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Chapter 26

Chapter 26. Nursing Care of Patients with Heart Failure. Heart Failure. Syndrome Occurs from Progressive Inability of Heart to Pump Enough Blood to Meet Body’s Oxygen/Nutrient Needs Older Term: C ongestive Heart Failure. Causes. Coronary Artery Disease Cardiomyopathy Hypertension

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Chapter 26

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  1. Chapter 26 Nursing Care of Patients with Heart Failure

  2. Heart Failure • Syndrome Occurs from Progressive Inability of Heart to Pump Enough Blood to Meet Body’s Oxygen/Nutrient Needs • Older Term: Congestive Heart Failure

  3. Causes • Coronary Artery Disease • Cardiomyopathy • Hypertension • Heart Valve Disorders • Myocardial Infarction

  4. Pathophysiology • Each Ventricle Pumps Equal Amount of Blood • If More Than Either Ventricle Can Handle, Heart Not Effective Pump • Left Ventricle Typically Weakens First • Failure of One Leads to Failure of Other

  5. Left-Sided Heart Failure • Afterload • Force Generated by Left Ventricle to Eject Blood Into Aorta Through Aortic Valve • Peripheral Vascular Resistance (PVR) • Pressure Within Aorta/Arteries • PVR Influences Afterload

  6. Left-Sided Heart Failure (cont’d) • Hypertension Major Cause • Blood Backs Up from Left Ventricle • Alveolar Edema Results

  7. Left-Sided Heart Failure (cont’d)

  8. Right-Sided Heart Failure • Left-sided Heart Failure Major Cause • Must Continually Pump Blood Against Increased Fluid in Pulmonary Artery and Lungs

  9. Right-Sided Heart Failure (cont’d) • Cor Pulmonale • Right Ventricle Hypertrophies and Fails Due to Increased Pulmonary Pressures • Backward Buildup of Blood in Systemic Blood Vessels • Peripheral Edema Results

  10. Right-Sided Heart Failure (cont’d)

  11. Compensatory Mechanisms Maintain Cardiac Output • Designed to Maintain Cardiac Output • Also Contribute to Cycle of Heart Failure

  12. Compensatory Mechanisms • Maintain Cardiac Output When Low • Sympathetic Nervous System Raises Heart Rate • Increases Cardiac Oxygen Needs • Renin-Angiotensin-Aldosterone System, Antidiuretic Hormone Save Water • Increases Fluid Volume

  13. Compensatory Mechanisms (cont’d) • Chambers Enlarge (Dilation) • Muscle Mass Increases (Hypertrophy) • Increases Cardiac Oxygen Needs

  14. Pulmonary Edema • Acute Heart Failure • Severe Fluid Congestion in the Alveoli • Life-threatening • Drowning in Own Secretions

  15. Signs and Symptoms • Classic: Pink, Frothy Sputum • Rapid Respirations with Accessory Muscles • Severe Dyspnea, Orthopnea • Crackles, Wheezes • Anxiety, Restlessness • Clammy, Cold Skin

  16. Diagnosis • X-Ray • ABGs • Pulmonary Pressures

  17. Therapeutic Interventions • Immediate Treatment • Reduce Workload of Left Ventricle • Treat Underlying Cause • Fowler’s Position • Oxygen/Mechanical Ventilation

  18. Therapeutic Interventions (cont’d) • Morphine IV • Diuretics IV • Inotropic Agents IV • Vasodilators IV

  19. Nursing Diagnoses • Impaired Gas Exchange • Decreased Cardiac Output • Excess Fluid Volume • Acute Pain • Anxiety

  20. Chronic Heart Failure • Progressive • Signs and Symptoms May Worsen Over Time

  21. Signs and Symptoms • Fatigue and Weakness • Exertional Dyspnea • Orthopnea, Paroxysmal Nocturnal Dyspnea • Cough • Crackle and Wheezes • Tachycardia • Chest Pain

  22. Signs and Symptoms (cont’d) • Cheyne-Stokes Respiration • Edema • Anemia • Nocturia • Cyanosis • Altered Mental Status • Malnutrition

  23. Complications of Heart Failure • Liver and Spleen Enlargement • Pleural Effusion • Thrombosis and Emboli • Cardiogenic Shock

  24. Diagnostic Tests • Screening Tests • BNP • Serum BUN, Creatinine • Liver Function Tests • Thyroid Function Test • Ferritin

  25. Diagnostic Tests (cont’d) • Chest X-Ray • Echocardiography • ECG • Exercise Stress Testing • Cardiac Magnetic Imaging • Cardiac Catheterization/Angiography • Sleep Studies

  26. Therapeutic Intervention Goals • Improve Heart’s Pumping Ability and Decrease Heart’s Oxygen Demands • Identify and Correct Underlying Cause • Increase Strength of Heart’s Contraction • Maintain Optimum Water and Sodium Balance • Decrease Heart’s Workload

  27. Drug Therapy • Oxygen Therapy • ACE Inhibitors or ARBs • Beta Blockers • Diuretics • Inotropic Agents • Vasodilators

  28. Therapeutic Interventions • Activity • Sodium and Weight Control • Pacemakers, ICD • Cardiac Resynchronization Therapy

  29. Therapeutic Interventions (cont’d) • Mechanical Assistive Devices • Intra-aortic Balloon Pump • Ventricular Assist Device • Total Artificial Heart • Implantable Replacement Heart

  30. Intra-Aortic Balloon Pump

  31. Ventricular Assist Devices and Artifical Heart • Support Failing Heart • Bridge to Transplantation • Destination Therapy • Heart Replacement

  32. Surgical Interventions • CABG • Valve Replacement • Ventricular Reconstruction

  33. Nursing Diagnoses • Impaired Gas Exchange  • Decreased Cardiac Output  • Acute Pain  • Anxiety  • Excess Fluid Volume

  34. Nursing Interventions • Oxygen • Rest and Activity • Positioning • Fluid Management • Reduce Oxygen Consumption

  35. Nursing Interventions (cont’d) • Medications/Teaching • Low-sodium Diet • Weight Control • Education • Coping

  36. Cardiac Transplantation • End Stage Heart Failure • Strict Selection Criteria

  37. Heart Transplant

  38. Cardiac Transplantation (cont’d) • Immunosuppressive Therapy Preoperatively • Lifelong Antirejection Therapy

  39. Cardiac Transplantation (cont’d) • Complications • Rejection • Infection • Malignancies • Anti-rejection Medicine Side Effects

  40. Postoperative Cardiac SurgeryNursing Diagnoses • Pain • Ineffective Airway Clearance • Impaired Gas Exchange • Decreased Cardiac Output • Risk for Infection • Deficient Knowledge

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