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power point about cardiac diseases and disorders, includes assessment findings and nursing interventions. Very helpful.
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CARDIAC DISORDERSCARDIAC DISORDERS
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
DESCRIPTION◦A narrowing or obstruction of one or more
coronary arteries due to atherosclerosis, an accumulation of lipid-containing plaque in the arteries
◦Causes decreased perfusion of myocardial tissue and inadequate myocardial oxygen supply
◦Leads to hypertension, angina, dysrhythmias, myocardial infarction, heart failure, and death
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
DESCRIPTION◦Collateral circulation, more than one artery
supplying a muscle with blood, is normally present in the coronary arteries, especially in older persons
◦The development of collateral circulation takes time and develops when chronic ischemia occurs to meet the metabolic demands; therefore, an occlusion of a coronary artery in a younger individual is more likely to be lethal than in an older individual
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
DESCRIPTION◦Symptoms occur when the coronary artery is
occluded to the point that inadequate blood supply to the muscle occurs, causing ischemia
◦Coronary artery narrowing is significant if the lumen diameter of the left main artery is reduced at least 50%, or if any major branch is reduced at least 75%
◦The goal of treatment is to alter the atherosclerotic progression
ATHEROSCLEROSISATHEROSCLEROSISFrom Thibodeau GA, Patton KT: Anatomy and Physiology, ed. 4, St. Louis, 1999, Mosby.
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
ASSESSMENT◦Findings may be normal during asymptomatic
periods◦Chest pain◦Palpitations◦Dyspnea◦Syncope◦Cough or hemoptysis◦Excessive fatigue
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
ECG◦When blood flow is reduced and ischemia
occurs, ST segment depression or T wave inversion is noted; the ST segment returns to normal when the blood flow returns
◦With infarction, cell injury results in ST segment elevation, followed by T wave inversion
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
CARDIAC CATHETERIZATION◦Provides the most definitive source for
diagnosis◦Shows the presence of atherosclerotic lesions
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
BLOOD LIPID LEVELS◦May be elevated◦Cholesterol-lowering medications may be
prescribed to reduce the development of atherosclerotic plaques
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
IMPLEMENTATION◦Assist the client to identify risk factors that can
be modified◦Assist the client to set goals to promote
lifestyle changes that will reduce the impact of risk factors
◦Assist the client to identify barriers to compliance with the therapeutic plan and to identify methods to overcome barriers
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
IMPLEMENTATION◦Instruct the client regarding a low-calorie, low-
sodium, low-cholesterol, and low-fat diet, with an increase in dietary fiber
◦Stress to the client that dietary changes are not temporary and must be maintained for life; instruct the client regarding prescribed medications
◦Provide community resources to the client regarding exercise, smoking reduction, and stress reduction
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
SURGICAL PROCEDURES◦PTCA to compress the plaque against the walls
of the artery and dilate the vessel◦Laser angioplasty to vaporize the plaque◦Atherectomy to remove the plaque from the
artery◦Vascular stent to prevent the artery from
closing and to prevent restenosis◦Coronary artery bypass graft to improve blood
flow to the myocardial tissue that is at risk for ischemia or infarction due to the occluded artery
CORONARY ARTERY DISEASE CORONARY ARTERY DISEASE (CAD)(CAD)
MEDICATIONS◦Nitrates to dilate the coronary arteries and to
decrease preload and afterload◦Calcium channel blockers to dilate coronary
arteries and reduce vasospasm◦Cholesterol-lowering medications to reduce the
development of atherosclerotic plaques◦Beta-blockers to reduce blood pressure in
individuals who are hypertensive
ANGINAANGINA
DESCRIPTION◦Chest pain resulting from myocardial ischemia
caused by inadequate myocardial blood and oxygen supply
