2 Incidence and Prevalence of Heart Failure Leading cause of death in the USMore than 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year.About 250,000 people a year die from heart disease.That means more than 680 Americans a day die from it!!!!!!!!Women have a poorer survival rate then men
3 Basic Needs: Oxygenation Two body systems that work together to meet this basic need.3
4 OxygenationOxygen is required to sustain life, primary basic human needThe cardiac & respiratory systems function to supply the body’s oxygen demandsCardiopulmonary physiology involves delivery of deoxygenated blood to the right side of the heart & to the pulmonary systemWhen we think about basic needs this is at the top of the list. If you cant find a bathroom you will find a place to go but you will continue to live. If your heart does not work or you are not breathing you are not able to sustain life.4
5 What are the 3 concepts in oxygenation? VentilationPerfusionDiffusion
6 What are the 2 mechanisms that drive the function of the heart? Electrical/conductionMechanical/pump
8 What are they???? What is Heart Failure? Heart cannot pump enough blood to meet the metabolic demands of the body.Results from changes in the systolic or diastolic function of the ventriclesThere are many causes?????What are they????Diabetes Mellitus, cigarette smoking, obesity, high serum cholesterol, hypertension, MI,CADHypertensive HDRheumatic Heart DisCongenital Heart DisCor pulmonaleCardiomyopathyAnemiaBacterial endocarditisValvular disordersAcute MIDysrhythmiasPulmonary emboliThyrotixicosisHypertensive crisisRupture of papillary muscleVSDMyocarditis
9 Types of Heart FailureLeft SidedRight sidedSystolicDiastolic
10 Left Sided Heart Failure Most CommonLV dysfunction causes blood to back up through the left atrium and into the pulmonary system.Common causes of left heart failure are:HTN, CAD, mitral and/or aortic valve disease, decreased tissue perfusion.
12 Right Sided Heart Failure Most common cause is left sided heart failure.Other causes MI or pulmonary HTNRV dysfunction causes the blood to back up in the right atrium and then the venous circulation.
14 Systolic Failure Defect in ventricular contraction Left Ventricle loses ability to generate enough pressure to eject blood forward through the high pressure aorta – Decreased ejection fractionAfterload – hypertension, cardiomyopathy, and valvular heart disease
15 Diastolic Failure Impaired ability of ventricles to fill Decreased filling = decreased stroke volume Which + decreased WHAT?Pulmonary congestion, pulmonary hypertension, with normal ejection fraction
17 Diagnostic Studies Goal: Assess the cause & degree of failure History and Physical ExamB-Type Natriuretic Peptide level (BNP).elevated in acute and chronic heart failureuseful in following the response to treatment of congestive heart failure.ABGs, Serum chemistries, LFTsChest x-rayEKGEchocardiogramNuclear imaging studiesCardiac catheterizationHemodynamic monitoring
19 Classification of Heart Failure Class 1 – No limitation of physical activityClass 2 – Slight limitation – fatigue, dyspnea, palpitationsClass 3 – marked limitation. Comfortable at rest; ordinary activities cause symptomsClass 4 – Inability to carry out any physical activity without symptoms –Pain/discomfort at rest
20 Management and Outcome Measures Use of ß-blockers at discharge and during admission.Use of aspirin at discharge and during admission.Timely and appropriate acute reperfusion (thrombolysis or primary angioplasty).The use of angiotensin-converting enzyme (ACE) inhibitors for patients with depressed left ventricular systolic function. Similarly, a minority of patients with AMI are potential candidates for this care process,
21 Management and Outcome Measures The proportion of patients eligible for smoking-cessation counseling is relatively small, and ascertainment can be difficult, given the variability in documentation as well as practice.Diet and exercise counselingCholesterol status assessment and management.
22 Congestive Heart Failure Medical Treatment Goals Decreasing Intravascular VolumeDecreasing Venous ReturnDecreases preload – decreases the volume to the left ventricle during diastoleMed: Diuretics – Lasix (furosemide)Decreasing AfterloadDecrease systemic vascular resistanceCO increasesPulmonary congestion decreasesMeds: Nitroglycerine (NTG); Morphine; Calcium Channel Blockers
23 Congestive Heart Failure Medical Treatment Goals Improving Gas Exchange & OxygenationSupplemental oxygenMorphineSevere cases – intubation / ventilationImproving Cardiac FunctionIncrease cardiac contractility without increasing cardiac oxygen consumptionHemodynamic Monitoring:pulmonary artery pressure; pulmonary artery wedge pressure (14-18mmg HG)Inotropic Meds: DigoxinInotropic meds used with hemodynamic monitoring:DobutamineInodilators: (inotropic & vasodilator): Milrinone
24 Congestive Heart Failure Medical Treatment Goals Reducing AnxietySedative action of IV MorphineComplication: respiratory depressionDetermine & Treat Underlying CauseSystolic or Diastolic failureAggressive drug therapy
25 So what medical complications do you think can occur??????? Pleural effusionDysrhythmiasLeft ventricular thrombusHepatomegaly – impaired liver functionAcute Pulmonary Edema
26 What basic needs are being effected? Why and how?
28 Nursing Care for the Patient with Heart Failure What will you assess????What are some potential nursing diagnosis?????What are your goals for those diagnosis????What are your interventions?????How will you evaluate your goals?????Assess: Assess: Hemodynamic status – VS, PO, CVP, PAP, PAWP, response to medicationcardiac rhythm, LOC, energy level; labsNx DxActivity intolerance r/t fatigue secondary to cardiac insufficiencyExcess fluid volume r/t cardiac failureDisturbed sleep pattern r/t nocturnal dyspneaImpaired gas exchange r/t increased preload and afterloadAnxiety r/t dyspnea / fear of deathKnowledge deficit r/t disease processNsg Action: Administer medications, oxygen, supportive treatment, community referral & home preparationPt/Family Education: Lifestyle modification, Medication
29 Case StudyA 74-year-old woman is admitted to the hospital with heart failure. She had been growing progressively weaker and has ankle edema, dyspnea on exertion, and three-pillow orthopnea. On admission, she is severely dyspneic and can answer questions only with one-word phrases. She is diaphoretic and has central cyanosis, with a heart rate of 132 beats/min, and blood pressure 98/70. She is extremely anxious.
30 Case Study1. Because this client cannot breath or talk easily, prioritize the immediate nursing assessments and intervetions upon admission.2. Considering the process of congestive heart failure, explain the symptoms she is having.3.Based on assessment, identify nursing diagnoses for this client.4. What diagnostic studies do you anticipate being ordered and why?
31 Case Study5. The physician orders the following items for this client. (Start an IV, then give dobutamine 3 mcg/kg/min IV; Furosemide (Lasix) 40 mg IV stat; Digoxin 0.5 mg IV stat, then 0.125mg PO every 6 hours for three doses, with ECG before doses 3 and 4; Morphine 2 mg IV stat and then 2 mg IV every 1 to 2 hours prn; Oxygen to maintain O2 sat >94%; Schedule for an echocardiogram; Low Na, Fat, Cardiac diet; Weigh daily and monitor input and output) Explain the rationale for these medications and treatments. Would you ask for any other ORDERDS and why?