestion.
Can be caused as a result of chronic cardiopulmonary problem (systemic htn, MI, pulmonary htn, dysrhythmias, valvular heart disease, pericarditis, cardiomyopathy)
Left sided heart failure
results in inadequate left ventricle output (cardiac output) and inadequate tissue perfusion
can be systolic heart failure (EF less than 40%, pulmonary and systemic congestion)
Or can be diastolic heart failure (inadequate relaxation or stiffening which prevents ventricular filling)
Right sided heart failure
results in inadequate right ventricle output and systemic venous congestion (peripheral edema)
Can also be high output heart failure or cardiomyopathy is a part of heart failure
Risk factors:
L sided
HTN, CAD, MI, angina, valvular disease (mitral and aortic)
R sided
L sided heart failure, right ventricular MI, pulmonary problems (COPD, pulmonary fibrosis)
High output
increased metabolic needs, septicemia, anemia, hyperthyroidism
Cardiomyopathy (leading to heart failure)
CAD, infection or inflammation, various cancer tx, prolonged alcohol use, heredity
Interventions
Monitor intake and output, daily weights
administer oxygen as prescribed/needed
Monitor VS, assess lung and heart sounds
Position patient in high fowlers, encourage bed rest, maintain heart healthy diet
Administer meds as prescribed
Meds
Diuretics
afterload reducing agents (ACE inhibitors, ang receptor 2 blockers, calcium channel blockers, phosphodiesterase 3 inhibitors)
inotropic (digoxin, dopamine, dobutamine)
beta blockers
vasodilators
hyperpolarization activated cyclic nucleotide-gated channel blocker
Human B type natriuretic peptides
anticoagulants
Assessment
s/s
Left sided
dyspnea, orthopnea (SOB while laying down), noctural dyspnea, fatigue, displaced apical pulse (hypertrophy), S3 heart sounds (gallop), pulmonary congestion (dyspnea, cough, crackles), frothy sputum (can be blood tinged), AMS, manifestations of organ failure (oliguria), nocturia
Right sided
JVD, ascending dependent edema, abdominal distention, ascites, fatigue, weakness, nausea, anorexia, polyuria, live enlargement (hepatomegaly) and tenderness, weight gain
Cardiomyopathy
fatigue, weakness, HF, dysrhythmias, s3 gallop, cardiomegaly, angina
Labs
hBNP
Troponin
CBC, UA, electrolytes, BUN, creatinine, liver function tests,
Diagnostics
hemodynamic monitoring (increased CVP, increased PAWP, increased PAP, decreased CO), a drop in SvO2 indicates worsening cardiac function
Ultrasound - used to measure the systolic and diastolic functioning of the heart
L ventricular EF: volume of blood pumped from L ventricle into arteries, 55-70%
R ventricular EF: volume of blood pumped from R ventricle to lungs, 45-60%
TEE
view of cardiac structures
chest x ray
ReferencesIgnatavicius, D., Workman, L., Rebar, C., & Heimgartner, N. (2021). Medical-surgical nursing:
Patient-centered collaborative care.
Evolve
, (10th ed.). ISBN: 978-0-323-61242-5
Holman, H. C., Williams, D., Johnson, J., Ball, B. S., Wheless, L., Leehy, P., & Lemon, T. (2019). RN Adult medical surgical nursing: Review module. Assessment Technologies Institute