Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download HF Prezi Presentation
Document related concepts
no text concepts found
Transcript
Heart Failure BY: Shannon, Mi r anda, & N oel l e He a r t A n a t o m y Type something (Anatomy of a Human Heart 2019) Ca r di a c S y s t e m O v e r v i e w SA Node "Each day, the average human heart beats about 100,000 times, pumping 2,000 gallons of blood through the body"(An atom y Vagus Nerve Innervation AV Node Bundle of HIS Bundle Branches of a Hu m an Heart 2 0 1 9 ). of SA & AV Nodes Purkinje Fibers The Coronary Art eries: Normal Cardiac Vitals: Provi de the hea rt ti ssue wi th bl ood/nutri ents/O2 Pulse: RT, LT Ma i n, Ci rcumfl ex, & LT a nteri or descendi ng corona ry BP: a rteri es CO: 60-100 BPM 90/60 mmHg - 120/80 mmHg 5-6 Liters per minute (Vitalsigns:MedlinePlusMedicalEncyclopedia2021) Types of Heart Failure: 1. LT- Sided HF 2. RT - Sided HF Pericardium - a sac that surrounds the heart 3. Congestive HF (Typesof Heart Failure References Cardiac Output. (2019, December 15). Retrieved January 31, 2021, from https://www.uofmhealth.org/health- library/tx4080abc#:~:text=What%20is%20a%20normal%20cardiac,when%20a%20person%20is%2 0resting. Medicine, M. (2019, February 27). Anatomy of a Human Heart. Retrieved January 31, 2021, from https://healthblog.uofmhealth.org/heart-health/anatomy-of-a-human-heart Types of Heart Failure. (2017, May 31). Retrieved January 31, 2021, from https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure Vital signs: MedlinePlus Medical Encyclopedia. (2021, January 05). Retrieved January 31, 2021, from https://medlineplus.gov/ency/article/002341.htm#:~:text=Normal%20vital%20sign%20ranges% 20for,to%20100%20beats%20per%20minute Heart Failure Pathophysiology Heart Failure: CO < Demand The heart cannot pump enough blood out to the tissues. Ventricular failure, MI, valvular issues, hypertrophy cardiac muscle, arrhythmias Compensatory Mechanisms SNS - baroreceptors, sense low BP, catecholamines, INCREASES: HR, SV, CO & contraction LONG TERM = DAMAGING/exacerbate HF RAAS - low BP, renal detection, RAAS triggered, vasoconstriction, salt, and fluid retention LONG TERM = cardiac dysfunction/remodeling (Heart failure 1: pathogenesis, presentation and diagnosis 2019) (Heart failure 1: pathogenesis, presentation and diagnosis 2019) Heart Failure Classes No physical activity limitation, no No evidence of cardiovascular I dyspnea, SOB, palpitations w/ physical A disease and no symptoms activity Slight limitation on physical activity, Objective evidence of minimal II dyspnea, SOB, fatigue, palpitations w/ B cardiovascular disease, Mild symptoms physical activity, Comfortable @ rest III Marked limitation on physical activity, Objective evidence of moderately severe easy to dyspnea, SOB, palpitations, fatigue, cardiovascular disease, marked physical C Comfortable @ rest limitation due to symptoms Evidence of severe cardiovascular disease, Unable to carry on physical activity severe symptoms, severe physical limitations, IV w/o discomfort, symptoms of HF @ rest (Classes of Heart Failure 2017) D symptoms even @ rest References Classes of Heart Failure. (2017, May 31). Retrieved February 01, 2021, from https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes- of-heart-failure Contributor, N. (2019, August 05). Heart failure 1: Pathogenesis, presentation and diagnosis. Retrieved January 31, 2021, from https://www.nursingtimes.net/clinical- archive/cardiovascular-clinical-archive/heart-failure-1-pathogenesis-presentation-and- diagnosis-21-08-2017/ Heart Failure Diet Dietary Approach to Stop Hypertension eating plan Low Sodium Low Saturated Fat More Fruits & Veggies Studies have shown that following Whole grains, fish, poultry and nuts. "Following the reduced-sodium DASH diet plan can lead to an 8% increase in ejection fraction & stroke volume" (Butler et al., 2018 ) Heart Failure Diet: Sodium & Fluid Restrictions Eating too much sodium or