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
