Week 2(Stacy) Chapter 25 : Management of Patients with Complications from Heart Disease Flashcards
Heart Failure #1
Cardiovascular disease is the leading cause of death
in the United States
Heart disease remains a chronic and often
progressive condition, associated with serious
comorbidities, such as heart failure
Heart failure (HF) is a clinical syndrome resulting
from structural or functional cardiac disorders that
impair the ability of a ventricle to fill or eject blood;
the heart is unable to pump enough blood to meet
the body’s metabolic demands or needs
Heart Failure #2
The term heart failure indicates myocardial disease,
in which there is a problem with the contraction of
the heart (systolic dysfunction) or filling of the heart
(diastolic dysfunction) may cause pulmonary or
systemic congestion
Some cases are reversible depending on the cause
Most HF is a chronic, progressive condition managed
with lifestyle changes and medications
Chronic Heart Failure
The incidence of HF increases with age
Approximately 6 million people in the United States
have HF, and 870,000 new cases are diagnosed each
year
Most common reason for hospitalization of people
older than 65 years and the second most common
reason for visits to a provider’s office
Approximately 20% of patients discharged after
treatment for HF are readmitted to the hospital
within 30 days and nearly 50% are readmitted to
the hospital within 6 months
Right Sided HF
Viscera and peripheral
congestion
Jugular venous
distention (JVD)
Dependent edema
Hepatomegaly
Ascites
Weight gai
Left Sided HF
Pulmonary congestion,
crackles
S3 or “ventricular gallop”
Dyspnea on exertion
(DOE)
Low O2 sat
Dry, nonproductive
cough initially
Oliguria
Medical Management of the Patient with
Heart Failure
Vary according to the severity of the patient’s
condition, comorbidities, and cause
Treatment may include
o Oral and IV medications
o Lifestyle modifications
o Supplemental O2
o Surgical interventions: ICD and heart transplant
Comprehensive education and counseling to patient
and family is needed
Medications Used to Treat HF #1
Diuretics: decreases fluid volume, monitor serum
electrolytes
Angiotensin-converting enzyme (ACE) inhibitors:
vasodilation; diuresis; decreases afterload; monitor
for hypotension, hyperkalemia, and altered renal
function; cough
Angiotensin II receptor blockers: prescribed as an
alternative to ACE inhibitors; work similarly
Beta-blockers: prescribed in addition to ACE
inhibitors; may be several weeks before effects
seen; use with caution in patients with asthma
Medications Used to Treat HF #2
Ivabradine: decreases rate of conduction through
the SA node; observe for decrease HR and BP
Hydralazine and isosorbide dinitrate: alternative to
ACE inhibitors; observe for decreased BP
Digitalis: improves contractility; monitor for digitalis
toxicity especially if patient is hypokalemic
Medications Used to Treat HF #3
IV medications: indicated for hospitalized patients
admitted for acute decompensated HF
o Dopamine: vasopressor to increase BP and
myocardial contractility; adjunct with loop diuretics
o Dobutamine: used for patients with left ventricular
dysfunction; increases cardiac contractility and renal
perfusion
o Milrinone: decreases preload and afterload; causes
hypotension and increased risk of dysrhythmias
o Vasodilators: IV nitro, nitroprusside, nesiritide;
enhance symptom relief
Gerontologic Considerations
May present with atypical signs and symptoms such
as fatigue, weakness, and somnolence
Decreased renal function can make older patients
resistant to diuretics and more sensitive to changes
in volume
Administration of diuretics to older men requires
nursing surveillance for bladder distention caused by
urethral obstruction from an enlarged prostate gland
Assessment of the Patient with Heart
Failure
Focus
o Effectiveness of therapy
o Patient’s self-management
o S&S of increased HF
o Emotional or psychosocial response
Health history
PE
o Mental status; lung sounds: crackles and wheezes;
heart sounds: S3; fluid status or signs of fluid
overload; daily weight and I&O; asess responses to
medications
Collaborative Problems and Potential Complications of the Patient with HF
Pulmonary edema
Hypotension, poor perfusion, and cardiogenic shock
(see Chapter 11)
Arrhythmias (see Chapter 22)
Thromboembolism (see Chapter 26)
Pericardial effusion
Planning and Goals for the Patient With
