Imperio Heart Failure

7/29/2019 Imperio Heart Failure

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Superior venacava

Inferior venacava

Right

atrium

tricuspid valve

Right

ventricle

Pulmonic valve

Pulmonary

artery

LUNGS

Pulmonary vein

Leftatrium

bicuspid

valve

Leftventricle

Aorta

Aortic valve

Systemic

circulation

Blood Circulation



Heart Failure

•Inability of the heart to pump

sufficient blood to meet the needs of

the tissues for oxygen and nutrients.•Clinical syndrome characterized by

signs and symptoms of fluid overload

and decreased tissue perfusion.



RISK FACTORS:

•Coronary artery disease

•Cardiomyopathy

•

Myocardial infarction•Valve disease

•DM

•Hypertension



Diagnostic Test, Medical /

Surgical Management and

Nursing Management of HEART FAILURE



DIAGNOSTIC TEST:

•Echocardiogram•Radionuclide ventriculography

•Chest X-ray

•Electrocardiogram (ECG)

•

Laboratory Studies (serum electrolytes, blood ureanitrogen(BUN),creatinine, thyroid-Stimulating hormone,

complete blood cell count, BNP and routine urine

analysis.)

•Cardiac stress testing



Cardiac Stress Testing – to determine whether coronary artery disease and

cardiac ischemia are causing the HF.



•BNP level is a key diagnostic indicator of heart

failure.

Brain-type Natriuretic Peptide- a substance

secreted from the ventricles or lower chambers of

the heart in response to changes in pressure that

occur when heart failure develops and worsens.

Results:

•BNP levels below 100 pg/mL indicate no heart failure

•BNP levels of 100-300 suggest heart failure is present •BNP levels above 300 pg/mL indicate mild heart failure

•BNP levels above 600 pg/mL indicate moderate heart failure.

•BNP levels above 900 pg/mL indicate severe heart failure.



MEDICAL MANAGEMENT:

Goal: To relieve patient symptoms.

To improve functional status and quality of life, and

to extend survival.

Pharmacologic Therapy:

•Angiotensin-Converting Enzyme (ACE) inhibitors

•Beta-adrenergic Blocking Agents (beta-blockers)

•Diuretics•Digitalis



MEDICATION THERAPEUTIC EFFETCS NURSING CONSIDERATIONS

Angiotensin Converting Enzyme (ACE)

inhibitors

•Lisinopril (Prinivil, Zestril)

•Captopril (Lotensin)

•Enalapril (Vasotec)

Decrease BP and afterload

Relieve signs and symptoms of HF.

Prevents progression of HF.

Observe for symptomatic hypotension,

increase serum potassium, cough and

worsening renal function.

Beta – adrenergic Blocking Agents

(Beta Blockers)

•Metoprolol (Lopressor, Toprol)

•

Atenolol (Tenormin)•Carvedilol (Coreg)

Dilates blood vessels and decrease

afterload.

Decrease signs and symptoms of HF.

Observe for decrease heart rate,

symptomatic hypotension, and fatigue.

Diuretics

Loop Diuretic:

•Furosemide (Lasix)

Thiazide Diuretic:•Metolazone (Zaroxolyn)

Aldosterone Antagonist:

•Spironolactone (Aldactone)

Decreasefluid volume overload.


Observe for electrolyte abnormalities,

renal dysfunction, and decrease BP.

Carefully monitor I and O and daily

weight.

Digitalis

•Digoxin ( Lanoxin)

Improves contractility.


Observe for bradycardia and digitalis

toxicity.



Angiotensin Receptor Blockers (ARBs)

•Valsartan (Diovan)

•Irbesartan Avapro)

•Losartan (Gozaar)

Decrrease BP and afterload.

Relieves sign and symptoms of Hf.

Prevents progression of HF.


increase serum potassium, cough and

worsening renal function.

Calcium channel blockers

•Amlodipine (Norvasc)

•Felodipine (Plendil)

Vasodilation and reduction of systemic

vascular resistance.


drowsiness or dizziness.



Other medication for Heart Failure:

•

Anticoagulant may be prescribed.•Medications that manage hyperlipidemia (statins).

MEDICATIONS TO AVOID!

•Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin).



Nutritional Therapy:

•Low-sodium (2 to 3 g/day) diet

•Avoidance of drinking excessive amounts of fluid are usually recommended.

Supplemental Oxygen:

•Oxygen may become necessary as HF progresses.

•Some patients require supplemental only during periods of activity.

•Administer oxygen therapy per nasal cannula at 2 to 6 L/min as orderd.

•Maintain semi-Fowler’s or high Fowler’s position to maximize oxygenation by

promoting greater lung expansion.



NURSING MANAGEMENT:

Promoting Activity Tolerance

•Advice patient that prolonged bed rest should be avoided because of it’s

deconditionig effects and risk such as pressure ulcers, venous thrombosis,

and pulmonary embolism.