drinking too much fluid can increase the body's water content causing the heart to work harder (UCSF, 2021) Fluid intake should be limited to 64oz per day to prevent fluid retention (American Heart Association, 2021a) Limit Sodium intake to 1500mg a day (Mayo Clinic, 2021) "One portion of prefabricated food can contain as much as the whole daily recommended intake of sodium" (Philipson et al, 2010) Chronic Heart Failure Actvity Level Research shows that being active helps people living with heart failure by: Improving Moods Reducing Symptoms Increasing the Heart's Ability to Pump Blood (American Heart Association, 2021a) Heart Failure: Recommended Physical Activity Low-intensity Activity 5-10 minutes 3x/Week Casual Walking, Pedaling Light House Work, Water Aerobics, Stationary Bike (National Heart Lung and Blood Institute, 2007) Stretching Exercises 3x/Week Torso, Neck, Hip, Hamstring (American Heart Association, 2021b) References Am e rican He art Association. (2021a). How can I im prove m y low e je ction fraction? Re trie ve d from https://www.he art.org/e n/he althtopics/he art-failure /diagnosing-he art-failure /how-can-i-im prove -m y-low-e je ction-fraction Am e rican He art Association. (2021b). Stre tching and fle xibility e xe rcise s. Re trie ve d from https://www.he art.org/e n/he alth-topics/cardiacre hab/ge tting-physically-active /stre tching-and-fle xibility-e xe rcise s Butle r, T., Ge orgousopoulou, E. N., & M e llor, D . (2018). D ie tary approache s for patie nts with he art failure and diabe te s. Practical D iabe te s, 35(4), 127– 130a. https://doi-org.blue cc.idm .oclc.org/10.1002/pdi.2179 M ayo Clinic. (2021). D ASH die t: He althy e ating to lowe r your blood pre ssure . Re trie ve d from https://www.m ayoclinic.org/he althylife style /nutrition-and-he althy-e ating/in-de pth/dash-die t/art20048456#:~ :te xt= The %20D ASH%20die t%20e m phasize s%20ve ge table s,sodium %20ve rsion%20of%20the %20die t National He art and Blood Institute . (2007). Caring for your he art: Living we ll with he art failure . [Pam phle t].lth Philipson H, Ekm an I, Swe dbe rg K, & Schaufe lbe rge r M . (2010). A pilot study of salt and wate r re striction in patie nts with chronic he art failure . Scandinavian Cardiovascular Journal, 44(4), 209– 214. https://doi-org.blue cc.idm .oclc.org/10.3109/14017431003698523 U nive rsity of California San Francisco. (2021). D ie t and conge stive he art failure . Re trie ve d from https://www.ucsfhe alth.org/e ducation/die t-and-conge stive -he art-failure Pharmacology Therapies Many Drug Classes Used to Treat HF Multiple systems involved, multi-drug involvement, proven to prolong life, saved lives, & improve heart function HF Medication Types > ACE (Angiotensin Converting Enzyme) Inhibitor > Angiotensin II Receptor Inhibitors/Blockers (ARBs) > Diuretics > Beta-Blockers (Beta-Adrenergic Blocking Agents) > Nitroglycerin (Medications Used to Treat Heart Failure 2017) ACE Inhibitors NURSING Implications Monitor BP and pulses Assess PT for signs of angioedema W/ HF monitor: Angiotensin-Converting Enzyme Inhibitor Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) DRUG INTERACTIONS Lisinopril (Prinivil, Zestril) > CAUTION W/ Potassium sparing Diuretics (e.g., spironolactone), Risk: HYPERKALEMIA fluid overload ACE Inhibitor: Action dyspnea, lung sounds, weight gain, JVD Monitor daily weights while Angiotensin I Angiotensin II > ARB's: hypotension, syncope, hyperkalemia, Monitor Renal function Used in the management of HTN & HF > Sacubitril/valsartan, increased risk of angioedema Reduces BP and improves symptoms of HF > Increase sensitivity to antidiabetic agents SX: dizziness, drowsiness, fatigue, headache, insomnia, vertigo, weakness, > Lithium: ACE increase concentration of Lithium hypotension, edema, chest pain, and tachycardia >DO NOT administer to pregnant patients (Dalpoas & Samal, 2017) taking this (Vallerand & Sanoski, 2021). medication Angiotensin II Receptor