Heart Failure
Goals
o Promote activity and reduce fatigue
o Relieve fluid overload symptoms
o Decrease anxiety or increase the patient’s ability
to manage anxiety
o Encourage the patient to verbalize his or her
ability to make decisions and influence outcomes
o Educate the patient and family about
management of the therapeutic regimen
Nursing Interventions for the Patient with
Heart Failure #1
Promote activity tolerance
o Bed rest for acute exacerbations
o Encourage regular physical activity; build up to about
30 minutes daily
o Exercise training
o Pacing of activities; wait 2 hours after eating for
physical activity
o Avoid activities in extreme hot, cold, or humid
weather
o Modify activities to conserve energy
o Positioning; elevation of the head of bed to facilitate
breathing and rest, support of arms
Nursing Interventions for the Patient with
Heart Failure #2
Manage fluid volume
o Assess for symptoms of fluid overload
o Daily weight
o I&O
o Diuretic therapy; timing of meds
o Fluid intake; fluid restriction
o Maintenance of sodium restriction
Patient Education for the Patient with
Heart Failure
Medications
Diet: low-sodium diet and fluid restriction
Monitor for signs of excess fluid, hypotension, and
symptoms of disease exacerbation, including daily
weight
Exercise and activity program
Stress management
Prevention of infection
Know how and when to contact health care provider
Include family in education
Pulmonary Edema
Acute event reflecting a breakdown of physiologic
compensatory mechanisms
As LV begins to fail, blood backs up into the
pulmonary circulation, causing pulmonary interstitial
edema
Results in hypoxemia, often severe
Clinical manifestations: restlessness, anxiety,
tachypnea, dyspnea, cool and clammy skin,
cyanosis, weak and rapid pulse, cough, lung
congestion (moist, noisy respirations), increased
sputum production (sputum may be frothy and
blood tinged), decreased level of consciousness
Management of Pulmonary Edema
Easier to prevent than to treat
Early recognition: monitor lung sounds and for signs
of decreased activity tolerance and increased fluid
retention
Minimize exertion and stress
Oxygen; nonrebreather
Medications
o Diuretics (furosemide), vasodilators
(nitroglycerin)
Nursing Interventions for the Patient with
Pulmonary Edema
Positioning the patient to promote circulation
o Positioned upright with legs dangling
Providing psychological support
o Reassure patient and provide anticipatory care
Monitoring medications
o I&O
End-of-Life Considerations
HF is a chronic and often progressive condition
o Need to consider issues related to the end of life
o When palliative or hospice care should be
considered
Cardiogenic Shock
A life-threatening condition with a high mortality
rate
Decreased CO leads to inadequate tissue perfusion
and initiation of shock syndrome
Commonly occurs following acute MI when a large
area of myocardium becomes ischemic and
hypokinetic
Can occur as a result of end-stage HF, cardiac
tamponade, pulmonary embolism (PE),
cardiomyopathy, and arrhythmias
Thromboembolism
Patients with cardiovascular disorders are at risk for
the development of arterial thromboemboli and
venous thromboemboli (VTE)
Decreased mobility and circulation increase the risk
for thromboembolism in patients with cardiac
disorders, including those with HF
Intracardiac thrombi can form in patients with atrial
fibrillation because the atria do not contract
forcefully, and increasing the likelihood of thrombus
formation
Pulmonary embolism: blood clot from the legs
moves to obstruct the pulmonary vessel
Pericardial Effusion and Cardiac
Tamponade
Pericardial effusion is the accumulation of fluid in the
pericardial sac
Cardiac tamponade is the restriction of heart
function because of this fluid, resulting in decreased
venous return and decreased CO
Clinical manifestations: ill-defined chest pain or
fullness, pulsus paradoxus, engorged neck veins,
labile or low BP, shortness of breath
Cardinal signs of cardiac tamponade: falling systolic
BP, narrowing pulse pressure, rising venous
pressure, distant heart sounds
Medical Management of Pericardial
Effusion and Cardiac Tamponade
Pericardiocentesis
o Puncture of the pericardial sac to aspirate
pericardial fluid
Pericardiotomy
o Under general anesthesia, a portion of the
pericardium is excised to permit the exudative
pericardial fluid to drain into the lymphatic
system
