Interventions for Clients with Cardiac Problems

Heart Failure Also called pump failure, general term for the inadequacy of the heart to pump blood throughout the body; causes insufficient perfusion of body tissue with vital nutrients and oxygen Also called pump failure, general term for the inadequacy of the heart to pump blood throughout the body; causes insufficient perfusion of body tissue with vital nutrients and oxygen Left-sided heart failure Left-sided heart failure Right-sided heart failure Right-sided heart failure High-output failure High-output failure

Compensatory Mechanisms Sympathetic nervous system stimulation Sympathetic nervous system stimulation Renin-angiotensin system activation Renin-angiotensin system activation Other neurohumoral responses Other neurohumoral responses Myocardial hypertrophy Myocardial hypertrophy

Left-Sided Heart Failure Manifestations include: Manifestations include: –Weakness –Fatigue –Dizziness –Confusion –Pulmonary congestion –Shortness of breath (Continued)

Left-Sided Heart Failure (Continued) –Oliguria –Organ failure, especially renal failure –Death Assess blood pressure, mental status, breath sounds Assess blood pressure, mental status, breath sounds

Right-Sided Heart Failure Manifestations include: Manifestations include: –Distended neck veins, increased abdominal girth –Hepatomegaly (liver engorgement) –Hepatojugular reflux –Ascites –Dependent edema –Weight: the most reliable indicator of fluid gain or loss

Assessments Laboratory assessment Laboratory assessment Radiographic assessment Radiographic assessment Electrocardiography Electrocardiography Echocardiography Echocardiography Pulmonary artery catheters Pulmonary artery catheters

Hemodynamic Regulation Interventions include: Interventions include: –Reduce afterload. –Reduce preload. –Improve cardiac muscle contractility. –Administer drugs as prescribed. –Monitor for therapeutic and adverse effects. –Teach client and family drug therapy.

Valvular Heart Disease Mitral stenosis Mitral stenosis Mitral regurgitation (insufficiency) Mitral regurgitation (insufficiency) Mitral valve prolapse Mitral valve prolapse Aortic stenosis Aortic stenosis Aortic regurgitation (insufficiency) Aortic regurgitation (insufficiency)

Assessment Client may become suddenly ill or slowly develop symptoms over many years. Client may become suddenly ill or slowly develop symptoms over many years. Question client about attacks of rheumatic fever, infective endocarditis, and possibility of IV drug abuse. Question client about attacks of rheumatic fever, infective endocarditis, and possibility of IV drug abuse. Obtain chest x-ray, echocardiogram, and exercise tolerance test. Obtain chest x-ray, echocardiogram, and exercise tolerance test.

Nonsurgical Management Drug therapy, including diuretics, beta blockers, digoxin, oxygen, and sometimes nitrates Drug therapy, including diuretics, beta blockers, digoxin, oxygen, and sometimes nitrates Prophylactic antibiotic Prophylactic antibiotic Management of atrial fibrillation, cardioversion Management of atrial fibrillation, cardioversion Anticoagulant Anticoagulant Rest with limited activity Rest with limited activity

Infective Endocarditis Microbial infection involving the endocardium Microbial infection involving the endocardium Occurs primarily with IV drug abuse, valvular replacements, systemic infections, or structural cardiac defects Occurs primarily with IV drug abuse, valvular replacements, systemic infections, or structural cardiac defects Possible ports of entry: mouth, skin rash, lesion, abscess, infections, surgery, or invasive procedures including IV line placement Possible ports of entry: mouth, skin rash, lesion, abscess, infections, surgery, or invasive procedures including IV line placement

Pericarditis Inflammation or alteration of the pericardium, the membranous sac that encloses the heart Inflammation or alteration of the pericardium, the membranous sac that encloses the heart Dressler’s syndrome Dressler’s syndrome Postpericardiotomy syndrome Postpericardiotomy syndrome Chronic constrictive pericarditis Chronic constrictive pericarditis

Assessment Substernal precordial pain radiating to left side of the neck, shoulder, or back Substernal precordial pain radiating to left side of the neck, shoulder, or back Grating, oppressive pain, aggravated by breathing, coughing, swallowing Grating, oppressive pain, aggravated by breathing, coughing, swallowing Pain worsened by the supine position; relieved when the client sits up and leans forward Pain worsened by the supine position; relieved when the client sits up and leans forward Pericardial friction rub Pericardial friction rub

Interventions Hospitalization for diagnostic evaluation, observation for complications, and symptom relief Hospitalization for diagnostic evaluation, observation for complications, and symptom relief Nonsteroidal anti-inflammatory drugs Nonsteroidal anti-inflammatory drugs Corticosteroid therapy Corticosteroid therapy Comfortable position, usually sitting Comfortable position, usually sitting Pericardial drainage Pericardial drainage(Continued)

Cardiomyopathy Subacute or chronic disease of cardiac muscle Subacute or chronic disease of cardiac muscle Dilated cardiomyopathy Dilated cardiomyopathy Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy Restrictive cardiomyopathy Restrictive cardiomyopathy

Cardiomyopathy