Heart failure is defined as the inability of the heart to pump enough blood to meet the body's needs. It can be caused by structural or functional problems with the heart's ventricles. Heart failure is classified based on whether the left ventricle has reduced ejection fraction (systolic) or increased filling pressures (diastolic), and whether cardiac output is high or low. Treatment involves reducing preload and afterload on the heart through medications like ACE inhibitors, ARBs, beta blockers, and diuretics. More advanced treatments include CRT, VADs, heart transplantation, and surgical procedures.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
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Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
2. • Heart Failure is defined as “ a complex clinical
syndrome that results from any structural or
functional impairment of ventricular
filling(diastole) or ejection of blood. (systole)
”It is the pathophysiological process in which the heart as a
pump is unable to meet the metabolic requirements of the tissue
for oxygen and substrates despite the venous return to heart is
either normal or increased.
3. CLASSIFICATION BY DEFNITION
• SYSTOLIC HEART FAILURE
– Characterized by reduced ejection fraction and
enlarged ventricle size. Clinically present with left
ventricular failure and marked cardiomegaly.
• DIASTOLIC HEART FAILURE
– Characterized by increased resistance to filling due
to increased filling pressures. Clinically present
with pulmonary congestion with normal or slightly
enlarged ventricles .
4.
5. CLASSIFICATION BASED ON
CARDIAC OUTPUT
• HIGH OUTPUT FAILURE-
– The normal heart fails to maintain normal or
increased output in conditions like anemia,
hyperthyroidism, pregnancy.
• LOW OUTPUT FAILURE-
– Heart fails to generate adequate output in conditions
like cardiomyopathy, valvular heart disease, tamponade
and bradycardia.
6. RIGHT AND LEFT SIDED HEART FAILURE
• Right sided heart failure is characterised by the
presence of peripheral edema, raised JVP and
hypotension and congestive hepatomegaly.
• Left sided heart failure – pulmonary edema is the
striking feature. Other signs are tachypnea,
tachycardia, third heart sound, pulsus alternans,
cardiomegaly.
• Congestive Cardiac Failure – Characterised by
combination of both left and right sided heart
failure.
7. FORWARD AND BACKWARD HEART
FAILURE
• FORWARD HEART FAILURE-
– This results from inadequate discharge of blood
into arterial system leading to poor tissue
perfusion
• BACKWARD HEART FAILURE-
– This results from failure of one or both ventricles
to fill normally and discharge its contents, causing
back pressure on the atria and venous system.
15. Increased demand for oxygen/ Decreased supply
Failure of cardiac reserve
Activation of compensatory
mechanism
Ventricular Dilation Increased
Sympathetic
stimulation
Activation of RAAS
Over stretching of
Muscles and Hypoxia
Arteriolar constriction
Looses
contractility
Increased after load and
myocardial contractility
Increased preload and
after load
Worsening of cardiac
function - Heart Failure
Retention of Fluid
16. PHYSICAL
EXAMINATION• Patient will present with laboured breathing in
an acute LVF. He/she may not be able to
finish the sentence due to shortness of
breath. He / she may have difficulty to talk
due to shortness of breath.
• Blood pressure may be normal or high in
early HF may decrease consequently and is
usually low.
• Low pulse pressure (reduced stroke volume)
• Sinus tachycardia (increased sympathetic
activity) cool peripheries, cyanosis of tips of
fingers and nail bed.
18. PHYSICAL
EXAMINATION
• Respiratory system
– Bilateral rales/crepitations may be present
as a result of transudate of fluid from
intravascular space to intraalveolar space.
– May be accompanied by expiratory
wheeze (cardiac asthma).
– Pleural effusion may/may not be
present. (common in CCF)
19. PHYSICAL
EXAMINATION
• Cardiovascular system
– Apical impulse may shift inferiorly / laterally.
– S3 gallop can be heard.
– S4 gallop is usually present in diastolic
dysfunction.
– MR or TR may be present additionally.
20. PHYSICAL
EXAMINATION• Per abdomen
– Hepatomegaly is present (tender / pulsatile)
– Ascites , Jaundice , raised liver enzymes
– Peripheral edema can be pre tibial or pre
sacral edema
• Cardiac cachexia
– Cause for cachexia is multifactorial
• Elevation of BMR
• Elevated circulating cytokines like TNF
• Congestion of intestinal veins
21. Medical Management
Objectives of management
1. Reduce preload and after
load
2. Reduce symptoms
3. Stabilization of patient
condition
4. Delay the progression of HF
22. Pharmacological Therapy
•ACE Inhibitors: Decreases
afterload and BP
•Angiotensin receptors blockers:
Decreases afterload and BP
•Hydralazine and isosorbide
dinitrate: Dilates blood vessels,
Decreases afterload and BP
•Beta Blockers: Dilates blood
vessels, Decreases afterload and BP
•Diuretics: Decreases fluid overload
26. Ventricular assist devices
Ventricular assist device (VAD) is a mechanical
pump that's used to support heart function and
blood flow in people who have weakened hearts.
The device takes blood from a lower chamber of
the heart and helps pump it to the body and vital
organs, just as a healthy heart would.
27.
28. IABP
The Intra-aortic balloon pump
(IABP) is a mechanical device that
increases myocardial oxygen perfusion
while at the same time increasing
cardiac output.
It consists of a cylindrical polyethylene
balloon that sits in the aorta,
approximately 2 centimeters from the
left subclavian artery
29. It actively deflates in systole,
increasing forward blood flow by
reducing afterload. It actively inflates in
diastole, increasing blood flow to the
coronary arteries. These actions
combine to decrease myocardial oxygen
demand and increase myocardial
oxygen supply.
30.
31.
32. External counterpulsation
ECP increases coronary perfusion
pressure and blood flow, thereby
reducing heart workload and
improving cardiac output. It is
absolutely painless, safe treatment,
which requires no hospitalisation.
33. Procedure
The patient has to lie down on a padded
table
Three sets of rubber cuffs more than four
inches wide, are tied around three points of
the body- thighs, legs and hips.
These connect to air hoses, which in turn
are connected to valves of the machine.
34.
35. Cont…
When the heart contracts the cuffs are
deflated and when it relaxes the cuffs are
inflated with a predetermined amount of
pressure, which pushes the blood from the
lower extremities in a timed and sequential
manner, towards the heart.
Duration of the Treatment
patient has to undergo the procedure
several times, usually 35 days of treatment,
six days a week for six weeks.
37. Procedure : Orthotopic
•General anesthesia is given
•Patient is kept on Cardio pulmonary bypass
machine
•Recipient's heart is removed except the posterior
right and left atrial wall and their venous
connection
•Recipient’s heart is then replaced with doner’s
heart
41. Cardiomyoplasty
Cardiomyoplasty is a surgical procedure in
which healthy muscle from another part of the
body is wrapped around the heart to provide
support for the failing heart.
Most often the latissimus dorsi muscle is used
for this purpose. A special pacemaker is
implanted to make the skeletal muscle contract.