◦Caused by an imbalance between oxygen supply and demand
◦Causes include obstruction of coronary blood flow due to atherosclerosis, coronary artery spasm, and conditions increasing myocardial oxygen consumption
ANGINAANGINA
DESCRIPTION◦The goal of treatment is to provide relief of an
acute attack, correct the imbalance between myocardial oxygen supply and demand, prevent the progression of the disease and further attacks to reduce the risk of MI
ANGINAANGINA
STABLE ANGINA◦Also called exertional angina◦Occurs with exertion or emotional stress, and is
relieved with rest or nitroglycerin◦It usually has a stable pattern of onset,
duration, severity, and relieving factors
ANGINAANGINA
UNSTABLE ANGINA◦Also called preinfarction angina◦Occurs with an unpredictable degree of
exertion or emotion and increases in occurrence, duration, and severity over time
◦Pain may not be relieved with nitroglycerin
ANGINAANGINA
INTRACTABLE ANGINA◦A chronic, incapacitating angina that is
unresponsive to interventionsPOSTINFARCTION ANGINA
◦Occurs after an MI, when residual ischemia may cause episodes of angina
ANGINAANGINA
ASSESSMENT: PAIN◦Can develop slowly or quickly◦Usually described as mild or moderate pain◦Substernal, crushing, squeezing pain◦May radiate to the shoulders, arms, jaw, neck,
back◦Usually lasts less than 5 minutes; however, can
last up to 15 to 20 minutes◦Relieved by nitroglycerin or rest
ANGINAANGINA
ASSESSMENT◦Dyspnea◦Pallor◦Sweating◦Palpitations and tachycardia◦Dizziness and faintness◦Hypertension◦Digestive disturbances
ANGINAANGINA
ECG◦Normal during rest, with ST depression or
elevation and/or T wave inversion during an episode of pain
STRESS TEST◦Chest pain or changes in the ECG or vital signs
during testing may indicate ischemiaCARDIAC ENZYMES
◦Normal findings in anginaCARDIAC CATHETERIZATION
◦Provides a definitive diagnosis
ANGINAANGINA
IMMEDIATE MANAGEMENT◦Assess pain◦Provide bed rest◦Administer oxygen at 3 L via nasal cannula as
prescribed◦Administer nitroglycerin as prescribed to dilate
the coronary arteries, reduce the oxygen requirements of the myocardium, and relieve the chest pain
◦Obtain a 12-lead ECG◦Provide continuous cardiac monitoring
ANGINAANGINA
FOLLOWING ACUTE EPISODE◦Assist the client to identify angina-precipitating
events◦Instruct the client to stop activity and rest if
chest pain occurs and to take nitroglycerin as prescribed
ANGINAANGINA
FOLLOWING ACUTE EPISODE◦Instruct the client to seek medical attention if
pain persists◦Instruct the client regarding prescribed
medications◦Provide diet instructions to the client, stressing
that dietary changes are not temporary and must be maintained for life
◦Assist the client to identify risk factors that can be modified
ANGINAANGINA
FOLLOWING ACUTE EPISODE◦Assist the client to set goals that will promote
changes in lifestyle to reduce the impact of risk factors
◦Assist the client to identify barriers to compliance with therapeutic plan and to identify methods to overcome barriers
◦Provide community resources to the client regarding exercise, smoking reduction, and stress reduction
ANGINAANGINA
SURGICAL PROCEDURES◦Same procedures performed to treat CAD
MEDICATIONS◦Same medications used to treat CAD◦Antiplatelet therapy may be prescribed to
inhibit platelet aggregation and reduce the risk of developing an acute MI
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
DESCRIPTION◦Occurs when myocardial tissue is abruptly and
severely deprived of oxygen◦Ischemia can lead to necrosis of myocardial
tissue if blood flow is not restored◦Infarction does not occur instantly, but evolves
over several hours◦Obvious physical changes do not occur in the
heart until 6 hours after the infarction, when the infarcted area appears blue and swollen
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
DESCRIPTION◦After 48 hours, the infarct turns gray with
yellow streaks as neutrophils invade the tissue◦By 8 to 10 days after infarction, granulation
tissue forms◦Over 2 to 3 months, the necrotic area develops
into a scar; scar tissue permanently changes the size and shape of the entire left ventricle
ACUTE MYOCARDIAL INFARCTIONACUTE MYOCARDIAL INFARCTION5 TO 7 DAYS OLD5 TO 7 DAYS OLD
From Kumar V, Cotran RS, Robbins SL: Basic Pathology, ed. 6, Philadelphia, 1997, W.B. Saunders.
