imperio heart failure
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7/29/2019 Imperio Heart Failure
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Superior venacava
Inferior venacava
Right
atrium
tricuspid valve
Right
ventricle
Pulmonic valve
Pulmonary
artery
LUNGS
Pulmonary vein
Leftatrium
bicuspid
valve
Leftventricle
Aorta
Aortic valve
Systemic
circulation
Blood Circulation
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Heart Failure
•Inability of the heart to pump
sufficient blood to meet the needs of
the tissues for oxygen and nutrients.•Clinical syndrome characterized by
signs and symptoms of fluid overload
and decreased tissue perfusion.
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RISK FACTORS:
•Coronary artery disease
•Cardiomyopathy
•
Myocardial infarction•Valve disease
•DM
•Hypertension
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Diagnostic Test, Medical /
Surgical Management and
Nursing Management of HEART FAILURE
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DIAGNOSTIC TEST:
•Echocardiogram•Radionuclide ventriculography
•Chest X-ray
•Electrocardiogram (ECG)
•
Laboratory Studies (serum electrolytes, blood ureanitrogen(BUN),creatinine, thyroid-Stimulating hormone,
complete blood cell count, BNP and routine urine
analysis.)
•Cardiac stress testing
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Cardiac Stress Testing – to determine whether coronary artery disease and
cardiac ischemia are causing the HF.
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•BNP level is a key diagnostic indicator of heart
failure.
Brain-type Natriuretic Peptide- a substance
secreted from the ventricles or lower chambers of
the heart in response to changes in pressure that
occur when heart failure develops and worsens.
Results:
•BNP levels below 100 pg/mL indicate no heart failure
•BNP levels of 100-300 suggest heart failure is present •BNP levels above 300 pg/mL indicate mild heart failure
•BNP levels above 600 pg/mL indicate moderate heart failure.
•BNP levels above 900 pg/mL indicate severe heart failure.
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MEDICAL MANAGEMENT:
Goal: To relieve patient symptoms.
To improve functional status and quality of life, and
to extend survival.
Pharmacologic Therapy:
•Angiotensin-Converting Enzyme (ACE) inhibitors
•Beta-adrenergic Blocking Agents (beta-blockers)
•Diuretics•Digitalis
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MEDICATION THERAPEUTIC EFFETCS NURSING CONSIDERATIONS
Angiotensin Converting Enzyme (ACE)
inhibitors
•Lisinopril (Prinivil, Zestril)
•Captopril (Lotensin)
•Enalapril (Vasotec)
Decrease BP and afterload
Relieve signs and symptoms of HF.
Prevents progression of HF.
Observe for symptomatic hypotension,
increase serum potassium, cough and
worsening renal function.
Beta – adrenergic Blocking Agents
(Beta Blockers)
•Metoprolol (Lopressor, Toprol)
•
Atenolol (Tenormin)•Carvedilol (Coreg)
Dilates blood vessels and decrease
afterload.
Decrease signs and symptoms of HF.
Observe for decrease heart rate,
symptomatic hypotension, and fatigue.
Diuretics
Loop Diuretic:
•Furosemide (Lasix)
Thiazide Diuretic:•Metolazone (Zaroxolyn)
Aldosterone Antagonist:
•Spironolactone (Aldactone)
Decreasefluid volume overload.
Decrease signs and symptoms of HF.
Observe for electrolyte abnormalities,
renal dysfunction, and decrease BP.
Carefully monitor I and O and daily
weight.
Digitalis
•Digoxin ( Lanoxin)
Improves contractility.
Decrease signs and symptoms of HF.
Observe for bradycardia and digitalis
toxicity.
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Angiotensin Receptor Blockers (ARBs)
•Valsartan (Diovan)
•Irbesartan Avapro)
•Losartan (Gozaar)
Decrrease BP and afterload.
Relieves sign and symptoms of Hf.
Prevents progression of HF.
Observe for symptomatic hypotension,
increase serum potassium, cough and
worsening renal function.
Calcium channel blockers
•Amlodipine (Norvasc)
•Felodipine (Plendil)
Vasodilation and reduction of systemic
vascular resistance.
Observe for symptomatic hypotension,
drowsiness or dizziness.
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Other medication for Heart Failure:
•
Anticoagulant may be prescribed.•Medications that manage hyperlipidemia (statins).
MEDICATIONS TO AVOID!
•Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin).
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Nutritional Therapy:
•Low-sodium (2 to 3 g/day) diet
•Avoidance of drinking excessive amounts of fluid are usually recommended.
Supplemental Oxygen:
•Oxygen may become necessary as HF progresses.
•Some patients require supplemental only during periods of activity.
•Administer oxygen therapy per nasal cannula at 2 to 6 L/min as orderd.
•Maintain semi-Fowler’s or high Fowler’s position to maximize oxygenation by
promoting greater lung expansion.
