NURS 5263 Introduction to Chronic Heart Failure
Student Resources Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medical-surgical nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins. Chapter 26: Assessment of Cardiovascular Function Chapter 30: Management of Patients with Complications from Heart Disease
Objectives Explain normal and abnormal pathophysiology of the heart in relation to chronic heart failure. Differentiate between left and right sided heart failure. Discuss current medical treatments for patients with heart failure. Discuss common teaching principles related to heart failure. Utilize the nursing process as a framework for care in patients with heart failure. Demonstrate competent and compassionate nursing care for the heart failure patient.
Stroke Volume The amount of blood pumped by the ventricles per beat. Average resting SV is 60-80 ml (2 Ounces) per beat.
Cardiac Output CO – the amount of blood pumped by the heart in 1 minute. Normal CO = 5 Liters per min CO = Heart rate X stroke volume The entire blood volume passes through the heart every minute
Starling’s Law of the Heart The greater the stretch of the myocardial fibers, the stronger the force of the contraction.
Inotropic effect Positive inotropic effect – increase stroke volume by increasing the force of contraction without stretching the fibers. Digitalis Negative Inotropic Effect – decrease in contraction
Congestive Heart Failure Heart is unable to pump adequate amount of blood to meet metabolic needs CHF describes the accumulation of blood and fluid in organs and tissues from impaired circulation.
Preload The amount of blood presented to the ventricles just before systole. Blood volume - stretches cardiac muscle fibers Ventricular compliance – the elasticity or amount of give when blood enters ventricle. Ventricular hypertrophy = decreased ventricular compliance
Afterload The amount of resistance to the ejection of blood from the ventricle. Resistance caused by tension in aorta and systemic vessels.
Contractility The force of contraction Catecholamines – released by SNS, increases contractility and stroke volume MI = myocardial cell damage = decreased contractility = HF
Test Your Knowledge Stroke Volume of the heart is determined by: The degree of cardiac muscle strength. The intrinsic contractility of the cardiac muscle. The pressure gradient against which the muscle ejects blood during contraction. All of the above
Heart Failure The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
Test Your Knowledge When collecting subjective data, the nurse could expect that the client who is developing left-sided congestive heart failure would describe having: a. to sleep in a reclining chair b. intolerance for fatty foods c. tight fitting shoes d. to urinate frequently
Test Your Knowledge All of the following are clinical manifestations of right-sided heart failure except: Hepatomegaly Jugular vein distention Ascites Orthopnea
Ejection Fraction The percentage of blood the LV ejects when it contracts Normal = 55% - 65% Mild reduction= 45-55% Moderately reduced = 35-45% Severely reduced = < 35%
BNP Brain (B-Type) Natriuretic Peptide Helps regulate BP and fluid volume Secreted from the ventricles in response to increased preload Used to diagnose and monitor HF > 51.2 pg/mL = mild HF > 1000 pg/mL = severe HF
Managementof CHF and Pulmonary Edema Reduce the heart’s workload Improve cardiac output How do we do that?
Drug Therapy for Chronic HF Goals: Identification of TYPE of HF and underlying cause Correction of Na+ and water retention Reduction of cardiac workload Improvement of cardiac contractility
Drug Categories for Treating CHF Drug Categories for Treating HF Standard TX: Diuretics ACE inhibitors Beta Blockers Other drugs used: Cardiac Glycosides (Positive inotropic drugs)[Digoxin] Vasodilator drugs[Nitroprusside] Nonglycoside inotropic Agents (Dobutrex) See Brunner pgs 952-956
Test Your Knowledge A client admitted with heart failure who is taking a thiazide diuretic has been ordered to receive furosemide (Lasix). What side effect of these medications should the nurse be alert for? a. Hypertension b. Headache c. Bradycardia d. Arrhythmias
Test Your Knowledge The treatment of cardiac failure is directed at: Decreasing oxygen needs of the heart Increasing CO by strengthening muscle contraction and decreasing PVR Reducing the amount of circulating blood volume All of the above
Test Your Knowledge The physiologic effect of an angiotensin converting enzyme inhibitor in the management of congestive heart failure includes which of the following: (Mark all that apply) a. Decrease peripheral vascular resistance (PVR) b. Decrease in heart rate c. Increase myocardial contractility d. Decrease in afterload
Nursing Diagnoses for HF Name some Nursing Diagnoses for HF
Test Your Knowledge If a client with left sided heart failure experiences paroxysmal nocturnal dyspnea, which one of the following would be most appropriate to add to the plan of care? a. Place the client on an alternating pressure mattress b. Use several pillows to support the head and thorax c. Administer oxygen per nasal cannula at bedtime d. Cough forcefully to expectorate accumulated secretions
Resources Lehne, R.A., Pharmacology For Nursing Care, 7th Edition, 2010, Elsevier Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medical-surgical nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins.