Heart Failure: Symptoms and Interventions

Heart Failure: Signs, Symptoms, and Interventions

• Left-sided heart failure results in decreased cardiac output.
• Symptoms of left-sided heart failure include weakness, fatigue, dizziness, acute confusion, and oliguria.
• Pulmonary congestion symptoms in left-sided heart failure are breathlessness, cough, S3 heart sound, crackles, and pink frothy sputum.
• Other signs of left-sided heart failure are confusion, tachycardia, orthopnea, and nocturnal dyspnea.
• Right-sided heart failure causes systemic congestion.
• Signs of right-sided heart failure include jugular vein distention, increased abdominal girth, hypertension, and dependent edema.
• Additional manifestations of right-sided heart failure are hepatomegaly, hepatojugular reflux, ascites.
• Weight is the most reliable indicator of fluid gain or loss in heart failure.

Preload and Afterload

• Preload is the amount the ventricles stretch at the end of diastole (LVEDP).
• Preload relates to venous return and ventricles.
• Increased venous return from conditions like renal disease or CHF increases preload.
• Too little circulating blood volume (hemorrhage, third spacing) decreases preload, leading to decreased stroke volume, cardiac output, and perfusion.
• Afterload is the resistance the left ventricle must overcome to eject blood into circulation (SVR).
• Right ventricle afterload is pulmonary vascular resistance (PVR), while left ventricle afterload is systemic vascular resistance (SVR), affected by vascular tone.
• Low afterload decreases forward blood flow systemically and to the coronaries.

Heart Failure: Nursing Interventions

• Sodium restriction in diet and fluid assessment.
• Loop diuretics (e.g., furosemide) help reduce fluid overload.
• Thiazide diuretics (e.g., hydrochlorothiazide, metolazone) can be used.
• Potassium-sparing diuretics (e.g., spironolactone) help to prevent potassium loss.
• Morphine sulfate reduces anxiety, preload, afterload, respiratory distress, and pain.
• Venous vasodilators like nitrates decrease preload.

Cardiac Medications: Nursing Considerations

• Digoxin: Monitor for toxicity (e.g., vision changes, nausea, bradycardia).
• Nitroglycerin: Monitor blood pressure; teach patients about proper storage and administration.
• Morphine sulfate: Monitor respiratory rate and blood pressure.
• Thrombolytic (rtPA): Administer within a specific time window of stroke onset; monitor for bleeding.
• Antiplatelets: Monitor for bleeding; educate patients about bleeding precautions.

Post-MI and PCI Care

• Monitor for signs of ischemia and injury by balancing oxygen supply and demand.
• Assess vital signs, cardiac rhythm, and pain levels.
• Administer medications as prescribed (e.g., antiplatelets, anticoagulants, pain relievers).
• Provide education on lifestyle modifications and medication adherence.

Central Venous Pressure (CVP)

• CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood back into the arterial system
• Normal CVP range is typically 2-8 mmHg.
• Elevated CVP may indicate fluid overload or right-sided heart failure. Interventions include fluid restriction and diuretics.
• Decreased CVP may indicate hypovolemia. Interventions include fluid administration.

Seizure Triggers

• Identify and minimize potential triggers of seizure activity, such as stress, sleep deprivation, alcohol or drug use, and flashing lights.

Tonic-Clonic vs. Absence Seizures

• Tonic-clonic seizures last 2-5 minutes and involve a tonic phase (muscle rigidity, loss of consciousness) followed by a clonic phase (jerking).
• Absence seizures are brief, sudden lapses in attention.
• Patients experiencing tonic-clonic seizures may experience incontinence. .

Tonic-Clonic Seizure Phases

• Tonic phase: continuous muscular contraction may compromise the airway.
• Clonic phase: alternating contraction and relaxation of muscles.
• Basal Metabolic Rate rises (increases 02 demand) during the clonic phase .
• Patients may become pale or cyanotic due to hypoxia, and hypoglycemic if glucose demand is excessive.
• Tonic seizure: only tonic movement, lasting 30 seconds or more.
• Clonic seizure: muscle contractions and relaxation, lasting several minutes.

Seizure: Nursing Considerations

• Description of seizure - Number, timing, pattern of seizures
• Preictal phase
• Physical and neurologic examination
• Other medical history
• Diagnostics: CBC, Liver enzymes, Blood Chemistry (including therapeutic blood levels), Lead level, Toxicology, EEG, CT, MRI, SPECT/PET

Seizure: Safety and Interventions

• Protect from injury during a seizure.
• Do not force anything into the mouth.
• Turn to the side to prevent aspiration and maintain airway.
• Remove objects that might cause injury.
• Suction oral secretions, if possible.
• Loosen restrictive clothing.
• Do not restrain movements; guide if necessary.
• Record the time the seizure began and ended.

Seizure Medications and Teaching

• Evaluate blood levels of medication.
• Be aware of drug-drug/drug-food interactions.
• Maintain therapeutic blood levels for maximal effectiveness.
• Avoid administering warfarin with phenytoin.
• Document and report side/adverse effects.

Stroke Types

• TIA (transient ischemic attack): Brief interruption of blood flow, symptoms resolve within 24 hours.
• Ischemic stroke: Blockage of blood vessel, leading to ischemia and infarction.
• Hemorrhagic stroke: Rupture of blood vessel, causing bleeding into the brain.

Stroke Prevention

• Control hypertension, hyperlipidemia, and diabetes.
• Quit smoking.
• Maintain a healthy weight.
• Regular exercise.
• Follow a heart-healthy diet.

Stroke Onset and Thrombolytic Therapy

• Note the time of symptom onset for potential thrombolytic therapy (e.g., rtPA).
• Thrombolytic therapy must be administered within a specific time window.

Stroke: Hemisphere Involvement

• Damage to the left hemisphere can affect language, math skills, and analytic thinking.
• Right hemisphere damage can affect visual and spatial awareness, and proprioception.

Increased Intracranial Pressure (ICP)

• Signs and symptoms include headache, altered level of consciousness, pupillary changes, and motor weakness.
• Nursing considerations include monitoring neurological status, elevating the head of the bed, and administering medications to reduce ICP.

Stroke: Safety

• Implement measures to prevent falls, aspiration, and skin breakdown.
• Provide assistance with activities of daily living.
• Offer emotional support and encouragement.

Carotid Interventions: Patient Education

• Explain the purpose of the procedure, potential risks and complications, and post-operative care instructions.

End-of-Life Care and Grief

• Provide compassionate care and support to patients and families facing end-of-life issues.
• Understand the different stages and expressions of grief.

Gastrointestinal Disorders

• Cholecystitis: Inflammation of the gallbladder.
• PUD (Peptic Ulcer Disease): Ulcers in the lining of the stomach or duodenum.
• Pancreatitis/Pancreatic CA: Inflammation/cancer of the pancreas.
• Inflammatory Bowel Disease:
  • Crohn’s disease: Inflammation of the digestive tract.
  • Ulcerative colitis: Inflammation and ulcers in the large intestine.
• Appendicitis: Inflammation of the appendix.
• Diverticulitis: Inflammation or infection in one or more small pouches in the digestive tract.
• Focus includes reviewing signs and symptoms, nursing considerations, assessment features, and nursing interventions related to nonsurgical and surgical interventions for each condition.