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
LOCATION OF MI◦Obstruction of the left anterior descending
(LAD) artery results in anterior and/or septal MI or both
◦Obstruction of the circumflex artery results in posterior wall MI or lateral wall MI
◦Obstruction of the right coronary artery results in inferior wall MI
COMMON LOCATIONS OF MICOMMON LOCATIONS OF MIFrom Lewis SM, Heitkemper M, Dirksen S: Medical-Surgical Nursing: Assessment and Management of Clinical Problems (5th ed), St. Louis, 2000, Mosby.
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
TOTAL CK LEVELS◦Rise within 3 hours after the onset of chest pain◦Peak within 24 hours after damage and death
of cardiac tissue CK-MB ISOENZYME
◦Peak elevation occurs 12 to 24 hours after the onset of chest pain
◦Levels return to normal 48 to 72 hours later
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
TROPONIN LEVELS◦Rise within 3 hours◦Remain elevated for up to 7 days
MYOGLOBIN◦Rises within 1 hour after cell death, peaks in 4
to 6 hours, and returns to normal within 24 to 36 hours or less
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
LDH LEVELS◦Rise within 12 to 24 hours after MI◦Peak between 40 and 72 hours and fall to
normal in 7 days◦Serum levels of LDH1 isoenzyme rise higher
than serum levels of LDH2
WHITE BLOOD CELL (WBC) COUNT ◦An elevated count of 10,000 to 20,000
cells/mm3 appears on the second day following the MI and lasts up to a week
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
ECG◦ST segment elevation, T wave inversion,
abnormal Q wave◦Hours to days after the MI, ST and T wave
changes will return to normal but the Q wave usually remains permanently abnormal
ECG PATTERNSECG PATTERNSFrom Black, J., Hawks, J, and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
DIAGNOSTIC TESTS FOLLOWING ACUTE STAGE◦ Exercise tolerance test or stress test: prescribed to
assess for ECG changes and ischemia and to evaluate for medical therapy or identify clients who may need invasive therapy
◦ Thallium scans: prescribed to assess for ischemia or necrotic muscle tissue
◦ MUGA scans: Used to evaluate left ventricular function◦ Cardiac catheterization: Performed to determine the
extent and location of obstructions of the coronary arteries
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
ASSESSMENT: PAIN ◦Crushing substernal pain◦May radiate to the jaw, back, and left arm◦Occurs without cause, primarily early in the
morning◦Is unrelieved by rest or nitroglycerin, and
relieved only by opioids◦Lasts 30 minutes or longer
POSSIBLE EXTENT OF PAIN FROM POSSIBLE EXTENT OF PAIN FROM MIMI From Black, J., Hawks, J, and Keene, A. (2001). Medical-surgical nursing, ed 6,
Philadelphia: W.B. Saunders
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
ASSESSMENT◦Nausea and vomiting◦Diaphoresis◦Dyspnea◦Dysrhythmias◦Feelings of fear and anxiety◦Pallor, cyanosis, coolness of extremities
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
COMPLICATIONS OF MI◦Dysrhythmias◦Heart failure◦Pulmonary edema◦Cardiogenic shock◦Thrombophlebitis◦Pericarditis◦Mitral valve insufficiency
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
COMPLICATIONS OF MI◦Postinfarction angina◦Ventricular rupture◦Dressler’s syndrome (a combination of
pericarditis, pericardial effusion, and pleural effusion, which can occur several weeks to months following an MI)
MAJOR COMPLICATIONS OF ACUTE MAJOR COMPLICATIONS OF ACUTE MIMI From O’Rourke RA (1982) The bedside diagnosis of the complications of myocardial
infarction. In R.S. Eliot (ed.) Cardiac Emergencies. Mount Kisco, NY: Futura Publishing.
