Download Heart Failure

Heart Failure
Karen Ruffin RN, MSN Ed.
Incidence and Prevalence of Heart Failure
• Leading cause of death in the US
• More than 5 million Americans are living with
heart failure, and 550,000 new cases are
diagnosed each year.
• About 250,000 people a year die from heart
disease.
• That means more than 680 Americans a day
die from it!!!!!!!!
• Women have a poorer survival rate then men
Basic Needs: Oxygenation
Oxygenation
• Oxygen is required to sustain life, primary
basic human need
• The cardiac & respiratory systems function to
supply the body’s oxygen demands
• Cardiopulmonary physiology involves delivery
of deoxygenated blood to the right side of the
heart & to the pulmonary system
What are the 3 concepts in oxygenation?
• Ventilation
• Perfusion
• Diffusion
What are the 2 mechanisms that
drive the function of the heart?
• Electrical/conduction
• Mechanical/pump
What is Heart Failure?
• Heart cannot pump enough blood to meet the
metabolic demands of the body.
• Results from changes in the systolic or
diastolic function of the ventricles
• There are many causes?????
What are they????
http://www.americanheart.org/presenter
Types of Heart Failure
• Left Sided
• Right sided
• Systolic
• Diastolic
Left Sided Heart Failure
• Most Common
• LV dysfunction causes blood to back up
through the left atrium and into the pulmonary
system.
• Common causes of left heart failure are:
HTN, CAD, mitral and/or aortic valve disease,
decreased tissue perfusion.
What does that patient look like?????
Right Sided Heart Failure
• Most common cause is left sided heart failure.
• Other causes MI or pulmonary HTN
• RV dysfunction causes the blood to back up
in the right atrium and then the venous
circulation.
What does that patient look like?????
Systolic Failure
• Defect in ventricular contraction
• Left Ventricle loses ability to generate
enough pressure to eject blood forward
through the high pressure aorta –
Decreased ejection fraction
• Afterload – hypertension,
cardiomyopathy, and valvular heart
disease
Diastolic Failure
• Impaired ability of ventricles to fill
• Decreased filling = decreased stroke
volume Which + decreased WHAT?
• Pulmonary congestion, pulmonary
hypertension, with normal ejection
fraction
Heart Failure
Diagnostic Studies
• Goal: Assess the cause & degree of failure
• History and Physical Exam
• B-Type Natriuretic Peptide level (BNP).
– elevated in acute and chronic heart failure
– useful in following the response to treatment of
congestive heart failure.
• ABGs, Serum chemistries, LFTs
• Chest x-ray
• EKG
• Echocardiogram
• Nuclear imaging studies
• Cardiac catheterization
• Hemodynamic monitoring
Lets Compare!!!!
Classification of Heart Failure
• Class 1 – No limitation of physical activity
• Class 2 – Slight limitation – fatigue, dyspnea,
palpitations
• Class 3 – marked limitation. Comfortable at
rest; ordinary activities cause symptoms
• Class 4 – Inability to carry out any physical
activity without symptoms –
Pain/discomfort at rest
Management and Outcome
Measures
• Use of ß-blockers at discharge and during
admission.
•
Use of aspirin at discharge and during admission.
•
Timely and appropriate acute reperfusion
(thrombolysis or primary angioplasty).
•
The use of angiotensin-converting enzyme (ACE)
inhibitors for patients with depressed left
ventricular systolic function. Similarly, a minority of
patients with AMI are potential candidates for this
care process,
Management and Outcome
Measures
• The proportion of patients eligible for
smoking-cessation counseling is relatively
small, and ascertainment can be difficult,
given the variability in documentation as
well as practice.
• Diet and exercise counseling
• Cholesterol status assessment and
management.
Congestive Heart Failure
Medical Treatment Goals
• Decreasing Intravascular Volume
– Decreasing Venous Return
• Decreases preload – decreases the volume to the left
ventricle during diastole
• Med: Diuretics – Lasix (furosemide)
• Decreasing Afterload
– Decrease systemic vascular resistance
• CO increases
• Pulmonary congestion decreases
• Meds: Nitroglycerine (NTG); Morphine; Calcium Channel
Blockers
Congestive Heart Failure
Medical Treatment Goals
• Improving Gas Exchange & Oxygenation
– Supplemental oxygen
– Morphine
• Severe cases – intubation / ventilation
• Improving Cardiac Function
– Increase cardiac contractility without increasing cardiac oxygen
consumption
– Hemodynamic Monitoring:
• pulmonary artery pressure; pulmonary artery wedge
pressure (14-18mmg HG)
– Inotropic Meds: Digoxin
• Inotropic meds used with hemodynamic monitoring:
– Dobutamine
– Inodilators: (inotropic & vasodilator): Milrinone
Congestive Heart Failure
Medical Treatment Goals
• Reducing Anxiety
– Sedative action of IV Morphine
• Complication: respiratory depression
• Determine & Treat Underlying Cause
– Systolic or Diastolic failure
– Aggressive drug therapy
So what medical
complications do
you think can
occur???????
What basic needs
are being
effected?
Why and how?
Nursing Care for the Patient with Heart
Failure
• What will you assess????
• What are some potential nursing
diagnosis?????
• What are your goals for those diagnosis????
• What are your interventions?????
• How will you evaluate your goals?????
Case Study
• A 74-year-old woman is admitted to the
hospital with heart failure. She had been
growing progressively weaker and has
ankle edema, dyspnea on exertion, and
three-pillow orthopnea. On admission,
she is severely dyspneic and can
answer questions only with one-word
phrases. She is diaphoretic and has
central cyanosis, with a heart rate of
132 beats/min, and blood pressure
98/70. She is extremely anxious.
Case Study
• 1. Because this client cannot breath or talk
easily, prioritize the immediate nursing
assessments and intervetions upon
admission.
• 2. Considering the process of congestive
heart failure, explain the symptoms she is
having.
• 3.Based on assessment, identify nursing
diagnoses for this client.
• 4. What diagnostic studies do you anticipate
being ordered and why?
Case Study
• 5. The physician orders the following items for
this client. (Start an IV, then give dobutamine 3
mcg/kg/min IV; Furosemide (Lasix) 40 mg IV stat;
Digoxin 0.5 mg IV stat, then 0.125mg PO every 6
hours for three doses, with ECG before doses 3
and 4; Morphine 2 mg IV stat and then 2 mg IV
every 1 to 2 hours prn; Oxygen to maintain O2
sat >94%; Schedule for an echocardiogram; Low
Na, Fat, Cardiac diet; Weigh daily and monitor
input and output) Explain the rationale for these
medications and treatments. Would you ask for
any other ORDERDS and why?