Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsChapter 30Management of Patients WithComplications F...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCardiac Hemodynamics• CO = SV × HR• Preload• Afterlo...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Hea...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueHeart failure is the inability of the hear...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsHeart Failure• The inability of the heart to pump su...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPathophysiology of Heart Failure
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsClinical Manifestations• Right-sided failure– RV can...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsClassification of Heart Failure• NYHA classification...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedical Management of Heart Failure• Eliminate or re...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedications• Angiotensin: converting enzyme inhibito...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhich classification of medications play a p...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerAAngiotensin converting enzyme inhibitors play...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Heart F...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Heart F...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCollaborative Problems/PotentialComplications• Cardi...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Heart F...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsActivity Intolerance• Bed rest for acute exacerbatio...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsFluid Volume Excess• Assessment for symptoms of flui...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPatient Teaching• Medications• Diet: low-sodium diet...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Hyp...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueHyperkalemia may occur especially with the...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPulmonary Edema• Acute event in which the LV cannot ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsManagement of Pulmonary Edema• Prevent• Early recogn...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCardiogenic Shock• A life-threatening condition with...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsManagement of Cardiogenic Shock• Correct underlying ...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsIntra-Aortic Balloon Pump
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsThromboembolism• Decreased mobility and decreased ci...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPulmonary Emboli
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPericardial Effusion and CardiacTamponade• Pericardi...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedical Management• Pericardiocentesis• Pericardiotomy
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsSudden Cardiac Death/Cardiac Arrest• Emergency manag...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhat is the most reliable sign of cardiac ar...
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerDThe most reliable sign of cardiac arrest is t...
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management of patient with complication from heart disease

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management of patient with complication from heart disease

