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Understanding Heart Failure By Damon Cottrell, RN, ACNS-BC, CCNS, CCRN, CEN, MS; Cynthia Bither, RN, ANP, ACNP, MSN; Renee Garnes-Spence, RN, PCCN, MSN;

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Presentation on theme: "Understanding Heart Failure By Damon Cottrell, RN, ACNS-BC, CCNS, CCRN, CEN, MS; Cynthia Bither, RN, ANP, ACNP, MSN; Renee Garnes-Spence, RN, PCCN, MSN;"— Presentation transcript:

1 Understanding Heart Failure By Damon Cottrell, RN, ACNS-BC, CCNS, CCRN, CEN, MS; Cynthia Bither, RN, ANP, ACNP, MSN; Renee Garnes-Spence, RN, PCCN, MSN; and Michelle Jones, RN, ANP, ACNP, MSN LPN2009, March/April ANCC contact hours Online: © 2009 by Lippincott Williams & Wilkins. All world rights reserved.

2 What is heart failure? Progressive disease Affects heart’s ability to pump effectively Can’t supply sufficient blood and oxygen to the body’s tissues

3 Heart failure Usually caused by injury to myocardium Injury results in dilation or hypertrophy of one or both ventricles, called “remodeling” Cardiac output and blood pressure drop

4 Causes of heart failure Aortic regurgitation Aortic stenosis Cardiomyopathy Coronary artery disease Myocardial infarction Renal artery stenosis Volume overload Dysrhythmias (atrial fibrillation) HIV Hypertension Hyperthyroidism Medications

5 Causes of heart failure May be acute or chronic Patients usually exhibit signs of shortness of breath, tiredness, swelling of feet, ankles, abdomen May see jugular venous distention and hear a third heart sound

6 Signs and symptoms Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Weakness/fatigue Confusion Headache Insomnia Tachycardia Third heart sound Rales Edema Jaundice Alternating weak and strong pulse Cool, cold, or pale extremities Jugular venous distention Cyanosis

7 Diagnosing heart failure History and physical: provide clues about patient’s physical status ECG looks for dysrhythmias Echocardiography provides information about function and heart size Lab tests: electrolytes, thyroid studies, BUN, BNP

8 Classes and stages Heart failure is divided into classifications based on specific pathophysiology Helps guide best treatments Heart failure is also broken down into stages Treatment of stages is aimed at stabilizing patient’s condition and delaying progression

9 New York Heart Association Classification of Heart Failure Classification I Ordinary physical activity doesn’t cause undue fatigue, dyspnea, palpitations, or chest pain No pulmonary congestion or peripheral hypotension Patient is considered asymptomatic Usually no limitations of ADLs Prognosis: Good

10 New York Heart Association Classification of Heart Failure Classification II Slight limitation on ADLs Patient reports no symptoms at rest but increased physical activity will cause symptoms Basilar crackles and S 3 murmur may be detected Prognosis: Good

11 New York Heart Association Classification of Heart Failure Classification II Marked limitations on ADLs Patient feels comfortable at rest but less than ordinary activity will cause symptoms Prognosis: Fair Classification IV Symptoms of cardiac insufficiency at rest Prognosis: Poor

12 The four stages of heart failure Stage A: Patient at high risk of developing left ventricular dysfunction Stage B: Patients with left ventricular dysfunction who haven’t developed symptoms Stage C: Patients with left ventricular dysfunction with current or prior symptoms Stage D: Patients with refractory end-stage heart failure

13 Treating heart failure Primary treatment: lifestyle modifications - restrict dietary sodium - smoking cessation - weight reduction (if indicated) - regular exercise

14 Treating heart failure Medications - given to block hormones that circulate in excess when heart becomes weak - reverse changes in heart’s muscle that occur over time - first-line drugs given include angiotensin- converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers

15 Medications Most often recommended beta-blockers are bisoprolol (Concor) and carvedilol (Coreg) Best chance of cardiac recovery with higher doses to reduce heart workload and lower BP Evidence of lower mortality and fewer adverse reactions

16 Diuretics Used mainly for symptom relief Bumetanide (Bumex) and furosemide in low doses are preferred Spironolactone (Aldactone) for advanced patients African-Americans and patients with with renal failure may be given BiDil

17 Diuretics used to treat heart failure Thiazide diuretics Bendroflumethiazide (Naturetin) Benzthiazide (Exna) Chlorothiazide (Diuril) Chlorthalidone (Hygroton) Hydrochlorothiazide (HydroDIURIL, Esidrix, Oretic) Hydroflumethiazide (Diucardin, Saluron) Methyclothiazide (Enduron) Metolazone (Zaroxolyn, Mykrox) Polythiazide (Renese) Quinethazone (Hydromox) Trichlormethiazide (Metahydrin, Naqua)

18 Diuretics used to treat heart failure Loop diuretics Bumetanide (Bumex) Ethacrynic acid (Edecrin) Furosemide (Lasix) Torsemide (Demadex) Potassium-sparing diuretics Amiloride (Midamor) Spironolactone (Aldactone) Triamterene (Dyrenium)

19 Pacing Many patients have delayed time interval between contraction of right and left ventricles Synchronized biventricular pacing uses a third lead to pace ventricles simultaneously Improves cardiac output Nursing care: monitoring patient post procedure, elevation of head of bed, pain medication

20 Ventricular assist device Supports right, left, or both ventricles Used for patients awaiting transplant (“bridge to transplant”) Used as treatment (“destination therapy”) “Bridge to recovery” allows heart time to recover from remodeling; device is then removed

21 Nursing care of patients with a ventricular assist device Assessment and prevention of infection at “driveline site” (patient’s abdomen) Assess nutritional and functional status Assess pump function and troubleshoot alarms

22 Monitoring patient Vital signs Lab results Renal function Nutritional status Presence of infection or bleeding Effectiveness of anticoagulation Monitor pump parameters

23 Cardiac transplantation Treatment option for end-stage heart failure Approx. 2,500 procedures in U.S. each year 1- and 3-year survival rates 85.6% and 79.5% Rigorous screening of candidates Patient put on united organ sharing list

24 Cardiac transplantation Major postoperative difference in these patients is need for chronotropic (heart rate) support Immunosuppressive drug therapy to prevent rejection Consists of three types of drugs: calcineurin inhibitors, corticosteroids, antimetabolites

25 Nursing care of transplant patients Education on signs and symptoms of infection Education on signs and symptoms of rejection Nutrition counseling (well-balanced, low-fat diet) Review follow-up visits

26 Nursing management/interventions for patients with heart failure Administering medications and assessing patient response Assessing fluid balance, intake, and output with goal of optimizing balance Daily weights

27 Nursing management/interventions for patients with heart failure Assessing jugular venous distention Auscultating lung and heart sounds Identifying dependent edema Monitoring pulse, BP

28 Nursing management/interventions for patients with heart failure Checking for postural hypotension Examining skin turgor for signs of dehydration Assessing for symptoms of fluid overload

29 Potential complications of HF therapy Hypokalemia: low potassium; signs include dysrhythmias, weak muscles; can cause heart muscle weakness Hyperkalemia: abnormally high serum potassium, especially when taking ACEs, ARBs, or spironolactone

30 Potential complications of HF therapy Hyponatremia: deficiency of serum sodium Hyperuricemia: excessive uric acid in blood

31 Patient teaching Teach patients rationale for medications (doses, times, adverse reactions) Teach patient to limit fluid to 2 liters per day Teach patient to follow a low-sodium diet

32 Patient teaching Teach patient to weight himself daily and to notify healthcare provider of an increase in weight of 3 lbs or more Address patient’s psychological needs


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