1. Chapter 30 Management of Patients With Complications From Heart Disease

2. Heart Failure
The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.
A syndrome characterized by fluid overload or inadequate tissue perfusion. (insufficient CO)
HF is a progressive, life-long condition that is managed with lifestyle changes and medications to prevent episodes of acute decompensated heart failure.
The term heart failure indicates myocardial disease, in which there is a problem with the contraction of the heart (systolic failure) or filling of the heart (diastolic failure).

3. The EF is normal in diastolic HF but severely reduced in systolic HF.
systolic heart failure (alteration in ventricular contraction and a weakened heart muscle.)
Diastolic heart failure, (a stiff and noncompliant heart muscle, making it difficult for the ventricle to fill).
ejection fraction (EF) is performed to assist in determining the type of HF.
The EF is normal in diastolic HF but severely reduced in systolic HF.

4. Classification of Heart Failure
NYHA (NEW YORK HEART ASSOCIATION) classification of heart failure
Classification I , II, III, IV
ACC/AHA (AMERICAN COLLEGE OF CARDIOLOGY AND AMERICAN HEART) ASSOCIATION classification of heart failure
Stages A, B, C, D
Treatment guidelines are in place for each stage

5. Pathophysiology of Heart Failure

6. Clinical Manifestations

7. Clinical Manifestations
Right-sided failure
RV cannot eject sufficient amounts of blood and blood backs up in the venous system. This results in JVD and increased capillary hydrostatic pressure, peripheral edema, hepatomegaly, ascites, anorexia, nausea, weakness, and weight gain.
Left-sided failure
LV cannot pump blood effectively to the systemic circulation. Pulmonary venous pressures increase and result in pulmonary congestion with dyspnea, nocturia, cough, crackles, and impaired oxygen exchange.
Chronic heart failure is frequently biventricular.

8. Assessment and Diagnostic Findings
HF may go undetected until the patient presents with signs and symptoms of pulmonary and peripheral edema.
Assessment of ventricular function is an essential part of the initial diagnostic workup.
An echocardiogram is usually performed to confirm the diagnosis of HF,

9. -2determine the EF, which helps identify the type and severity of HF.
ECG
CxR
Serum electrolytes (BNP level)
radionuclide ventriculography
invasively ventriculography

10. Medical Management of Heart Failure
depend on the type, severity, and cause of HF
The overall goals of management of HF are to relieve patient symptoms, to improve functional status and quality of life, and to extend survival.
Eliminate or reduce etiologic or contributory factors.
Reduce the workload of the heart by reducing afterload and preload.
Optimize all therapeutic regimens.
Promote a lifestyle conducive to cardiac health
Prevent episodes of acute decompensated HF

11. oral and IV medications, major lifestyle changes, supplemental oxygen,
Implantation of assistive devices,
and surgical approaches, including cardiac transplantation.
provide comprehensive education and counseling
restriction of dietary sodium;
avoidance of excessive fluid intake,
alcohol, and smoking;
weight reduction and regular exercise
recognize signs and symptoms

12. Medications
Angiotensin: converting enzyme inhibitors and Angiotensin II receptor blockers
Decrease BP and decrease afterload
Relieves signs and symptoms of HF
Prevents progression of HF
Hydralazine and Isosorbide Dinitrate
cause venous dilation

13. Medications Beta-blockers Diuretics Decrease fluid volume overload
Decrease S&S of HF
Digitalis
Improves contractility
Other medications

14. Nutritional Therapy
A low-sodium (2 to 3 g/day) diet and avoidance of drinking excessive amounts of fluid
Supplemental Oxygen

15. Nursing Process: The Care of the Patient with Heart Failure—Assessment
Health history and Assess responses to medications
Sleep and activity
Knowledge and coping
Physical exam
Mental status
Lung sounds: crackles and wheezes
Heart sounds:
Fluid status/signs of fluid overload (JVD and assess for hepatojugular reflux)
Daily weight and I&O
assesses dependent parts of the patient’s body for perfusion and edema.

16. Nursing Process: The Care of the Patient with Heart Failure—Diagnoses
Activity intolerance and fatigue
Excess fluid volume
Anxiety
Powerlessness
Noncompliance

17. Collaborative Problems/Potential Complications
Cardiogenic shock
Dysrhythmias
Thromboembolism
Pericardial effusion and cardiac tamponade
Hypotension, poor perfusion, and cardiogenic shock

18. Nursing Process: The Care of the Patient with Heart Failure—Planning
Goals may include:
promoting activity and reducing fatigue,
relieving fluid overload symptoms,
decreasing anxiety or increasing the patient’s ability to manage anxiety,
encouraging the patient to make decisions and influence outcomes,
teaching the patient about the self-care program.

19. Activity Intolerance
Encourage regular physical activity; 30–45 minutes daily
Exercise training (increasing functional capacity and decreasing dyspnea.)
Wait 2 hours after eating for physical activity
Avoid activities in extreme hot, cold, or humid weather
Modify activities to conserve energy
Stop the activity if severe shortness of breath, pain, or dizziness develops.
short-term and long-term goals can be developed to gradually increase the intensity, duration, and frequency of activity.
Bed rest for acute exacerbations

20. Fluid Volume Excess Assessment for symptoms of fluid overload
Auscultating the lungs,
monitoring daily body weight,
and assisting the patient to adhere to a low-sodium diet and fluid restriction
I&O
patient is positioned or taught how to assume a position that facilitates breathing.
Frequent changes of position, positioning to avoid pressure, and leg exercises

21. Minimizing Powerlessness
Controlling Anxiety
Oxygen
promote physical comfort and provide psychological support
use relaxation techniques to control anxious feelings.
Minimizing Powerlessness
lack of knowledge and lack of opportunities to make decisions
influence the direction of their lives and the outcomes of treatment. .

22. Monitoring and Managing Potential Complications
Hypokalemia
Hyperkalemia
Hyponatremia
dehydration and hypotension.
increased
serum creatinine and hyperuricemia

23. Patient Teaching Medications
Diet: low-sodium diet and fluid restriction
Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, including daily weight
Exercise and activity program
Stress management
Prevention of infection
Know how and when to contact health care provider
Include family in teaching