Linda S. Williams / Paula D. Hopper Copyright © F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 26 Nursing Care of Patients with Heart Failure

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Heart Failure  Syndrome Occurs from Progressive Inability of Heart to Pump Enough Blood to Meet Body’s Oxygen/Nutrient Needs  Older Term: Congestive Heart Failure

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Causes  Coronary Artery Disease  Cardiomyopathy  Hypertension  Heart Valve Disorders  Myocardial Infarction

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pathophysiology  Each Ventricle Pumps Equal Amount of Blood  If More Than Either Ventricle Can Handle, Heart Not Effective Pump  Left Ventricle Typically Weakens First  Failure of One Leads to Failure of Other

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Left-Sided Heart Failure  Afterload  Force Generated by Left Ventricle to Eject Blood Into Aorta Through Aortic Valve  Peripheral Vascular Resistance (PVR)  Pressure Within Aorta/Arteries  PVR Influences Afterload

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Left-Sided Heart Failure (cont’d)  Hypertension Major Cause  Blood Backs Up from Left Ventricle  Alveolar Edema Results

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Left-Sided Heart Failure (cont’d)

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Right-Sided Heart Failure  Left-sided Heart Failure Major Cause  Must Continually Pump Blood Against Increased Fluid in Pulmonary Artery and Lungs

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Right-Sided Heart Failure (cont’d)  Cor Pulmonale  Right Ventricle Hypertrophies and Fails Due to Increased Pulmonary Pressures  Backward Buildup of Blood in Systemic Blood Vessels  Peripheral Edema Results

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Right-Sided Heart Failure (cont’d)

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Compensatory Mechanisms Maintain Cardiac Output  Designed to Maintain Cardiac Output  Also Contribute to Cycle of Heart Failure

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Compensatory Mechanisms  Maintain Cardiac Output When Low  Sympathetic Nervous System Raises Heart Rate  Increases Cardiac Oxygen Needs  Renin-Angiotensin-Aldosterone System, Antidiuretic Hormone Save Water  Increases Fluid Volume

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Compensatory Mechanisms (cont’d)  Chambers Enlarge (Dilation)  Muscle Mass Increases (Hypertrophy)  Increases Cardiac Oxygen Needs

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pulmonary Edema  Acute Heart Failure  Severe Fluid Congestion in the Alveoli  Life-threatening  Drowning in Own Secretions

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Classic: Pink, Frothy Sputum  Rapid Respirations with Accessory Muscles  Severe Dyspnea, Orthopnea  Crackles, Wheezes  Anxiety, Restlessness  Clammy, Cold Skin

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  X-Ray  ABGs  Pulmonary Pressures

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Immediate Treatment  Reduce Workload of Left Ventricle  Treat Underlying Cause  Fowler’s Position  Oxygen/Mechanical Ventilation

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Morphine IV  Diuretics IV  Inotropic Agents IV  Vasodilators IV

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Impaired Gas Exchange  Decreased Cardiac Output  Excess Fluid Volume  Acute Pain  Anxiety

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Heart Failure  Progressive  Signs and Symptoms May Worsen Over Time

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Fatigue and Weakness  Exertional Dyspnea  Orthopnea, Paroxysmal Nocturnal Dyspnea  Cough  Crackle and Wheezes  Tachycardia  Chest Pain

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms (cont’d)  Cheyne-Stokes Respiration  Edema  Anemia  Nocturia  Cyanosis  Altered Mental Status  Malnutrition

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications of Heart Failure  Liver and Spleen Enlargement  Pleural Effusion  Thrombosis and Emboli  Cardiogenic Shock

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  Screening Tests  BNP  Serum BUN, Creatinine  Liver Function Tests  Thyroid Function Test  Ferritin

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests (cont’d)  Chest X-Ray  Echocardiography  ECG  Exercise Stress Testing  Cardiac Magnetic Imaging  Cardiac Catheterization/Angiography  Sleep Studies

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Intervention Goals  Improve Heart’s Pumping Ability and Decrease Heart’s Oxygen Demands  Identify and Correct Underlying Cause  Increase Strength of Heart’s Contraction  Maintain Optimum Water and Sodium Balance  Decrease Heart’s Workload

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Drug Therapy  Oxygen Therapy  ACE Inhibitors or ARBs  Beta Blockers  Diuretics  Inotropic Agents  Vasodilators

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Activity  Sodium and Weight Control  Pacemakers, ICD  Cardiac Resynchronization Therapy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Mechanical Assistive Devices  Intra-aortic Balloon Pump  Ventricular Assist Device  Total Artificial Heart  Implantable Replacement Heart

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Intra-Aortic Balloon Pump

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ventricular Assist Devices and Artifical Heart  Support Failing Heart  Bridge to Transplantation  Destination Therapy  Heart Replacement

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Surgical Interventions  CABG  Valve Replacement  Ventricular Reconstruction

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Impaired Gas Exchange  Decreased Cardiac Output  Acute Pain  Anxiety  Excess Fluid Volume

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Interventions  Oxygen  Rest and Activity  Positioning  Fluid Management  Reduce Oxygen Consumption

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Interventions (cont’d)  Medications/Teaching  Low-sodium Diet  Weight Control  Education  Coping

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Transplantation  End Stage Heart Failure  Strict Selection Criteria

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Heart Transplant

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Transplantation (cont’d)  Immunosuppressive Therapy Preoperatively  Lifelong Antirejection Therapy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cardiac Transplantation (cont’d)  Complications  Rejection  Infection  Malignancies  Anti-rejection Medicine Side Effects

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Postoperative Cardiac Surgery Nursing Diagnoses  Pain  Ineffective Airway Clearance  Impaired Gas Exchange  Decreased Cardiac Output  Risk for Infection  Deficient Knowledge