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Heart Failure

Heart Failure. Karen Ruffin RN, MSN Ed. Incidence and Prevalence of Heart Failure. Leading cause of death in the US More than 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year. About 250,000 people a year die from heart disease.

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Heart Failure

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  1. Heart Failure Karen Ruffin RN, MSN Ed.

  2. Incidence and Prevalence of Heart Failure • Leading cause of death in the US • More than 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year. • About 250,000 people a year die from heart disease. • That means more than 680 Americans a day die from it!!!!!!!! • Women have a poorer survival rate then men

  3. Basic Needs: Oxygenation

  4. Oxygenation Oxygen is required to sustain life, primary basic human need The cardiac & respiratory systems function to supply the body’s oxygen demands Cardiopulmonary physiology involves delivery of deoxygenated blood to the right side of the heart & to the pulmonary system

  5. What are the 3 concepts in oxygenation? • Ventilation • Perfusion • Diffusion

  6. Electrical/conduction Mechanical/pump What are the 2 mechanisms that drive the function of the heart?

  7. What is Heart Failure? • Heart cannot pump enough blood to meet the metabolic demands of the body. • Results from changes in the systolic or diastolic function of the ventricles • There are many causes????? What are they???? http://www.americanheart.org/presenter

  8. Types of Heart Failure • Left Sided • Right sided • Systolic • Diastolic

  9. Left Sided Heart Failure • Most Common • LV dysfunction causes blood to back up through the left atrium and into the pulmonary system. • Common causes of left heart failure are: HTN, CAD, mitral and/or aortic valve disease, decreased tissue perfusion.

  10. What does that patient look like?????

  11. Right Sided Heart Failure • Most common cause is left sided heart failure. • Other causes MI or pulmonary HTN • RV dysfunction causes the blood to back up in the right atrium and then the venous circulation.

  12. What does that patient look like?????

  13. Systolic Failure • Defect in ventricular contraction • Left Ventricle loses ability to generate enough pressure to eject blood forward through the high pressure aorta – Decreased ejection fraction • Afterload – hypertension, cardiomyopathy, and valvular heart disease

  14. Diastolic Failure • Impaired ability of ventricles to fill • Decreased filling = decreased stroke volume Which + decreased WHAT? • Pulmonary congestion, pulmonary hypertension, with normal ejection fraction

  15. Heart Failure

  16. Diagnostic Studies • Goal: Assess the cause & degree of failure • History and Physical Exam • B-Type Natriuretic Peptide level (BNP). • elevated in acute and chronic heart failure • useful in following the response to treatment of congestive heart failure. • ABGs, Serum chemistries, LFTs • Chest x-ray • EKG • Echocardiogram • Nuclear imaging studies • Cardiac catheterization • Hemodynamic monitoring

  17. Lets Compare!!!!

  18. Classification of Heart Failure • Class 1 – No limitation of physical activity • Class 2 – Slight limitation – fatigue, dyspnea, palpitations • Class 3 – marked limitation. Comfortable at rest; ordinary activities cause symptoms • Class 4 – Inability to carry out any physical activity without symptoms – Pain/discomfort at rest

  19. Management and Outcome Measures • Use of ß-blockers at dischargeand during admission. • Use of aspirin at discharge and during admission. • Timely and appropriate acutereperfusion (thrombolysis or primaryangioplasty). • The use of angiotensin-convertingenzyme (ACE) inhibitors forpatients with depressed left ventricularsystolic function.Similarly, a minority of patients with AMIare potential candidatesfor this care process,

  20. Management and Outcome Measures • Theproportionof patients eligible for smoking-cessation counselingis relativelysmall, and ascertainment can be difficult, giventhe variabilityin documentation as well as practice. • Diet andexercise counseling • Cholesterol statusassessment and management.

  21. Congestive Heart FailureMedical Treatment Goals • Decreasing Intravascular Volume • Decreasing Venous Return • Decreases preload – decreases the volume to the left ventricle during diastole • Med: Diuretics – Lasix (furosemide) • Decreasing Afterload • Decrease systemic vascular resistance • CO increases • Pulmonary congestion decreases • Meds: Nitroglycerine (NTG); Morphine; Calcium Channel Blockers

  22. Congestive Heart FailureMedical Treatment Goals • Improving Gas Exchange & Oxygenation • Supplemental oxygen • Morphine • Severe cases – intubation / ventilation • Improving Cardiac Function • Increase cardiac contractility without increasing cardiac oxygen consumption • Hemodynamic Monitoring: • pulmonary artery pressure; pulmonary artery wedge pressure (14-18mmg HG) • Inotropic Meds: Digoxin • Inotropic meds used with hemodynamic monitoring: • Dobutamine • Inodilators: (inotropic & vasodilator): Milrinone

  23. Congestive Heart FailureMedical Treatment Goals • Reducing Anxiety • Sedative action of IV Morphine • Complication: respiratory depression • Determine & Treat Underlying Cause • Systolic or Diastolic failure • Aggressive drug therapy

  24. So what medical complications do you think can occur???????

  25. What basic needs are being effected? Why and how?

  26. Nursing Care for the Patient with Heart Failure • What will you assess???? • What are some potential nursing diagnosis????? • What are your goals for those diagnosis???? • What are your interventions????? • How will you evaluate your goals?????

  27. Case Study • A 74-year-old woman is admitted to the hospital with heart failure. She had been growing progressively weaker and has ankle edema, dyspnea on exertion, and three-pillow orthopnea. On admission, she is severely dyspneic and can answer questions only with one-word phrases. She is diaphoretic and has central cyanosis, with a heart rate of 132 beats/min, and blood pressure 98/70. She is extremely anxious.

  28. Case Study • 1. Because this client cannot breath or talk easily, prioritize the immediate nursing assessments and intervetions upon admission. • 2. Considering the process of congestive heart failure, explain the symptoms she is having. • 3.Based on assessment, identify nursing diagnoses for this client. • 4. What diagnostic studies do you anticipate being ordered and why?

  29. Case Study • 5. The physician orders the following items for this client. (Start an IV, then give dobutamine 3 mcg/kg/min IV; Furosemide (Lasix) 40 mg IV stat; Digoxin 0.5 mg IV stat, then 0.125mg PO every 6 hours for three doses, with ECG before doses 3 and 4; Morphine 2 mg IV stat and then 2 mg IV every 1 to 2 hours prn; Oxygen to maintain O2 sat >94%; Schedule for an echocardiogram; Low Na, Fat, Cardiac diet; Weigh daily and monitor input and output) Explain the rationale for these medications and treatments. Would you ask for any other ORDERDS and why?

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