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
ACUTE STAGE◦Obtain a description of the chest discomfort◦Assess vital signs◦Assess cardiovascular status and maintain
cardiac monitoring◦Obtain a 12-lead ECG◦Administer nitroglycerin as prescribed ◦Administer morphine sulfate as prescribed to
relieve chest discomfort that is unresponsive to nitroglycerin
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
ACUTE STAGE◦Administer oxygen at 2 to 4 liters by nasal
cannula as prescribed◦Place the client in semi-Fowler’s position to
enhance comfort and tissue oxygenation◦Establish an IV access route◦Administer IV nitroglycerin and
antidysrhythmics as prescribed
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
ACUTE STAGE◦Monitor thrombolytic therapy, which may be
prescribed within the first 6 hours of the coronary event
◦Monitor for signs of bleeding if the client is receiving thrombolytics
◦Monitor laboratory values as prescribed◦Administer beta-blockers to slow the heart rate
and increase myocardial perfusion, while reducing the force of myocardial contraction, as prescribed
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
ACUTE STAGE◦Monitor for complications related to the MI◦Monitor for cardiac dysrhythmias, since
tachycardia and PVCs frequently occur in the first few hours after MI
◦Assess distal peripheral pulses and skin temperature, since poor cardiac output may be identified by cool, diaphoretic skin and diminished or absent pulses
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
ACUTE STAGE◦Monitor I&O◦Assess respiratory rate and breath sounds for
signs of heart failure, as indicated by the presence of crackles or wheezes or dependent edema
◦Monitor the BP closely after the administration of medications; if the BP is less than 100 systolic or 25 mmHg lower than the previous reading, lower the head of the bed and notify the physician
◦Provide reassurance to the client and family
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
FOLLOWING ACUTE STAGE◦Maintain bed rest for the first 24 to 36 hours◦Allow the client to stand to void or use a
bedside commode if prescribed◦Provide range-of-motion exercises to prevent
thrombus formation and maintain muscle strength
◦Progress to dangling at the side of the bed or out of bed to the chair for 30 minutes three times a day as prescribed
MYOCARDIAL INFARCTION (MI)MYOCARDIAL INFARCTION (MI)
FOLLOWING ACUTE STAGE◦Progress to ambulation in the client’s room and
to the bathroom, then in the hallway, three times a day
◦Monitor for complications ◦Encourage the client to verbalize feelings
regarding the MICARDIAC REHABILITATION
◦Process of actively assisting the client with cardiac disease to achieve and maintain a vital and productive life within the limitations of the heart disease
HEART FAILUREHEART FAILURE DESCRIPTION
◦The inability of the heart to maintain adequate circulation to meet the metabolic needs of the body, due to an impaired pumping capability
◦Cardiac output is diminished, and peripheral tissue is not adequately perfused
◦Congestion of the lungs and periphery may occur
HEART FAILUREHEART FAILURE
ACUTE◦Occurs suddenly
CHRONIC◦Develops over time; however, a client with
chronic heart failure can develop an acute episode
TYPES OF HEART FAILURETYPES OF HEART FAILURERIGHT-SIDED/LEFT-SIDED HEART FAILURE
◦Because the two ventricles of the heart represent two separate pumping systems, it is possible for one to fail alone for a short period
◦Most heart failure begins with left ventricular failure and progresses to failure of both ventricles
◦Acute pulmonary edema, a medical emergency, results from left ventricular failure
◦If pulmonary edema is not treated, death will occur from suffocation as the client literally drowns in own fluids
TYPES OF HEART FAILURETYPES OF HEART FAILURE
FORWARD FAILURE/BACKWARD FAILURE◦In forward failure, an inadequate output of the
affected ventricle causes decreased perfusion to vital organs
◦In backward failure, blood backs up behind the affected ventricle, causing increased pressure in the atrium behind the affected ventricle
TYPES OF HEART FAILURETYPES OF HEART FAILURELOW OUTPUT/HIGH OUTPUT
◦In low-output failure, not enough cardiac output is available to meet the demands of the body