•Encourage a physical activity 30 minutes everyday.

Managing fluid volume

•Oral diuretics should be administered early in the morning.•Monitor intake and output.

•Monitor daily body weight.

•Advice the patient to avoid high sodium food such as canned, processed

and convenience foods.

•Monitor the patient’s IV fluid closely. •Elevate the head of the bed to facilitate breathing.

•Frequent change of position to avoid pressure.

•Leg exercise to prevent pressure ulcers.

•Gradual ambulation.



SURGICAL MANAGEMENT :

•Coronary Artery Bypass – to improve blood flow to heart

muscle

•Left Ventricle Reconstruction

•Heart valve reconstruction

•Cardiac transplantation







Left ventricle reconstruction- to remove damage to heart muscle



Implanted ventricular assist device- to help heart pump

blood



Heart transplantation



NURSING DIAGNOSIS:

•Impaired gas exchange

•Activity intolerance

•Fatigue

•Fluid volume excess•Anxiety

•Powerlessness

•Ineffective therapeutic regimen management



1. Which of the following assessment finding would elicit specific

information regarding the left ventricular function of a patient with

left ventricular failure?

a. Assessing peripheral and sacral edema.

b. Assessing jugular vein distention.c. Monitoring for organomegaly.

d. Listening to lung sounds.



2. Which of the following symptoms is most commonly associated with left-

sided heart failure?

a. Crackles

b. Hepatic engorgement

c. Hypotension

d. Arrhytmias

Rationale:

Crackles in the lungs are a classic sign of left-sided heart failure. These

sounds are caused by fluid backing up into the pulmonary system.

Arrhythmias can be associated with both right and left-sided heart

failure. Left-sided heart failure causes hypertension secondary to anincreased workload on the system.



3. Stimulation of the sympathetic nervous system produces which of the

following responses?

a. Tachycardia

b. Hypotension

c. Decreased myocardial contractility

d. Bradycardia

Rationale:

Stimulation of the sympathetic nervous system causes tachycardia and

increased contractility.



4. Which of the following classes of medications maximizes cardiac

performance in clients with heat failure by increasing ventricular contractility?

A. Inotropic agents

B. Beta-adrenergic Blockers

C. Calcium Channel Blockers

D. Diuretics

Rationale:

Inotropic agents are administered to increase the force of the heart’s

contractions, thereby increasing ventricular contractility and ultimately

increasing cardiac output.



5. Which of the following classes of medications protects the ischemic

myocardium by blocking catecholamines and sympathetic nerve

stimulation?

A. Nitrates

B. Beta-adrenergic Blockers

C. Narcotics

D. Calcium channel blockers

Rationale:

Beta-adrenergic blockers work by blocking beta receptors in the

myocardium, reducing the response to catecholamines and

sympathetic nerve stimulation. They protect the myocardium,

helping to reduce the risk of another infarction by decreasing theworkload of the heart and decreasing myocardial oxygen demand.



6. After an anterior wall myocardial infarction, which of the following

problems is indicated by auscultation of crackles in the lungs?

A. Left-sided heart failure

B. Right-sided heart failure

C. Pulmonic valve malfunction

D. Tricuspid valve malfunction

Rationale:

The left ventricle is responsible for the most of the cardiac output. An

anterior wall MI may result in a decrease in left ventricular function.

When the left ventricle doesn’t function properly, resulting in left-sided

heart failure, fluid accumulates in the interstitial and alveolar spaces in

the lungs and causes crackles.



7. Which of the following complications is indicated by a third heart

sound (S3)?

A.Ventricular dilation

B. Systemic hypertension

C. Aortic valve malfunction

D. Increased atrial contractions

Rationale:

Rapid filling of the ventricles causes vasodilation that is

auscultated as S3. Increased atrial contraction or systemic

hypertension can result is a fourth heart sound. Aortic valve

malfunction is heard as a murmur.



8. The nurse is aware that one of the following classes of medications

maximizes cardiac performance in clients with heart failure by increasing

ventricular contractility?

a. Beta-adrenergic blockers

b. Calcium channel blocker

c. Diureticsd. Inotropic agents



9. Mr. Mendoza who has suffered a congestive heart failure is too weak to

move on his own. To help the client avoid pressure ulcers, Nurse Celia should:

a.Turn him frequently.

b. Perform passive range-of-motion (ROM) exercises.

c. Reduce the client’s fluid intake.

d. Encourage the client to use a footboard.



10. Nurse Bea is assessing a male client with heart failure. The breath

sounds commonly auscultated in clients with heart failure are:

a. Tracheal

b. Fine crackles

c. Coarse crackles

d. Friction rubs

Rationale:

Fine crackles are caused by fluid in the alveoli and commonly occur

in clients with heart failure.

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Imperio Heart Failure