  1. 1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsChapter 30Management of Patients WithComplications From HeartDisease
  2. 2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCardiac Hemodynamics• CO = SV × HR• Preload• Afterload• Contractility
  3. 3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Heart failure is the inability of the heart to pump sufficientblood to meet the needs of the tissues for oxygen andnutrients.
  4. 4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueHeart failure is the inability of the heart to pump sufficientblood to meet the needs of the tissues for oxygen andnutrients.
  5. 5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsHeart Failure• The inability of the heart to pump sufficient blood tomeet the needs of the tissues for oxygen and nutrients.• A syndrome characterized by fluid overload or inadequatetissue perfusion.• The term heart failure indicates myocardial disease, inwhich there is a problem with the contraction of the heart(systolic failure) or filling of the heart (diastolic failure).• Some cases are reversible.• Most heart failure is a progressive, lifelong disordermanaged with lifestyle changes and medications.
  6. 6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPathophysiology of Heart Failure
  7. 7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsClinical Manifestations• Right-sided failure– RV cannot eject sufficient amounts of blood andblood backs up in the venous system. This resuts inperpheral edema, hepatomegaly, ascites, anorexia,nausea, weakness, and weight gain.• Left-sided failure– LV cannot pump blood effectively to the systemiccirculation. Pulmonary venous pressures increase andresult in pulmonary congestion with dyspnea, cough,crackles, and impaired oxygen exchange.• Chronic heart failure is frequently biventricular.
  8. 8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsClassification of Heart Failure• NYHA classification of heart failure– Classification I , II, III, IV• ACC/AHA classification of heart failure– Stages A, B, C, D• Treatment guidelines are in place for each stage
  9. 9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedical Management of Heart Failure• Eliminate or reduce etiologic or contributory factors.• Reduce the workload of the heart by reducing afterloadand preload.• Optimize all therapeutic regimens.• Prevent exacerbations of heart failure.• Medications are routinely prescribed for heart failure.
  10. 10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedications• Angiotensin: converting enzyme inhibitors• Angiotensin II receptor blockers• Beta-blockers• Diuretics• Digitalis• Other medications
  11. 11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhich classification of medications play a pivotal role in themanagement of heart failure due to systolic dysfunction?A.Angiotensin converting enzyme inhibitorsB.Beta blockersC.DiureticsD.Digitalis
  12. 12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerAAngiotensin converting enzyme inhibitors play a pivotal rolein the management of Heart Failure due to systolicdysfunction. Beta blockers have been found to reducemortality and morbidity in patients with NYHA class II orIII heart failure by reducing the adverse effects from theconstant stimulation of the sympathetic nervous system.Diuretics are prescribed to reduce excess extracellularfluid by increasing the rate of urine produced in patientswith signs and symptoms of fluid overload. Digitalisincreases the force of myocardial contraction and slowsconduction through the atrioventricular node.
  13. 13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Heart Failure—Assessment• Health history• Sleep and activity• Knowledge and coping• Physical exam– Mental status– Lung sounds: crackles and wheezes– Heart sounds: S3– Fluid status/signs of fluid overload• Daily weight and I&O• Assess responses to medications
  14. 14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Heart Failure—Diagnoses• Activity intolerance and fatigue• Excess fluid volume• Anxiety• Powerlessness• Noncompliance
  15. 15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCollaborative Problems/PotentialComplications• Cardiogenic shock• Dysrhythmias• Thromboembolism• Pericardial effusion and cardiac tamponade
  16. 16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsNursing Process: The Care of the Patientwith Heart Failure—Planning• Goals may include promoting activity and reducingfatigue, relieving fluid overload symptoms, decreasinganxiety or increasing the patient’s ability to manageanxiety, encouraging the patient to make decisions andinfluence outcomes, teaching the patient about the self-care program.
  17. 17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsActivity Intolerance• Bed rest for acute exacerbations• Encourage regular physical activity; 30–45 minutes daily• Exercise training• Pacing of activities• Wait 2 hours after eating for physical activity• Avoid activities in extreme hot, cold, or humid weather• Modify activities to conserve energy• Positioning; elevation of the HOB to facilitate breathingand rest, support of arms
  18. 18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsFluid Volume Excess• Assessment for symptoms of fluid overload• Daily weight• I&O• Diuretic therapy; timing of meds• Fluid intake; fluid restriction• Maintenance of sodium restriction
  19. 19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPatient Teaching• Medications• Diet: low-sodium diet and fluid restriction• Monitoring for signs of excess fluid, hypotension, andsymptoms 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
  20. 20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionIs the following statement True or False?Hyperkalemia may occur especially with the use of ACEinhibitors, angiotensin II receptor blockers, andspironolactone.
  21. 21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerTrueHyperkalemia may occur especially with the use of ACEinhibitors, angiotensin II receptor blockers, andspironolactone.
  22. 22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPulmonary Edema• Acute event in which the LV cannot handle an overload ofblood volume. Pressure increases in the pulmonaryvasculature, causing fluid movement out of thepulmonary capillaries and into the interstitial space of thelungs and alveoli.• Results in hypoxemia.• Clinical manifestations: restlessness, anxiety, dyspnea,cool and clammy skin, cyanosis, weak and rapid pulse,cough, lung congestion (moist, noisy respirations),increased sputum production (sputum may be frothy andblood-tinged), decreased level of consciousness.
  23. 23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsManagement of Pulmonary Edema• Prevent• Early recognition: monitor lung sounds and for signs ofdecreased activity tolerance and increased fluid retention• Place patient upright and dangle legs• Minimize exertion and stress• Oxygen• Medications– Morphine– Diuretic: furosemide
  24. 24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsCardiogenic Shock• A life-threatening condition with a high mortality rate• Decreased CO leads to inadequate tissue perfusion andinitiation of shock syndrome.• Clinical manifestations: symptoms of heart failure, shockstate, and hypoxia
  25. 25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsManagement of Cardiogenic Shock• Correct underlying problem• Medications– Diuretics– Positive inotropic agents and vasopressors• Circulatory assist devices– Intra-aortic balloon pump (IABP)
  26. 26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsIntra-Aortic Balloon Pump
  27. 27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsThromboembolism• Decreased mobility and decreased circulation increasethe risk for thromboembolism in patient with cardiacdisorders including those with Heart Failure.• Pulmonary embolism: blood clot from the legs moves toobstruct the pulmonary vessels.– The most common thromboembolic problem withheart failure– Prevention– Treatment– Anticoagulant therapy
  28. 28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPulmonary Emboli
  29. 29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsPericardial Effusion and CardiacTamponade• Pericardial effusion is the accumulation of fluid in thepericardial sac.• Cardiac tamponade is the restriction of heart function dueto this fluid resulting in decreased venous return anddecreased CO.• Clinical manifestations: ill-defined chest pain or fullness,pulsus parodoxus, engorged neck veins, labile or low BP,shortness of breath.• Cardinal signs of cardiac tamponade: falling systolic BP,narrowing pulse pressure, rising venous pressure, distantheart sounds.
  30. 30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsMedical Management• Pericardiocentesis• Pericardiotomy
  31. 31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsSudden Cardiac Death/Cardiac Arrest• Emergency management: cardiopulmonary resuscitation• A- airway• B- breathing• C- circulation• D- defibrillation for VT and VF
  32. 32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsQuestionWhat is the most reliable sign of cardiac arrest in an adultand child?A.Blood pressureB.Brachial pulseC.BreathingD.Carotid pulse
  33. 33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & WilkinsAnswerDThe most reliable sign of cardiac arrest is the absence of apulse. In an adult or child, the carotid pulse is assessed.In an infant, the brachial pulse is assessed.

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