◦High-output failure occurs when a condition causes the heart to work harder to meet the demands of the body
TYPES OF HEART FAILURETYPES OF HEART FAILURE
SYSTOLIC FAILURE/DIASTOLIC FAILURE◦Systolic failure leads to problems with
contraction and the ejection of blood◦Diastolic failure leads to problems with the
heart relaxing and filling with blood
Include increased heart rate, improved stroke volume, arterial vasoconstriction, sodium and water retention, and myocardial hypertrophy
Act to restore cardiac output to near normal levels
Initially these mechanisms increase cardiac output; however, they eventually have a damaging effect on pump action
Contribute to an increase in myocardial oxygen consumption and when this occurs, myocardial reserve is exhausted and clinical manifestations of heart failure develop
HEART FAILURECOMPENSATORY MECHANISMS
HEART FAILUREHEART FAILURE ASSESSMENT: RIGHT-SIDED HEART
FAILURE◦Signs will be evident in the systemic circulation◦Pitting, dependent edema in the feet, legs,
sacrum, back, buttocks◦Ascites from portal hypertension◦Tenderness of right upper quadrant,
organomegaly◦Distended neck veins
HEART FAILUREHEART FAILURE ASSESSMENT: RIGHT-SIDED HEART
FAILURE◦Pulsus alterans (regular alteration of weak and
strong beats noted in the pulse)◦Abdominal pain, bloating◦Anorexia, nausea◦Fatigue◦Weight gain◦Nocturnal diuresis
RIGHT-SIDED HEART RIGHT-SIDED HEART FAILUREFAILURE
From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W.B. Saunders
HEART FAILUREHEART FAILURE ASSESSMENT: LEFT-SIDED HEART FAILURE
◦Signs will be evident in the pulmonary system◦Cough, which may become productive with
frothy sputum◦Dyspnea upon exertion◦Orthopnea◦Paroxysmal nocturnal dyspnea◦Presence of rales or crackles on auscultation◦Tachycardia
HEART FAILUREHEART FAILURE
ASSESSMENT: LEFT-SIDED HEART FAILURE◦Pulsus alterans◦Fatigue◦Pallor◦Cyanosis◦Confusion and disorientation◦Signs of cerebral anoxia
LEFT-SIDED HEART FAILURELEFT-SIDED HEART FAILUREFrom Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W.B. Saunders
APPEARANCE OF A CLIENT WITH APPEARANCE OF A CLIENT WITH HEART FAILUREHEART FAILURE
From Mayo Clinic Health Letter (1997) 15:1-3. Mayo Foundation for Medical Education and Research, Rochester, MN. By permission of Mayo Foundation.
HEART FAILUREHEART FAILURE ASSESSMENT: ACUTE PULMONARY EDEMA
◦Severe dyspnea and orthopnea◦Pallor◦Tachycardia◦Expectoration of large amounts of blood-tinged,
frothy sputum◦Wheezing and rales◦Bubbling respirations
HEART FAILUREHEART FAILURE ASSESSMENT: ACUTE PULMONARY EDEMA
◦Acute anxiety, apprehension, restlessness◦Profuse sweating◦Cold, clammy skin◦Cyanosis◦Nasal flaring◦Use of accessory breathing muscles◦Tachypnea◦Hypocapnia evidenced by muscle cramps, weakness,
dizziness, and paresthesias
HEART FAILUREHEART FAILURE
ACUTE STAGE◦Place the client in high-Fowler's position with
the legs in a dependent position to reduce pulmonary congestion and relieve edema
◦Administer oxygen in high concentrations by mask or cannula as prescribed to improve gas exchange and pulmonary function
◦Prepare for intubation and ventilator support if required; monitor lung sounds for rales and decreased breath sounds
HEART FAILUREHEART FAILURE
ACUTE STAGE◦Suction as needed to maintain a patent airway◦Assess level of consciousness◦Provide reassurance to the client◦Monitor vital signs closely noting tachycardia or
pulsus alterans◦Monitor for hypotension due to decreased
tissue perfusion, or hypertension due to anxiety or history of hypertension
HEART FAILUREHEART FAILURE
ACUTE STAGE◦Monitor heart rate and dyrhythmias using a cardiac
monitor ◦Assess for edema in dependent areas and in the sacral,
lumbar, and posterior thigh region in the client on bed rest
◦Insert a Foley catheter as prescribed and monitor urine output closely following administration of a diuretic
◦Monitor I&O
HEART FAILUREHEART FAILURE
ACUTE STAGE◦Avoid the administration of unnecessary IV
fluids◦Administer morphine sulfate as prescribed to
provide sedation and vasodilation, and monitor for respiratory depression or hypotension after administration
◦Administer diuretics as prescribed to reduce preload, enhance renal excretion of sodium and water, reduce circulating blood volume, and reduce pulmonary congestion
