week 6 - heart failure Flashcards
Heart Failure
Also called pump failure
General term for the inability of the heart to work effectively as a pump
Diastolic failure-
inability of ventricle to relax
Systolic failure
MOST COMMON
inadequate ventricular contraction*
Most Common Causes
CAD- Myocardial Infarction
Systemic hypertension
Left-Sided Heart Failure FORMALY KNOWN AS
Formerly known as congestive heart failure
Left-Sided Heart Failure Typical Causes
Hypertension
Coronary Artery Disease
Valvular disease
Indicators of LVHF:
- Decreased tissue perfusion due to poor CO and pulmonary congestion from increased pressure in the pulmonary vessels
- Mitral or aortic valves affected
- Failure may be chronic or acute, mild to severe
Right-Sided Heart Failure TYPICAL CAUSES
- left ventricular failure
- right ventricular MI
- pulmonary hypertension
- Lung disease
Right-Sided Heart Failure
Right ventricle not able to empty completely
Increased volume and pressure in the venous system and peripheral edema
Most HF begins with
LVF and progresses to failure of both ventricles
RHF without LHF
usually due to pulmonary problems eg: COPD, pulmonary HTN
Left heart failure usually leads to
right heart failure
Heart Failure
Biventricular failure very difficult to treat
Need for increased volume or “stretch” on right while left cannot accommodate increased volumes
Fatigue may be only presenting symptom
High-Output Failure
-Less common
-Cardiac output remains normal or above normal
-Caused by increased metabolic needs of hyperkinetic conditions such as:
((Septicemia
Anemia
Hyperthyroidism))
Compensatory Mechanisms
Purpose: Maintain required Cardiac Output (CO) How does the body compensate? ((Increased heart rate Improved stroke volume Arterial vasoconstriction Sodium and water retention Myocardial hypertrophy))
- These mechanisms cause damage to the pump over time
- Manifestations of HF occur when compensation fails
Left-Sided Heart Failure Manifestations
Cough-irritating, nocturnal, non-productive *early manifestation Weakness Fatigue Dizziness Confusion…especially in elderly Palpitations/chest discomfort Anxiety Pulmonary congestion Air hunger, tachypnea, pulmonary edema= moist cough with pink frothy sputum *life-threatening Dyspnea on exertion (DOE) Orthopnea Tachycardia Diaphoresis Cyanosis or pallor Insomnia Anorexia Low 02 saturation Oliguria Death
What assessment questions you would ask?
What teaching does your patient need?
LHF Assessment Findings
Decreased BP Orthostatic hypotension Tachycardia Dysrhythmias Tachypnea Crackles S3-gallop
Right-Sided Heart Failure Manifestations
Distended neck veins increased abdominal girth due to ascites or dependent edema Hepatomegaly Abdominal tenderness N & V, constipation, anorexia Dependent edema Hands, feet/legs, sacrum or abdomen depending on positioning Nocturia Decreased U/O Weight—the most reliable indicator of fluid gain or loss*** check daily in a.m. BP may increase or decrease
RHF Assessment Findings
Hepatomegaly Splenomegaly Dependent pitting edema Jugular vein distention (JVD) Positive hepatojugular reflex Ascites
Assessments
--Psychosocial assessment Anxiety, potential depression --Lab Electrolytes, liver enzymes and renal function (BUN, Creatinine) INR Arterial Blood Gases (ABGs) B-type Natriuretic Peptide (BNP)
CXR, CT, MRI
Trans-esophageal Echocardiogram *diagnostic of HF
Coronary angiography/cardiac catheterization
—Electrocardiography
Monitor for dysrhythmias **atrial fib most common
Collaborative Management
Treat underlying cause and precipitating factors
Provide oxygen and support ventilation
Provide medications to relieve symptoms
Manage acute pulmonary edema
Initiate low-calorie(prn) and low-sodium diet
Initiate device or electronic therapy
Drugs that reduce afterload
ACE inhibitors and Beta Blockers are first line therapy
ARBs
human B-type natriuretic peptides
ACE inhibitors-
watch for cough, monitor K+, check fluid status
Interventions That Reduce Preload
- –Nutrition therapy (ie: reduce sodium, reduce calories prn)
- —Fluid restriction 1500-2000 ml/day
—Drug therapy
diuretics and venous vasodilators
Digoxin*, other inotropic drugs, beta-adrenergic blockers (enhance contractility)
Teach patient to notify MD if weight gain > or = 1 kg/day x 2 days
Potential for Pulmonary Edema
—Assessment:
crackles in the lung bases, cough with frothy pink sputum, dyspnea at rest, disorientation, and confusion, tachycardia, anxiety, restlessness, decreased U/O
*crackles start at bases and progress upwards as condition worsens
—Interventions:???
Digoxin
- Slows the rate of contraction
- Increases the strength of contraction
- Check the apical pulse for one full minute before administration. Hold if HR less than 60
- Therapeutic level 0.5-2.0
Digoxin Toxicity
Bradycardia Other arrhythmia Anorexia, nausea, diarrhea Blurred vision Depression Patients may think they have the ‘flu’
monitor dig levels
Report HR below 60 and above 100
Keep K+ above 4…hypokalemia=potential for dysrhythmias
Activity Intolerance
--Interventions include: Balance activity and rest Nap to restore energy Recognize energy limitations Conserve energy Adapt lifestyle to energy level Report adequate endurance for activity ROM, physio to maintain strength Organize nursing care to allow for rest periods
What are S & S of activity intolerance?
Other Nursing Diagnoses
--Risk for or Actual: Impaired Mobility Ineffective tissue perfusion Excess fluid volume Acute confusion Ineffective therapeutic regimen management Anxiety
Community-Based Care
Home care management
Health teaching*** MAWDS
Health care resources