Blockers (or Inhibitors) NURSING Implications Monitor BP and pulses ARBs: Commonly Prescribed Candesartan (Atacand) Assess PT for signs of angioedema Losartan (Cozaar) DO NOT administer to pregnant DRUG INTERACTIONS Valsartan (Diovan) patients W/ HF monitor: > CAUTION W/ Potassium sparing Diuretics ARBs: Action fluid overload (e.g., spironolactone), Risk: HYPERKALEMIA > ACE Inhibitors(concurrent): hypotension, syncope, ARBs block Angiotensin II receptors - prevents vasoconstriction and aldosterone - dyspnea, lung sounds, hyperkalemia, monitor renal function effects of angiotensin II weight gain, JVD NSAIDs and selective COX-2 Inhibitors increased Prevent reabsorption of sodium and H2O Monitor daily risk of renal dysfunction Lowers BP - Heart beneficial weights while SX: Dizziness, hypotension, hyperkalemia, cough, ANGIOEDEMA taking this May increase the effects ofamiodarone, fluoxetine, phenytoin, rosiglitazone, May (Dalpoas & Samal, 2017) hghghgh Blocks medication (Dalpoas & Samal, 2017) ↑ levels and may (Dalpoas & Samal, 2017) sertraline ↑ and the risk of warfarin. lithium toxicity Diuretics Diuretics: Types NURSING Implications Lasix (furosemide) Assess fluid status Watch for edema, skin turgor, lung sounds DRUG INTERACTIONS Bumex (bumetanide) Increased risk of Hypotension w/ Esidrix (hydrochlorothiazide) other antihypertensives Aldactone (spironolactone) Monitor BP and pulse Increased fall risk in older adults Do not administer before sleep Assess electrolyte balance Non-K+ sparing diuretics risk of hypokalemia Diuretics: Action w/ other diuretics, amphotericin B, laxatives, corticosteroids Lasix (furosemide): Monitor ERYTHEMA MULTIFORME, inhibits reabsorption of sodium and chloride in the loop of Henle/DRT STEVENS-JOHNSON SYNDROME, Promotes excretion of H2O, Na+, CI-, Mg2+, K+, Ca+ TOXIC EPIDERMAL NECROLYSIS, APLASTIC ANEMIA, Aldactone (spironolactone): Monitor daily weights while AGRANULOCYTOSIS (furosemide) inhibition of Na+ renal reabsorption K+ & H+ sparing (aldosterone receptor antagonist) Use with eplerenone ↑ ACE inhibitors, NSAIDs, SX: blurred vision, dizziness, headache, vertigo, dehydration, hypocalcemia, hypochloremia, taking this risk of hyperkalemia potassium supplements, ARBs, potassium-sparing diuretics, ACE inhibitors, or hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, anorexia, medication constipation, diarrhea, dry mouth, dyspepsia, ↑ liver enzymes, nausea, pancreatitis, vomiting, APLASTIC ANEMIA, AGRANULOCYTOSIS, ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, TOXIC (Dalpoas & Samal, 2017) EPIDERMAL NECROLYSIS (Dalpoas & Samal, 2017) ↑ cyclosporine, risk of hyperkalemia (spironolactone) (Dalpoas & Samal, 2017) Beta-Blockers Beta-Blockers: Types NURSING Implications Monitor BP, ECG, & pulses Monitor intake & output ratios/daily DRUG INTERACTIONS ↑ ↑ atenolol (Tenormin) General anesthesia, bisoprolol (Cardicor or Emcor) may cause metoprolol (Betaloc or Lopresor) crackles/rales, weight gain, peripheral edema, JVD) Watch for aginal attacks Beta-Blockers: Action verapamil risk of bradycardia when used with digoxin, clonidine hypotension may occur with other antihypertensives, acute ingestion of Blocks stimulation of beta-1 (myocardial)-adrenergic receptors BP & HR, frequency of angina, w/ HF phenytoin, and myocardial depression verapamil, diltiazem, or propranolol weights Assess routinely for SX of HF (dyspnea, ↑ IV cardio mortality, alcohol, or nitrates Use cautiously w/in 14 days of MAOI use Use with amphetamines, cocaine, ephedrine, hospitalizations Abrupt withdrawal = life-threatening, hypertension, arrhythmias, myocardial ischemia epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (Dalpoas & Samal, 2017) SX: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence, gastric pain, heartburn, ↑ liver enzymes, nausea, vomiting, hypotension, peripheral (excessive hypertension, bradycardia) Use of insulins and thyroid medications may alter effectiveness