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Chapter028

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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 28: Caring for Clients with Heart Failure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Heart Failure • Inability of the heart to pump sufficient blood; Ejection fraction • Decreased amount of ejected blood • Echocardiogram: Measurement of ejection fraction • Congestive heart failure – Accumulation of blood, fluid in organs – Tissues from impaired circulation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Question Is the following statement true or false? The heart has two pumps. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Answer True. The heart has two pumps, the right and the left ventricles. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Types of Heart Failure • Classification Factors: Development; Location – Acute vs. chronic heart failure • Acute: Change in heart contraction; Pulmonary edema • Chronic: Prolonged impaired contractility; Four stages Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Types of Heart Failure • Classification Factors: Development; Location (cont’d) – Left-sided vs. Right-sided heart failure • Factors: Location of pumping dysfunction • Left-sided: Conditions that impair ejection of blood into the aorta • Right-sided: Failure to eject total diastolic filling volume into the pulmonary artery; left-sided failure is a major cause of rightsided failure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Types of Heart Failure • Pathophysiology and Etiology – Mechanism: Inability of the heart muscle to contract • Myocardial infarction (MI) leads to acute heart failure – Mechanism: Cardiomyopathy; Hypertension Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Question Is the following statement true or false? Left-sided heart failure is a major cause of rightsided heart failure. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Answer True. When the right side of the heart cannot pump to sufficiently oxygenate the blood, the left ventricle becomes overworked – leading to failure. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Pathophysiology; Etiology • Mechanism: Cardiomyopathy; Hypertension (Cont’d) – Left-sided heart failure • Causes: Failure of contraction; Congested blood; Impaired gas exchange; Accumulation of CO2 in the blood; Factors which contribute to CHF • Conditions reducing cardiac output • Increased afterload • Reduction of ventricular ejection volume and loss of elasticity Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Pathophysiology; Etiology • Right-sided heart failure – Causes: Failure of forceful contraction to expel blood into the pulmonary artery • Congested blood; MI; Cor pulmonale • Chronic respiratory disorders – Pulmonary arterial vasoconstriction • Pulmonary hypertension Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Pathophysiology; Etiology • Compensatory Mechanisms – Increase stroke volume and maintain blood pressure – Temporarily improve the client’s cardiac output; Fails when contractility is further compromised – Hypotensive: Cardiac output falls; Release of catecholamines; Increase myocardial oxygen – Epinephrine: Supplies blood to vital organs of brain and heart; Decreased blood supply to the kidneys Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Pathophysiology; Etiology • Compensatory Mechanisms – Initiation of renin-angiotensin-aldosterone mechanism – Secretion of B-type natriuretic peptide: Cardioprotection, functions – Failure of compensatory mechanisms to restore homeostasis – Decrease cardiac output – Ventricle of the heart experiences dysfunction Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Signs and Symptoms • Severity of Symptoms: Body’s ability to adjust to the decreased cardiac output • Left-sided heart failure – Hypoxemia; Fatigue; Exertional dyspnea; Orthopnea – Rapid or irregular pulse; Paroxysmal nocturnal dyspnea; Cough; Restlessness – Hemoptysis; Elevated BP – Respiratory findings—crackles – Diminished urine output; Left-sided heart failure with pulmonary edema Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Signs and Symptoms • Right-sided heart failure – Weight gain from fluid retention; Pitting edema —feet and ankles; Ascites – Hepatomegaly – Jugular veins – Enlarged abdominal organs – Accumulation of blood in abdominal organs Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Figure 28-2 Pitting edema
