Nursing Care of Patients with Heart Failure Chapter 26 Nursing Care of Patients with Heart Failure

Heart Failure Syndrome Occurs from Progressive Inability of Heart to Pump Enough Blood to Meet Body’s Oxygen/Nutrient Needs Older Term: Congestive Heart Failure

Causes Coronary Artery Disease Cardiomyopathy Hypertension Heart Valve Disorders Myocardial Infarction

Pathophysiology Each Ventricle Pumps Equal Amount of Blood If More Than Either Ventricle Can Handle, Heart Not Effective Pump Left Ventricle Typically Weakens First Failure of One Leads to Failure of Other

Left-Sided Heart Failure Afterload Force Generated by Left Ventricle to Eject Blood Into Aorta Through Aortic Valve Peripheral Vascular Resistance (PVR) Pressure Within Aorta/Arteries PVR Influences Afterload

Left-Sided Heart Failure (cont’d) Hypertension Major Cause Blood Backs Up from Left Ventricle Alveolar Edema Results

Left-Sided Heart Failure (cont’d)

Right-Sided Heart Failure Left-sided Heart Failure Major Cause Must Continually Pump Blood Against Increased Fluid in Pulmonary Artery and Lungs

Right-Sided Heart Failure (cont’d) Cor Pulmonale Right Ventricle Hypertrophies and Fails Due to Increased Pulmonary Pressures Backward Buildup of Blood in Systemic Blood Vessels Peripheral Edema Results

Right-Sided Heart Failure (cont’d)

Compensatory Mechanisms Maintain Cardiac Output Designed to Maintain Cardiac Output Also Contribute to Cycle of Heart Failure

Compensatory Mechanisms Maintain Cardiac Output When Low Sympathetic Nervous System Raises Heart Rate Increases Cardiac Oxygen Needs Renin-Angiotensin-Aldosterone System, Antidiuretic Hormone Save Water Increases Fluid Volume

Compensatory Mechanisms (cont’d) Chambers Enlarge (Dilation) Muscle Mass Increases (Hypertrophy) Increases Cardiac Oxygen Needs

Pulmonary Edema Acute Heart Failure Severe Fluid Congestion in the Alveoli Life-threatening Drowning in Own Secretions

Signs and Symptoms Classic: Pink, Frothy Sputum Rapid Respirations with Accessory Muscles Severe Dyspnea, Orthopnea Crackles, Wheezes Anxiety, Restlessness Clammy, Cold Skin

Diagnosis X-Ray ABGs Pulmonary Pressures

Therapeutic Interventions Immediate Treatment Reduce Workload of Left Ventricle Treat Underlying Cause Fowler’s Position Oxygen/Mechanical Ventilation

Therapeutic Interventions (cont’d) Morphine IV Diuretics IV Inotropic Agents IV Vasodilators IV

Nursing Diagnoses Impaired Gas Exchange Decreased Cardiac Output Excess Fluid Volume Acute Pain Anxiety

Chronic Heart Failure Progressive Signs and Symptoms May Worsen Over Time

Signs and Symptoms Fatigue and Weakness Exertional Dyspnea Cough Orthopnea, Paroxysmal Nocturnal Dyspnea Cough Crackle and Wheezes Tachycardia Chest Pain

Signs and Symptoms (cont’d) Cheyne-Stokes Respiration Edema Anemia Nocturia Cyanosis Altered Mental Status Malnutrition

Complications of Heart Failure Liver and Spleen Enlargement Pleural Effusion Thrombosis and Emboli Cardiogenic Shock

Diagnostic Tests Screening Tests BNP Serum BUN, Creatinine Liver Function Tests Thyroid Function Test Ferritin

Diagnostic Tests (cont’d) Chest X-Ray Echocardiography ECG Exercise Stress Testing Cardiac Magnetic Imaging Cardiac Catheterization/Angiography Sleep Studies

Therapeutic Intervention Goals Improve Heart’s Pumping Ability and Decrease Heart’s Oxygen Demands Identify and Correct Underlying Cause Increase Strength of Heart’s Contraction Maintain Optimum Water and Sodium Balance Decrease Heart’s Workload

Drug Therapy Oxygen Therapy ACE Inhibitors or ARBs Beta Blockers Diuretics Inotropic Agents Vasodilators

Therapeutic Interventions Activity Sodium and Weight Control Pacemakers, ICD Cardiac Resynchronization Therapy

Therapeutic Interventions (cont’d) Mechanical Assistive Devices Intra-aortic Balloon Pump Ventricular Assist Device Total Artificial Heart Implantable Replacement Heart

Intra-Aortic Balloon Pump

Ventricular Assist Devices and Artifical Heart Support Failing Heart Bridge to Transplantation Destination Therapy Heart Replacement Please see figure 26.4, page 491 of the text for different types of ventricular assist devices.

Surgical Interventions CABG Valve Replacement Ventricular Reconstruction

Nursing Diagnoses Impaired Gas Exchange Decreased Cardiac Output Acute Pain  Anxiety  Excess Fluid Volume

Nursing Interventions Oxygen Rest and Activity Positioning Fluid Management Reduce Oxygen Consumption

Nursing Interventions (cont’d) Medications/Teaching Low-sodium Diet Weight Control Education Coping

Cardiac Transplantation End Stage Heart Failure Strict Selection Criteria

Heart Transplant

Cardiac Transplantation (cont’d) Immunosuppressive Therapy Preoperatively Lifelong Antirejection Therapy

Cardiac Transplantation (cont’d) Complications Rejection Infection Malignancies Anti-rejection Medicine Side Effects

Postoperative Cardiac Surgery Nursing Diagnoses Pain Ineffective Airway Clearance Impaired Gas Exchange Decreased Cardiac Output Risk for Infection Deficient Knowledge