CHF

Information about CHF

Published on July 14, 2014

Author: asiabilal

Source: authorstream.com

Content

Congestive Heart Failure Nursing Management: Congestive Heart Failure Nursing Management Definition CHF: Definition CHF Heart failure describes the clinical syndrome that develops when the heart cannot maintain an adequate cardiac output. The heart pumps blood inadequately, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and other changes that may further weaken the heart. Causes of Congestive Heart Failure: Causes of Congestive Heart Failure Coronary artery disease Heart attack High blood pressure Heart valves disorders Inflammation of Heart muscle (myocarditis, cardiomyopathy) Congestive heart failure: Congestive heart failure Types Left-sided heart failure There are two types of left-sided heart failure Systolic dysfunction Diastolic dysfunction Right-sided heart failure Early: * Basilar rales from overload * nocturia * exertional dyspnea * fatigue * positive hepatojuglar reflux from liver congestion * s3 heart sound : Early: * Basilar rales from overload * nocturia * exertional dyspnea * fatigue * positive hepatojuglar reflux from liver congestion * s3 heart sound HALLMARK SIGNS AND SYMPTOMS MILD:: MILD: Cough Orthopnea Discomfort in right upper abdomen due to hepatomegaly Cardiac Rales Edema Cardiomegaly LATE:: LATE: Anasarca---Generalized edema from ineffective pump function Frothy or Pink Sputum Interfering Test Results: Interfering Test Results B-type natriuretic—elevated levels in CHF ; produced when the ventricles are stretched. EKG may show signs of ischemia (T-wave inversion),tachycardia or extra beats. CBC may show anemia—Hgb less than 12 in females, less than 14 in males; HCT; less than 3 times the Hgb. Chemistry may show renal problems, electrolyte disturbance. Continued:: Continued: Chest x-ray Left sided Heart Failure Pulmonary congestion because of accumulation of fluid in the lungs Enlarged left ventricle (LVH) because of the increased stress on the heart to pump blood. Right sided Heart Failure Pulmonary congestion because of accumulation of fluid in the lungs. Enlarged Heart(cardiomegaly) because of the increased stress on the heart to pump blood. Diagnostic evaluation: Diagnostic evaluation Patient history Physical examination Diagnostic studies Electrocardiography (ejection fraction) Radionuclide magnetic resonance computed tomography imaging cardiac catheterization with angiography a biopsy of heart muscle is needed Treatment:: Treatment: lifestyle change Salt restriction Exercises Smoking and alcoholism Body weight (daily weight) Supportive stockings Continued:: Continued: Drug management Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers Beta-blockers Other vasodilators ( nitroglycerin) Cardiac glycosides (digoxin) Aldosterone receptor blockers (spironolactone) Loop diuretics Continued:: Continued: Potassium-sparing diuretics Thiazide and thiazide-like diuretics Anticoagulants (heparine) Opioids (morphine) to relieve anxiety Positive inotropic drugs (drugs that make muscle contract more forcefully) (dopamine) Oxygen for pulmonary edema is required Continued:: Continued: Non pharmacological management of heart failure (surgical intervention) Coronary artery bypass grafting ( revascularization) Percutaneous coronary intervention (Angioplasty) Valve replacement Biventricular pacemaker Heart transplantation Left ventricular assist device (LVAD) Nursing Diagnosis:: Nursing Diagnosis: Impaired Gas Exchange Decreased cardiac output Exchange Fluid Volume Risk for infection related to pulmonary congestion Imbalanced Nutrition: Less than body requirements related to increased metabolic demands with decreased caloric intake. Anxiety related to diagnosis and prognosis Activity intolerance related to myocardial dysfunction and pulmonary congestion. Alteration in Lifestyle and Self care. Nursing care of patients with congestive heart failure: Nursing care of patients with congestive heart failure Maintain the patient in high fowler's position Elevate extremities except when the patient is in acute distress Frequently monitor vital signs Change position frequently Monitor intake and output and daily weight Continued:: Continued: Restrict fluids as ordered Teach the patient and family and