vasoconstriction, BRADYCARDIA, HF, PULMONARY EDEMA (Dalpoas & Samal, 2017) Nitroglycerin Nitroglycerin DRUG INTERACTIONS Pharmacologic Class: Nitrates NURSING Implications Therapeutic Effect: relief OR prevention of anginal attacks, Assess location, duration, quality, the Concurrent use of avanafil, sildenafil, CO, Management of angina pectoris intensity of PTs anginal pain May cause falsely ↑ serum cholesterol Nitroglycerin: Action ↑ Coronary blood flow; dilating coronary arteries Vasodilation (more venous VS. arterial) urine catecholamine and urine vanillylmandelic acid concentrations Excessive doses may cause tadalafil, or vardenafil contradicted (severe hypotension) (severe hypotension) Improves collateral flow to ischemic regions levels May cause BP Concurrent use of riociguat contradicted Monitor BP and pulses; IV requires ECG ↑ LT ventricle end-diastolic pressure & preload Myocardial O2 consumption Antihypertensives, alcohol, beta-blockers, calcium channel blockers, haloperidolOr phenothiazines (additive hypotension) Anticholinergics (tricyclic antidepressants, antihistamines, phenothiazines) may ↓ absorption of TL or SL nitroglycerin methemoglobin concentrations SX: dizziness, headache, apprehension, restlessness, weakness, hypotension, tachycardia, syncope, abdominal pain, nausea, vomiting (Dalpoas & Samal, 2017) (Dalpoas & Samal, 2017) (Dalpoas & Samal, 2017) References Auty R. (2004). Pharmacological management of chronic heart failure in adults: a review of the literature. Malawi medical journal : the journal of Medical Association of Malawi, 16(1), 22–26. Dalpoas, S., & Samal, L. (2017, May 3). ACE inhibitors: Johns Hopkins Diabetes Guide. Retrieved February 01, 2021, from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/54 7002/all/ACE_inhibitors Medications Used to Treat Heart Failure. (2017, May 31). Retrieved January 31, 2021, from https://www.heart.org/en/health-topics/heart-failure/treatment-options-for- heart-failure/medications-used-to-treat-heart-failure Vallerand, A. H., & Sanoski, C. A. (2021). Davis's drug guide for nurses (Seventeenth ed.). Philadelphia, PA: F.A. Davis Company. Treatments & Other Therapies Smoking Cessation "Cigarette smokers are 2 to 4 times "Smoking cigarettes increases more likely to get heart disease than nonsmokers" your heart rate and blood pressure. Smoking can also (Smoking and cardiovascular disease). contribute to clumping or stickiness of the blood" "One out of every 5 smoking-related deaths is caused by heart disease" (Lifestyle Ch an ges for Heart Failu re 2017). (Smoking and cardiovascular disease). Treatments & Other Therapies Limiting Alcohol High Alcohol consumption leads to a rise in triglycerides, with high LDL or low HDL can lead to artery wall fatty build-up and Consumption Limiting alcohol consumption or avoiding drinking alcohol. 1-2 drinks per day for men and 1 drink per day for women. risk for myocardial infarction or stroke Excessively drinking can lead to: Cardiomyopathy Hypertension Cardiac arrhythmias Arteries age prematurely over time (esp. men) (Lifestyle Changes for Heart F ailure2017). CARDIOTOXIC Treatments & Other Therapies Cardiac Rehab Physical Activity Low Impact Exercise: Stationary Bike Education Education Designed to Inspire a Heart Healthy Lifestyle & Care Treadmill Walking Plan Compliance Resistance Training Flexibility Support Helping Patients and Family Manage Living With a Chronic Illness Medical Evaluations Regular Medical Evaluations to Ensure No Deterioration of Patients Condition Treatments & Other Therapies Surgical Procedures & Devices S urg ically placed and deliver pacing – or an electric counter-shock – when a lifeImplantable threatening abnorm al rhythm is detected cardioverter defibrillator (ICD) AKA biventricular pacing , a special pacem aker Cardiac Resynchronization Therapy (CRT) m akes the ventricles contract m ore norm ally/in synchrony This therapy can im prove heart function, hospitalization risk and