Chronic Heart Failure Exacerbation PNCI - Learner

Preparation Questions

List the risk factors for chronic left-sided heart failure related to coronary artery disease. smoking, alcohol, or drug use obesity hypertension heart disease diabetes coronary artery disease family history

Explain the cause of the compensations for chronic heart failure. The compensations of chronic heart failure are caused by decreased cardiac output due to impaired function of the heart ventricles, and the goal of the compensations is to maintain cardiac output. The compensations that occur are: increased heart rate and force of contraction in order to increase cardiac output activation of the RAAS system, which causes vasoconstriction and fluid retention which results in increased BP hypertrophy in order to increase force of contractions dilation of heart ventricles to increase cardiac output

Describe the manifestations and effects of right-sided and left-sided heart failure. Right sided: effect is blood back up into the body Manifestations include: edema ascites weight gain distended jugular veins enlarged liver and spleen GI distress Left sided: effect is blood back up into lungs pulmonary edema possible bloody sputum dyspnea orthopnea adventitious lung sounds crackles, wheezing, difficulty breathing confusion

List the goals in the interdisciplinary care of a patient with chronic heart failure. self management of disease by the pt. through pt education of disease and symptoms increase activity level obtain improved cardiac output and symptoms improved gas exchange increased quality of life

List the two hormones released by the heart muscle in response tochanges in blood volume. ANP (atrial natriuretic peptide) BNP (brain natriuretic peptide)The effects of these hormones are natriuresis, diuresis, and reduced blood pressure

Explain the nursing implications for the client receiving echocardiography with Doppler flow studies. Explain procedure to patient and verify understanding of the procedure from the patient Place patient in supine position and turn on left side

Define refractory heart failure. Refractory heart failure is defined as manifesting heart failure while at rest despite aggressive treatment.

List the nursing implications and education needs for each of the following categories of medication related to heart failure: Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) Implications: monitor BP, HR, BUN and creatinine levels notify pt that it can cause a decrease in taste Education: educate pt about adverse effects (rash, swelling) educate pt on hypotension do not stop this medication suddenlyBeta-adrenergic receptor blockers Implications: monitor BP, HR, and apical pulse do not administer med if apical pulse is less than 60 Education: Diuretic Implications: monitor intake and output, weight daily, monitor electrolyte levels Education: Positive inotrope agent Implications: take radial pulse before administration, do not administer if less than 60, assess rate and rhythm, of pulse, monitor Dig level and potassium levels Education: Sympathomimetic agent Implications: Education: Phosphodiesterase inhibitors Implications: Education:

List the interdisciplinary interventions for each of the following nursing diagnoses related to chronic heart failure.Decreased cardiac output: review diagnostic studies and labs ECG, echocardiogram, cardiac output/ventricular ejection studies, heart scan, chest radiograph Labs: CBC, electrolytes, ABGs, PT, PTT monitor heart for any cardiac dysrhythmias assess for signs of cardiac failure assess vital signs, cap refill, pulses, color and temperature of extremities, and change in mental status assess for edema educate pt on signs and symptoms to report immediately to provider educate pt on their medications, adverse effects, and establish drug regimenExcessive fluid volume monitor vital signs, pt weight, input and output, and signs of edema assess for jugular vein distension and lung sounds monitor for signs of renal and kidney insufficiency Labs: electrolytes dietary and fluid restrictions promote ambulation and frequent position changing educate pt on their medications, adverse effects, and establish drug regimenActivity intolerance assess vital signs during physical activity BP, HR, respirations before, during and after assess medication regimen for possible contributing side effects or interactions assist with activities and note fatigue level implement graded exercise or rehabilitation under medical supervision encourage use of relaxation techniques (visualization, meditation, guided imagery) encourage participation in activities Ineffective health maintenance identify risk factors in pt life assess pt ability and desire to learn include any barriers such as developmental status or communication barriers evaluate for substance abuse provide active listening for pt concerns encourage socialization to develop support system make referral as needed to community support servicesDeficient community health assess pt knowledge of disease and disease process and identify areas for education educate pt on signs and symptoms and when to contact provider educate pt on self management to minimize emergency episodes

List the signs and explain the interdisciplinary interventions for each of the following nursing diagnoses related to pulmonary edema. Impaired gas exchange - signs:dyspneacyanosisabnormal breathingtachycardiadiaphoresishypoxia, hypoxemialethargy- interventions: monitor lungs for presence of adventitious lung sounds monitor vital signs position pt in semi Fowlers to help alleviate dyspnea administer O2 as ordered

Decreased cardiac output - signs:altered heart rate and rhythmjugular vein distentionedemadyspneaprolonged cap refilldecreased pulsesfatiguerestlessness- interventions: review EKG, echocardiogram, chest radiograph, heart scan/catherization review CBC, ABGs, electrolytes, cardiac enzymes, liver function, kidney function, thyroid, and PT and PTT assess heart sounds and lung sounds monitor BP, HR, respirations, temperature and input and outputs apply compression devices elevate legs when resting teach home monitoring for self management

Anxiety - signs:pt verbalized concerns and fear about life events, uncertainty, worry, feelings of inadequacy, insomniarestlessnessshakiness, dry mouth, heart poundingrespiratory difficulty (shortness of breath, difficulty breathing)nausea, abdominal pain, diarrhea- interventions: obtain family history, medical history, and social history- include assessment of current stressors assess level of anxiety: mild, severe, panic) - based on objective and subjective data review diagnostic tests:- drug screening, CBC, chemistry panel assess and educate use of coping skills provide safe environment to prevent self injury