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CHF have increased 116% The rate of sudden cardiac death in a patient with CHF is 6 to 9 times higher than for the general population Lewis
Precipitating causes
Increase workload of ventricles Leads to decreased myocardial function
Types of CHF
Left sided failure
Back up of blood into the lungs Common causes are: CAD, HTN, cardiomyopathy and rheumatic heart disease Other causes can be: MI damage, ischemia, scar tissue (reducing contractility),
Types of CHF
Right sided failure
Backup of blood into the venous system and right side of the heart Primary cause is left sided failure Also caused by Cor pulmonale (caused by COPD, and pulmonary emboli) Also caused by MI damage, ischemia and scarring
Remember: Nursing care will focus on continual physical assessment of the patient, hemodynamic monitoring, and monitoring the patients response to the treatment.
Phosphodiesterase inhibitors
Amrinone (Inocor) Milrinone (Primacor)
Vasodilators:
Nipride (IV) (usually in ICU) and nitroglycerine (often in paste form)
Nursing Assessment
Subjective data:
Past health history Medications Functional health patterns
Health perception-health management: (fatigue?) Nutritional-metabolic: (usual sodium intake, etc) Elimination: (nocturia?) Activity-exercise: (dyspnea?) Sleep-rest: (nocturnal dyspnea?) Cognitive-perceptual: (chest pain?)
Nursing Assessment
Objective data:
Skin Respiratory system Cardiovascular system Gastrointestinal system Neurologic system Lab values Hemodynamic monitoring Other tests: chest x-ray, echocardiogram, etc...
Nursing Diagnoses
Activity intolerance r/t.. Sleep pattern disturbance r/t. Fluid volume excess r/t Risk for impaired skin integrity r/t Impaired gas exchange r/t Anxiety r/t Ineffective management of therapeutic regimen r/t (See Text pg 900-901)
Nursing Interventions
Regular assessment of patients level of fatigue, dyspnea, heart rate, and weight Provide emotional and physical rest Provide frequent small feedings Teach patient energy expenditure and how to self monitor activities for appropriateness Teach patient reasons for nocturnal dyspnea
Nursing Interventions
Help patient explore alternative positions for comfortable sleep and relief of dyspnea Teach patient to take diuretics early in day to prevent having to get up at night Give all meds as ordered Monitor intake and output Monitor for signs of peripheral edema or lung congestion
Nursing Interventions
Instruct patient to weigh daily and to keep a record of their weights Monitor patient for signs and symptoms of hypokalemia Provide client with a diet that is sodium restricted as ordered by physician If patient has edema, measure and record Assess edematous sites for skin breakdown
Nursing Interventions
Perform passive ROM to extremities q 4h Handle edematous skin gently Turn and reposition q 2 h Monitor for impaired breathing Position HOB up if having difficulty breathing Give O2 if needed by nasal cannula Use pulse ox prn
Nursing Interventions
Assess heart and lung sounds q 4-8 h and prn Assess patient for anxiety. Medicate as needed Allow patient to ask questions and verbalize concerns. Explain all procedures to patient in understandable terms Respond to call light quickly
Nursing Interventions
Use measures to decrease dyspnea for patient, thereby relieving anxiety r/t breathing difficulty Use calm behavior with patient Teach patient what to report to nursing staff, shortness of breath, edema/swelling in ankles, weight gain,etc Teach patient and family about sodium restricted diet