survival Left ventricular assist device (LVAD) A battery-operated, m echanical pum p-like device that’s surg ically im planted, helps m aintain the pum ping ability of a heart that can’t effectively work on its own Treatments & Other Therapies Surgical Procedures & Devices Valve Replacement: Mechanical valve (metal/plastic/ human/animal tissue) During the surgery, the patient is connected to a Type something heart-lung machine that supplies blood to the brain and body. Coronary Artery Bypass: Surgeons remove healthy blood vessels from another part of the body, such as a leg or the chest wall. They then surgically attach the vessels to the diseased artery so that the blood can flow around the blocked section Percutaneous Coronary Intervention (PCI, AKA angioplasty): Privacy news data policies analytics documents.Now digital designs id anywhere atoms. Now strategy startups documents designs. Venture crypto adopters niche through to the diseased artery. Then the balloon is inflated to push open the artery Small tube (catheter) with a tiny deflated balloon on the end is inserted through an incision in the groin and pushed Heart Transplant: Surgeons replace the damaged heart with a healthy one from a donor who has been declared brain dead. The surgeon connects the patient to a heart-lung machine, removes diseased heart and replaces it with the donor heart Resources American Heart Association. (2021). Lifestyle changes for heart failure. Retrieved from https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure Cardiac Rehabilitation. (2020, November 26). Retrieved January 25, 2021, from https://www.mayoclinic.org/tests- procedures/cardiac-rehabilitation/about/pac-20385192 Devices and Surgical Procedures to Treat Heart Failure. (2017, May 31). Retrieved February 15, 2021, from https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/devices-and-surgical-procedures-to- treat-heart-failure Smoking and Cardiovascular Disease. (n.d.). Retrieved February 14, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/smoking-and-cardiovascular- disease#:~:text=Facts%20about%20smoking%20and%20heart,get%20heart%20disease%20than%20nonsmokers. Slips, Trips, and Falls Don't rush to the bathroom Keep cords tidy Move furniture & keep floor clear Walkers & wheelchairs Safety Precautions Bathroom Safety Shower chair/bathtub grips Prevent Falls Assistance w/fatigue, safe home mobility (DMESUSA)2021 Stay Safe From Infection (EHHF 2020) (PHCSLTC) 2021 Daily Checks Blood Pressure HR O2 Saturation Weight - Daily 3 lbs+ rapid weight gain - seek medical attention Log in Journal or App Medication Safety Pill Planner/ Set Alarms Patient Medication Knowledge Know adverse reactions know drug to drug interactions Know when to not take med (e.g., HR<60) Know general action Know expected outcomes Watch for Side Effects Log new side effects Report to physician Medication Therapy Adherence Do not self adjust Do not stop taking, unless permitted by a physician Do not self medicate (EH H F 2020) (ncbi 201 3) (N AN DA 201 4) Ref References Personal Home Care Services LTC (PHCSLTC) 2021 https://www.facebook.com/PHCSLTD/ DME Supply USA (DMESUSA) 2021 https://dmesupplyusa.com/drive-medical-folding-universal-sliding-transfer-bench.html?gclid=CjwKCAiAjeSABhAPEiwAqfxURR-i1b80r_1O_kjLJy2vt-vg5wxPJRfa8LRTyW3nmLiB2hi0HP7WZBoCRAQQAvD_BwE DH-Whole sale 2021 https://www.dhgate.com/wholesale/anti+slip+shower+stickers.html Lee, K., Pressler, S. J., & Titler, M. (2016). Falls in Patients With Heart Failure: A Systematic Review. The Journal of cardiovascular nursing, 31(6), 555–561. https://doi.org/10.1097/JCN.0000000000000292 National Center for Biotechnology Information (2013 Jan 10). Home Monitoring for Heart Failure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254025/ ElevatingHOME (2020) Heart Failure https://www.elevatinghome.org/heartfailurehomehealth Wiley-Blackwell (2014) Nursing Diagnoses Definitions and Classification, NANDA International