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NURSING MANAGEMENT:
Promoting Activity Tolerance
•Advice patient that prolonged bed rest should be avoided because of it’s
deconditionig effects and risk such as pressure ulcers, venous thrombosis,
and pulmonary embolism.
•Encourage a physical activity 30 minutes everyday.
Managing fluid volume
•Oral diuretics should be administered early in the morning.•Monitor intake and output.
•Monitor daily body weight.
•Advice the patient to avoid high sodium food such as canned, processed
and convenience foods.
•Monitor the patient’s IV fluid closely. •Elevate the head of the bed to facilitate breathing.
•Frequent change of position to avoid pressure.
•Leg exercise to prevent pressure ulcers.
•Gradual ambulation.
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SURGICAL MANAGEMENT :
•Coronary Artery Bypass – to improve blood flow to heart
muscle
•Left Ventricle Reconstruction
•Heart valve reconstruction
•Cardiac transplantation
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Left ventricle reconstruction- to remove damage to heart muscle
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Implanted ventricular assist device- to help heart pump
blood
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Heart transplantation
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NURSING DIAGNOSIS:
•Impaired gas exchange
•Activity intolerance
•Fatigue
•Fluid volume excess•Anxiety
•Powerlessness
•Ineffective therapeutic regimen management
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1. Which of the following assessment finding would elicit specific
information regarding the left ventricular function of a patient with
left ventricular failure?
a. Assessing peripheral and sacral edema.
b. Assessing jugular vein distention.c. Monitoring for organomegaly.
d. Listening to lung sounds.
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2. Which of the following symptoms is most commonly associated with left-
sided heart failure?
a. Crackles
b. Hepatic engorgement
c. Hypotension
d. Arrhytmias
Rationale:
Crackles in the lungs are a classic sign of left-sided heart failure. These
sounds are caused by fluid backing up into the pulmonary system.
Arrhythmias can be associated with both right and left-sided heart
failure. Left-sided heart failure causes hypertension secondary to anincreased workload on the system.
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3. Stimulation of the sympathetic nervous system produces which of the
following responses?
a. Tachycardia
b. Hypotension
c. Decreased myocardial contractility
d. Bradycardia
Rationale:
Stimulation of the sympathetic nervous system causes tachycardia and
increased contractility.
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4. Which of the following classes of medications maximizes cardiac
performance in clients with heat failure by increasing ventricular contractility?
A. Inotropic agents
B. Beta-adrenergic Blockers
C. Calcium Channel Blockers
D. Diuretics
Rationale:
Inotropic agents are administered to increase the force of the heart’s
contractions, thereby increasing ventricular contractility and ultimately
increasing cardiac output.
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5. Which of the following classes of medications protects the ischemic
myocardium by blocking catecholamines and sympathetic nerve
stimulation?
A. Nitrates
B. Beta-adrenergic Blockers
C. Narcotics
D. Calcium channel blockers
Rationale:
Beta-adrenergic blockers work by blocking beta receptors in the
myocardium, reducing the response to catecholamines and
sympathetic nerve stimulation. They protect the myocardium,
helping to reduce the risk of another infarction by decreasing theworkload of the heart and decreasing myocardial oxygen demand.
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6. After an anterior wall myocardial infarction, which of the following
problems is indicated by auscultation of crackles in the lungs?
A. Left-sided heart failure
B. Right-sided heart failure
C. Pulmonic valve malfunction
D. Tricuspid valve malfunction
Rationale:
The left ventricle is responsible for the most of the cardiac output. An
anterior wall MI may result in a decrease in left ventricular function.
When the left ventricle doesn’t function properly, resulting in left-sided
heart failure, fluid accumulates in the interstitial and alveolar spaces in
the lungs and causes crackles.
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7. Which of the following complications is indicated by a third heart
sound (S3)?
A.Ventricular dilation
B. Systemic hypertension
C. Aortic valve malfunction
D. Increased atrial contractions
Rationale:
Rapid filling of the ventricles causes vasodilation that is
auscultated as S3. Increased atrial contraction or systemic
hypertension can result is a fourth heart sound. Aortic valve
malfunction is heard as a murmur.
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8. The nurse is aware that one of the following classes of medications
maximizes cardiac performance in clients with heart failure by increasing
ventricular contractility?
a. Beta-adrenergic blockers
b. Calcium channel blocker
c. Diureticsd. Inotropic agents
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9. Mr. Mendoza who has suffered a congestive heart failure is too weak to
move on his own. To help the client avoid pressure ulcers, Nurse Celia should:
a.Turn him frequently.
b. Perform passive range-of-motion (ROM) exercises.
c. Reduce the client’s fluid intake.
d. Encourage the client to use a footboard.
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10. Nurse Bea is assessing a male client with heart failure. The breath
sounds commonly auscultated in clients with heart failure are:
a. Tracheal
b. Fine crackles
c. Coarse crackles
d. Friction rubs
Rationale:
Fine crackles are caused by fluid in the alveoli and commonly occur
in clients with heart failure.