Vous êtes sur la page 1sur 3

HEART FAILURE Right Sided Heart Failure

 Cause is unknown  Cor Pulmonale – enlargement of right


 Heart is unable to supply blood to the ventricle – right sided failure is caused
parts of the body by another problem
 Cardiomyopathy  Distended neck vein – pressure on the
o myocardium/muscles of the right side of the heart is high – inferior
heart are enlarged is connected in the liver – hepatomegaly
o 20% is caused by alcoholism; – peritoneal cavity – acites – abdominal
usually unknown pain and anorexia – legs are swelling –
o If already dilated  dilated pitting edema – jaundice
cardiomyopathy  contractions  Gain in weight
become weak  decreased  Oliguria in day, polyuria (nocturia) at
cardiac output night
o Dilated muscle  increase blood  > 4-5 cm – jugular vein – pressure
volume  left ventricular
hypertrophy Cheyne – Stokes Breathing – rapid breathing
 Stenosis  Hyperventilating – blowing of CO2 – not
o Valve is narrow  accumulation enough to stimulate the medulla
in atrium  backflow to oblongata = apnea
lungs/body  heart failure
 Regurgitation Exertional Dyspnea
o Valve does not close all the way  Shortness of breath during activity –
 backflow to lungs/body  heart cannot give sufficient amount of
heart failure oxygen – difficutly breathing
 Aortic Valve Open
o Blood pushed to aorta will go Orthopnea
back to ventricle  dolate
 Breathlessness if patient is put in a flat
o Aortic Insufficiency  not closing
position (2, 3, 4-pillow orthopnea)
o Aortic Regurge  backflow
 Hypertension Paroxysmal Nocturnal Dyspnea
o Muscle will increase in size 
reduced contractility of the heart  While sleeping, sudden awakening
 decreased cardiac output because cannot breathe
 Myocardial Infarction Nocturia – need to urinate at night
*if blood in pulmonary bed = pulmonary  Recumbent position – more blood will
congestion go to the lumbar area – more blood
*if blood inside alveoli = pulmonary edema  supply to kidneys – the make more
decreased surfactant  atelectasis urine

Left Sided Heart Failure Brain Natriuretic Peptide

 Orthopnea – lungs are already  Secreted primary by the ventricles in


congested with water response to an expansion
 Tachycardia – less cardiac output –  Less than 100
stimulate SNS – release of epinephrine  100 – 300 pg/mL – mild heart failure
 Exertional dyspnea – activity – decrease  300 – 700 pg/mL – moderate heart
cardiac output – dyspnea failure
 Fatigue  Above 700 pg/mL – severe heart failure
 Cyanosis  X-ray can tell if enlarged heart
 Paroxysmal nocturnal dyspnea – at Echocardiogram
night – awaken suddenly – wakes up
gasping for air  Non-invasive ultrasound used to
 Pulmonary congestion – cough, evaluate the structure and function of
crackles, wheezes, blood tinged sputum the heart
(frothy – air), tachypnea  Age – better transmission of sound
waves where transducer is passed
 Chest x-ray to evaluate the site and
determine the amount of fluid buildup
in his lungs
 Normal EF greater than 55%
Treatment Nursing Management

 Goal is to prevent development of  Bed Rest to reduce myocardial oxygen


symptoms demand
 ACE inhibitor  Provide bedside commode – to prevent
 Beta-blockers Valsalva maneuver
 Dyspnea, fatigue, peripheral edema and  Placing toiletry and other items within
distention of the jugular vein easy reach
 First line therapy – corrects fluid  Assisting with ADL as needed
overload  Help the patient space activities and
 Diuretics – to remove excess water avoid the hour after meals when
 Ace inhibitors (can cause hyperkalemia) gastrointestinal perfusion needs are
and ARBs greatest – heart is already giving more
 Beta-blockers blood to stomach but with activity
 Hypokalemia – U wave increases workload – heart attack
 High fowler’s
Other drugs used in HF  Patient with pitting edema – skin
 Digoxin breakdown (epidermis is avascular and
o positive inotropic (contractility), can have no blood supply)
negative chronotropic (cardiac  Side to side every 2 hours
rate)  Gentle cleansing and application of
o Used to slow conduction lotion
o Check pulse rate – if 60 and  Pressure-relieving mattresses (egg crate
below – do not administer mattresses, air mattress)
 Nitroglycerin and Nitroprusside  Pitting edema – edema of the feet,
o dilate the veins in the arteries, ankles and legs
decreases venous return – gives  To describe an indentation in the skin
rest to the heart created by pressure – the thumb is the
o Patches are used primarily to one used to place firm pressure over
reduce preload the dorsum of each foot
 Norepinephrine and Epinephrine
Depth of Edema
o Causes vasoconstriction – BP
will go up – so more blood will go  Time the indentation remains after the
to the brain pressure
 Dobutamine  1+ - slight indentation (2mm) – rapid
o infusion pump to increase renal  2+ - deeper pit after pressing (4mm) –
blood flow thereby enhancing last longer than 1+
dieresis  3+ - deep pit (6mm) – 1-2 minutes, skin
o Stimulate heart rate and swelling is obvious
myocardial contraction –  4+ - deep pit (8mm) – 2-5 minutes,
increase systemic vascular frank swelling, clinically evident
resistance – increase cardiac
output Diet Therapy
 Vasopressin/Anticoagulant  Moderate to severe – 3g Na diet
o infusion pump  Severe – 2g Na diet
 Dobutamine  Avoid fried foods
 Tachycardia = A/E  One glass of beer/wine/alcohol is
 Blood pressure and ECG should restricted to one drink per day
be monitored  If overweight – lose weight
 Continuous IV infusion  Minimizing caffeine is advisable with
Other Treatments patients with tachycardia
 Alcohol use should be stopped. Alcohol
 Oxygen is a powerful cardiac depressant
 Stool Softener – to decrease Valsalva
maneuver
 NPO if dyspneic, low salt diet (Na
<2gm/day)
 Vital signs every hour and document
Fluid Restriction

 No evidence on retention of water so Na


is restricted
 Weigh daily
 Increase of 3 pounds in 2 days or 5
pounds in a week
 Avoid Valsalva maneuver – increase
intrathoracic pressure, reduces right
atrial filling, triggers tachycardia
 If taking digitalis glycoside (digoxin)
Signs and symptoms of Digitalis Toxicity

 Anorexia
 Nausea and vomiting
 Fatigue (most frequent side effect)
 Visual disturbances – blurred vision,
appearance of halos around dark
objects, yellow or green color perception
Signs of Hypokalemia

 Hypokalemia potentiates the actions of


digoxin and increases risk for digitalis
toxicity which can cause life
threatening dysrhythmias
 Potassium rich – cantaloupe (highest in
melons), honey dew, avocado, banana,
red bean, green bean, peas, potatoes,
tomatoes, dried fruits, milk and milk
products (high in sodium)

Vous aimerez peut-être aussi