Download Chapter 21

Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Chapter 26
Nursing Care of Patients with
Heart Failure
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
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 © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Causes





Coronary Artery Disease
Cardiomyopathy
Hypertension
Heart Valve Disorders
Myocardial Infarction
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
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 © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
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 © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Left-Sided Heart Failure
(cont’d)
 Hypertension Major Cause
 Blood Backs Up from Left Ventricle
 Alveolar Edema Results
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Left-Sided Heart Failure
(cont’d)
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Right-Sided Heart Failure
 Left-sided Heart Failure Major Cause
 Must Continually Pump Blood Against
Increased Fluid in Pulmonary Artery and
Lungs
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
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 © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Right-Sided Heart Failure (cont’d)
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Compensatory Mechanisms
Maintain Cardiac Output
 Designed to Maintain Cardiac Output
 Also Contribute to Cycle of Heart Failure
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
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 © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Compensatory Mechanisms
(cont’d)
 Chambers Enlarge (Dilation)
 Muscle Mass Increases (Hypertrophy)
 Increases Cardiac Oxygen Needs
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Pulmonary Edema




Acute Heart Failure
Severe Fluid Congestion in the Alveoli
Life-threatening
Drowning in Own Secretions
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms






Classic: Pink, Frothy Sputum
Rapid Respirations with Accessory Muscles
Severe Dyspnea, Orthopnea
Crackles, Wheezes
Anxiety, Restlessness
Clammy, Cold Skin
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
 X-Ray
 ABGs
 Pulmonary Pressures
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions





Immediate Treatment
Reduce Workload of Left Ventricle
Treat Underlying Cause
Fowler’s Position
Oxygen/Mechanical Ventilation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
(cont’d)




Morphine IV
Diuretics IV
Inotropic Agents IV
Vasodilators IV
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnoses





Impaired Gas Exchange
Decreased Cardiac Output
Excess Fluid Volume
Acute Pain
Anxiety
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Chronic Heart Failure
 Progressive
 Signs and Symptoms May Worsen Over
Time
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms
 Fatigue and Weakness
 Exertional Dyspnea
 Orthopnea, Paroxysmal Nocturnal Dyspnea




Cough
Crackle and Wheezes
Tachycardia
Chest Pain
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms (cont’d)







Cheyne-Stokes Respiration
Edema
Anemia
Nocturia
Cyanosis
Altered Mental Status
Malnutrition
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Complications of Heart Failure




Liver and Spleen Enlargement
Pleural Effusion
Thrombosis and Emboli
Cardiogenic Shock
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests
 Screening Tests





BNP
Serum BUN, Creatinine
Liver Function Tests
Thyroid Function Test
Ferritin
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests (cont’d)







Chest X-Ray
Echocardiography
ECG
Exercise Stress Testing
Cardiac Magnetic Imaging
Cardiac Catheterization/Angiography
Sleep Studies
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
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 © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Drug Therapy






Oxygen Therapy
ACE Inhibitors or ARBs
Beta Blockers
Diuretics
Inotropic Agents
Vasodilators
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions




Activity
Sodium and Weight Control
Pacemakers, ICD
Cardiac Resynchronization Therapy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
(cont’d)
 Mechanical Assistive Devices




Intra-aortic Balloon Pump
Ventricular Assist Device
Total Artificial Heart
Implantable Replacement Heart
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Intra-Aortic Balloon Pump
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Ventricular Assist Devices and
Artifical Heart




Support Failing Heart
Bridge to Transplantation
Destination Therapy
Heart Replacement
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Surgical Interventions
 CABG
 Valve Replacement
 Ventricular Reconstruction
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnoses





Impaired Gas Exchange
Decreased Cardiac Output
Acute Pain
Anxiety
Excess Fluid Volume
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Interventions





Oxygen
Rest and Activity
Positioning
Fluid Management
Reduce Oxygen Consumption
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Interventions (cont’d)





Medications/Teaching
Low-sodium Diet
Weight Control
Education
Coping
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiac Transplantation
 End Stage Heart Failure
 Strict Selection Criteria
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Heart Transplant
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiac Transplantation (cont’d)
 Immunosuppressive Therapy
Preoperatively
 Lifelong Antirejection Therapy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cardiac Transplantation (cont’d)
 Complications




Rejection
Infection
Malignancies
Anti-rejection Medicine Side Effects
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Postoperative Cardiac Surgery
Nursing Diagnoses






Pain
Ineffective Airway Clearance
Impaired Gas Exchange
Decreased Cardiac Output
Risk for Infection
Deficient Knowledge
Copyright © 2011. F.A. Davis Company