  • 16. Diagnostic Findings • Left-sided heart failure – Chest radiography; Echocardiogram – Multigated acquisition scan (MUGA) • Decrease in the ejection fraction – Gamma camera: Radioactive; Contraindicated—diuretics; Relieve cough; Allergic reactions – Arterial blood gas analysis; Serum sodium levels; BUN – Hemodynamic monitoring; Pulmonary artery catheter; BNP levels Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Diagnostic Findings • Right-sided heart failure – Chest radiograph; ECG; Echocardiograph – Lung scan; Pulmonary arteriography – Impaired liver: Elevated liver enzymes – Ventricular enlargement – Cor pulmonale; Liver enzymes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Medical Management • Drug Therapy – Digoxin: Slow and strengthen the heart – Digitalization; Apical heart rate – Digitalis drugs: Drugs are withheld – Diuretic therapy: Decreases exertion – Digitalis toxicity; Vasodilators reduce afterload; Angiogenesis – ACE inhibitors Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Medical Management • Cardiac Resynchronization Therapy (CRT) – Synchronizes contractions of the right and left ventricles; Used for heart failure caused by dilated cardiomyopathy – Biventricular pacemaker; Dual ventricular lead stimulation • Intra-aortic Balloon Pump (IAPD) – Used in cardiogenic shock and left ventricular heart failure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Medical Management • Intra-aortic Balloon Pump (Cont’d) – Functions • Temporary; Secondary; Mechanical; Circulatory pump – Procedure • Left femoral artery; Counterpulsation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Surgical Management • Surgery: VAD insertion; Cardiomyoplasty; Artificial heart • Ventricular assist device (VAD): Auxiliary cardiac pump – Type of clients; LVAD – Types of VADs • Cardiomyoplasty – Chest muscle grafted to aorta; Electrical stimulator; Ventricular containment procedure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Surgical Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Surgical Management • Partial Ventriculectomy, Ventricular Restoration – Poor results – Surgical ventricular restoration (SVR): Decreases size of heart; Coronary artery bypass • Artificial Heart – Age group; Long-term use – Complications; AbioCor Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Nursing Management • Control Heart Failure: Medications; Lifestyle changes; Diet restrictions • Nursing Interventions – Monitor therapeutic and adverse effects; Signs of excess fluid volume and evidence of electrolyte imbalance – Promote heart’s ability to eject blood • Promote Oxygenation; Client, family education Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. Nursing Process • Assessment – Client history, symptoms, medications; Physical assessment – Observe dyspnea, vital signs, weight, and distended neck veins; Auscultate apical heart rate; Monitor for signs of peripheral edema, lethargy, or confusion – Monitor lab results; Report abnormalities – Abdominal girth; Respiratory difficulties – Nocturnal dyspnea; Pulse oximetry Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 26. Nursing Process • Diagnosis, Planning, and Interventions – Decreased cardiac output – Excess fluid volume – Risk for impaired gas exchange – Activity intolerance – Expected outcomes – Monitor for hypokalemia Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 27. Pulmonary Edema • Fluid Accumulation in the Lungs – Interferes with gas exchange in alveoli – Noncardiogenic pulmonary edema—ARDS – Causes: Pulmonary embolism, infection, and blast injury • Pathophysiology and Etiology – Cardiogenic pulmonary edema • Left ventricle becomes incapable of maintaining sufficient output of blood • Retrograde fluid accumulation; Effects of hyperventilation; Respiratory acidosis; Metabolic acidosis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 28. Pulmonary Edema • Assessment Findings: Signs and Symptoms – Sudden dyspnea; Wheezing; Orthopnea; Restlessness; Cough (pink frothy sputum) – Cyanosis; Tachycardia; Severe apprehension – Respiratory sound; Pulmonary artery catheter; Hypotensive; Loss of peripheral pulses; Radiographs; ABGs • Medical Management – Relieve lung congestion: Can be fatal – Inotropic medications; Supplemental O2; Mechanical ventilation; Surgical procedure Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 29. Medical Management • Drug Therapy: Inotropic agents; Diuretics; Morphine; ACE inhibitors; Calcium channel blockers – IV administration: Force of ventricular contraction; Reduction of myocardial oxygen consumption – Promote vasodilation; Lessen anxiety • Oxygenation: – Facilitate gas exchange; Methods of administration; Respiratory failure: Intubation, CPAP, and PEEP Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 30. Medical Management • Invasive Measures – Insertion of an IABP, biventricular pacemaker, or LVAD – Cardiomyoplasty: Artificial heart; Heart transplantation • Nursing Management – Critically ill clients: Pulmonary artery catheter insertion; Urinary catheter – Monitoring equipment: Mechanical ventilation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 31. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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