provide emotional support ( life style change ) Explain the side effect of diuretic medications for additional actions ( side effects of diuretics include electrolyte imbalance, symptomatic hypotension Use aseptic procedures when caring for invasive lines Nursing Care Plans /Sample: Nursing Care Plans /Sample Problem/Nursing Diagnosis Impaired Gas Exchange May be related to: Altered O2 supply Alveolar-capillary membrane changes Altered blood flow Altered oxygen-carrying capacity of blood Goals:: Goals: After---the patient will be able to: Maintain optimal gas exchange as evidenced by normal ABG,s and alert responsive mentation or no further reduction in mental status. Intervention: Assess respirations: note quality,rate,pattern,depth, and breathing effort. Assess lung sounds, noting areas of decrease ventilation and the presence of adventitious sounds. Continued:: Continued: Assess for signs and symptoms of hypoxemia. Monitor vital signs. Monitor arterial blood gases and note changes. Use pulse oximetry to monitor o2 saturation and pulse rate continuously. Assess skin color for development of cyanosis. Monitor chest x-ray reports. Maintain oxygen administration device as ordered,attempting to maintain o2 saturation at 90% or greater. Position with proper body alignment for optimal respiratory excursion. Suction as needed. Evaluation:: Evaluation: After complete intervention, the patient: Maintained optimal gas exchange as evidenced by normal ABG,s and alert responsive mentation or no further reduction in mental status. Practice Questions:: Practice Questions: A patient diagnosed with congestive heart failure asks you why fluid accumulates in his lungs. The best response is: (a): Because of the excessive volume of IV fluid that is being administered. (b): The left side of his heart is weak and losing the capability to pump blood to his lungs. (c): The right side of his heart is weak and losing the capability to pump blood to his lungs. (d): He stands too long at work. Correct Answer:: Correct Answer: (B) Continued:: Continued: Your patient is experiencing congestive heart failure. What medication would you expect to administer to strengthen myocardial contractility? (a): Nitroprusside (b): Digoxin (c): Nitroglycerine ointment (d): Furosemide Correct Answer:: Correct Answer: (B) Continued:: Continued: The patient asks you why she is being administered so many arterial blood gas tests. The best response is: (a): This test determines if your liver and kidneys are functioning properly. (b): This test determines if you have a sufficient WBC to fight infection. (c): This test determines if you are hyperglycemic, which is side effect of your medication. (d): This test determines how well your tissues are oxygenated. Correct Answer:: Correct Answer: (D) Continued:: Continued: A nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which of the following disorders reported by the client is unlikely to play a role in excerbating the heart failure? (a): Atrial Fibrillation (b): Nutritional anemia (c): Peptic ulcer disease (d): Recent upper respiratory infection Correct Answer:: Correct Answer: (C) Continued:: Continued: A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide in the amount of 40 mg intravenous push. Knowing that the client will also be started on digoxin, the nurse should review which laboratory result? (a): Sodium level (b): Digoxin level (c): Creatinine level (d): Potassium level Correct Answer:: Correct Answer: (D) References:: References: www.austincc.edu/nursmods/online/online.../ HeartFailure nurfac.mans.edu.eg/files/.../ congestive_heart_failure. Congestive Heart Failure Dr. Walaa Nasr Lecturer of Adult Nursing Second year “ Nursing Practice ” 10 th Edition. ‘ ’Lippioncott Manual of Nursing Practice’’. “ Fundamentals of Nursing . The Art and Science of Nursing Care. Carol Lillis Priscilla LeMona. Pamela Lynn. 6 th Edition. Lippioncott Williams & Wilkins. Clinical Nursing and Related Sciences. Watson’s 6 th Edition. Mike Walsh. Medical-Surgical Nursing{ Demystified Series}. Mary Digiulio,RN/MSN/APRN. Donna Jackson, RN/MSN/APRN. ( A self-Teaching Guide ). Saunders ‘Comprehensive Review for the NCLEX-RN Examination. Linda Anne Silvestri . (Edition:4)

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