CHF/ Pulmonary Edema Flashcards
Pulmonary Edema
Not a disease
A symptom
Is an Emergency
Acute Cardiovascular Conditions
Hypertension (Primary/ Secondary) CAD Angina Myocardial Infarction Peripheral arterial disease Peripheral vascular disease Pulmonary edema CHF Shock (hypovol/ anaphylactic/ septic/ cardio/ neurogenic)
Pulmonary Edema: Manifestations
Acute and severe dyspnea SOB Anxiety Skin cool, clammy, and cyanotic Productive cough with pink frothy sputum is a late sign Cerebral hypoxia - confusion or lethargy Crackles heard throughout lung fields "Drowning"
Pulmonary Edema: Nursing Care Goal
Restoration of effective gas exchange
Reduction of fluid and pressure in pulmonary vascular system
Intervention: Upright, sitting position with legs dependent
Pulmonary Edema: Medication and Treatment
Medication
- IV morphine to reduce anxiety, improve breathing, to vasodilate, which reduces venous return and left atrial pressure
Oxygen administration to achieve 100% oxygen concentration
Continuous positive airway pressure (CPAP) with mask
Intubation and mechanical ventilation
Pulmonary Edema: Other Medications
Loop diuretics for rapid diuresis
Vasodilators such as IV nitroprusside to reduce after load and improve cardiac output
Dopamine or dobutamine infusion or digoxin to improve myocardial contractility
IV aminophylline cautiously to reduce bronchospasm and decrease wheezing
Pulmonary Edema: Nursing Care
Improve oxygenation
Reduce fluid volume
Support emotionally
Involves early recognition and initiation of treatment; emergent care is ABC (airway, breathing, circulation)
Pulmonary Edema: Nursing Diagnoses
Impaired Gas Exchange
- Work of breathing is increased which leads to fatigue and decreased effort
Decreased Cardiac Output
- When cardiogenic in nature, cause is acute decrease in myocardial contractility or increased workload for left ventricle
- Accurate intake and output with indwelling catheter
Fear
Pulmonary Edema: Home Care
Teaching r/t cause usually CHD or acute MI
Nursing Assessment: Subjective
Past Health Hx
- MI, heart disease, respiratory infections, previous or current treatment
Risk Factors
- Family Hx heart disease, HTN, DM, high cholesterol, smoking, alcohol intake
Medications
- Understanding of meds and compliance with treatment
Current Complaints
- SOB, level of activity, number of pillows used to sleep, swelling of legs and feet, weight changes, appetite, nausea, abdominal discomfort
Nursing Assessment: Objective
Integumentary
- Skin colour, temp, moisture, cap refill, extent and degree dependent edema, daily weight
Respiratory
- Dyspnea, relation to activity, O2 sats, lung sounds: crackles, wheezes, ABGs
Cardiovascular
- Heart sounds, presence of extra sounds (S3, S4), rhythm, dysrhythmias
GI
- Anorexia, nausea, abdominal distention, liver enlargement
Neurologic
- LOC, anxiety, restlessness
Diagnostic Findings
- Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) levels, serum electrolytes, serum drug levels (digoxin)
Heart Failure Classification
A- high risk for heart failure, but no current structural or functional damage
B- Structural heart disease, but no symptoms of heart failure
C- Structural heart disease with current or prior symptoms of heart failure
D- Advanced heart disease with symptoms of heart failure at rest despite treatment
Heart Failure Classification: Limitations
Based on the person’s tolerance to activity
Class A: No limitation
Class B: Slight limitation
Class C: Marked limitation
Class D: Inability to carry on any physical activity without discomfort
Nursing Diagnosis
Decreased cardiac output Excess fluid volume Activity intolerance Disturbed sleep pattern Impaired gas exchange Anxiety Deficient knowledge
Expected Outcomes
Overall goals for patient with CHF
- Decreased peripheral edema
- Decreased SOB
- Increased exercise tolerance
- Compliance with drug regimen
- No complications r/t CHF
Implementation: Medications
ACE Inhibitors: block renin-angiotensin activity, dec. cardiac work and inc. CO
Beta Blockers: prevent effects of SNS, reduces force of contraction
Diuretics: dec. fluid retention , may cause fluid and electrolyte imbalances
Vasodilators: arterial dilation - decrease afterload, venous dilation - dec. preload, pulmonary vascular relaxation - reabsorption fluid
Inotropic medications: inc. strength of contraction
Treatments
Diet and Activity
- Low fat, low cholesterol, low Na diet
- Gradual activity
Heart Transplantation
- VAD: ventricular assist device to bridge transplant
- Rejection
Surgical Procedures
- Cardiomyoplasty: use other muscles from body to wrap and help heart (lattissimus dorsis muscle)
- Ventricular reduction surgery
- These do not improve the prognosis or quality of life
Treatments
Complementary
Hawthorn, Coenzyme Q10
- Increases coronary blood flow, positive inotropic effects
- Increases CO, decreases BP, cardiac workload, oxygen consumption - acts like an ACE Inhibitor
Evaluation
Collect data to evaluate the effectiveness of nursing care
- VS, output, degree of dyspnea at rest and activity
- Presence or absence of abnormal heart or lung sounds and edema
- Ability to tolerate gradually increased activity levels
Discharge Considerations
The chronic and progressive nature of heart failure requires that the:
- Client
- Family
- Resources
Be assessed and teaching be completed prior to discharge
Patient and Family Teaching
Rest Drug therapy Weight daily, checking for swelling Dietary therapy Activity program Ongoing monitoring
Children with CHF
Left heart failure manifested as poor feeding and sucking - leads to failure to thrive
Dyspnea, tachypnea, diaphoresis
Retractions, grunting, and nasal flaring
Wheezing, coughing and crackles are rare in children
Pallor or mottling
Systemic venous congestion rare - peripheral edema and weight gain associated with renal disease
Children with CHF: Assessment of Progress
Low weight with normal length and head circumference
Failure to thrive - result of increased metabolic expenditure related to caloric intake
ECG dysrhythmia or hypertrophy
Treatment of CHF in Children
Aimed at decreased cardiac workload Increasing efficiency of heart function Medical management similar to adults - Diuretics - ACE Inhibitors - Beta blockers Surgical management of congenital heart disease