HEART FAILUREHEART FAILURE ACUTE STAGE
◦Administer digitalis as prescribed to increase ventricular contractility and improve cardiac output
◦Administer bronchodilators as prescribed for severe bronchospasm or bronchoconstriction
◦Administer additional inotropic medications such as dopamine (Intropin) or dobutamine (Dobutrex) as prescribed to facilitate myocardial contractility and enhance stroke volume
HEART FAILUREHEART FAILURE
ACUTE STAGE◦Administer vasodilators as prescribed to
reduce afterload, increase the capacity of the systemic venous bed, and decrease venous return to the heart
◦Monitor weight to determine a response to treatment
◦Assess for hepatomegaly and ascites and measure and record abdominal girth
HEART FAILUREHEART FAILURE
ACUTE STAGE◦Monitor peripheral pulses◦Analyze arterial blood gas results and evaluate
electrolyte values for imbalances◦Monitor potassium level closely, which may decrease
due to diuretic therapy, and administer potassium supplements as prescribed to prevent digitalis toxicity
HEART FAILUREHEART FAILURE
FOLLOWING ACUTE STAGE◦Encourage the client to verbalize feelings about
the lifestyle changes required as a result of the heart failure
◦Assist the client to identify precipitating risk factors of heart failure and methods of eliminating these risk factors
HEART FAILUREHEART FAILURE CLIENT EDUCATION
◦Prescribed medication regimen, which may include digoxin (Lanoxin), a diuretic, and vasodilators
◦Notify the physician if side effects occur from the medications
◦Avoid over-the-counter medications◦Contact the physician if unable to take
medications due to illness
HEART FAILUREHEART FAILURE CLIENT EDUCATION
◦Avoid large amounts of caffeine found in coffee, tea, cocoa, chocolate, and some carbonated beverages
◦Prescribed low-sodium, low-fat, and low-cholesterol diet
◦Provide the client with a list of potassium-rich foods because diuretics will cause hypokalemia (except for potassium-sparing diuretics)
HEART FAILUREHEART FAILURE CLIENT EDUCATION
◦Fluid restriction, if prescribed, advising the client to spread the fluid out during the day, and to suck on hard candy to reduce thirst
◦Space periods of activity and rest◦Avoid isometric activities that increase pressure in
the heart◦Monitor daily weight and report signs of fluid
retention such as edema or weight gain
CARDIOGENIC SHOCKCARDIOGENIC SHOCK
DESCRIPTION◦Failure of the heart to pump adequately,
thereby reducing cardiac output and compromising tissue perfusion
◦Necrosis of more than 40% of the left ventricle occurs usually as a result of occlusion of major coronary vessels
◦The goal of treatment is to maintain tissue oxygenation and perfusion and improve the pumping ability of the heart
CARDIOGENIC SHOCKCARDIOGENIC SHOCK
ASSESSMENT◦Hypotension: BP less than 90 mmHg systolic or
30 mmHg less than the client’s baseline◦Urine output of less than 30 ml/hour◦Cold, clammy skin◦Poor peripheral pulses◦Tachycardia, tachypnea◦Pulmonary congestion◦Disorientation, restlessness, and confusion◦Continuing chest discomfort
CARDIOGENIC SHOCKCARDIOGENIC SHOCK
IMPLEMENTATION◦Administer IV morphine sulfate as prescribed to
decrease pulmonary congestion and relieve pain
◦Administer oxygen as prescribed◦Prepare for intubation and mechanical
ventilation◦Administer diuretics and nitrates as prescribed
while monitoring blood pressure constantly
CARDIOGENIC SHOCKCARDIOGENIC SHOCK
IMPLEMENTATION◦Administer vasopressors and positive inotropics
as prescribed to maintain organ perfusion◦Prepare the client for insertion of an intraaortic
balloon pump (IABP), if prescribed, to facilitate emptying of the left ventricle and improve cardiac output
◦Prepare the client for immediate reperfusion procedures such as PTCA or CABG
INTRAAORTIC BALLOON PUMPINTRAAORTIC BALLOON PUMPFrom Lewis SM, Heitkemper MM, Dirksen SR: Medical-Surgical Nursing: Assessment and Management of Clinical Problems (5th ed), St. Louis, 2000, Mosby.
CARDIOGENIC SHOCKCARDIOGENIC SHOCK
IMPLEMENTATION◦Monitor urinary output ◦Monitor arterial blood gas levels and prepare to
treat imbalances◦Assist with the insertion of Swan-Ganz catheter
to assess heart failure◦Monitor distal pulses and maintain the
transducer at the level of the right atrium if the client has a Swan-Ganz catheter
Recommended