NUR 170: Care of Client with Heart Failure

Care of the Client with Common Perfusion Problems (NUR 170)

• The heart's purpose is to deliver essential supplies to tissues.
• The heart has components including the pump, electrical system, vascular system, and blood volume.

Pump - Heart Failure

• Heart failure means the heart doesn't pump effectively, causing fluid buildup.
• This buildup can occur on either the left or right side of the heart.

Left-Sided Heart Failure

• Blood backs up into the lungs.
• This causes edema in the lungs, which can be detected by crackles and shortness of breath (alveoli filled with fluid.)

Right-Sided Heart Failure

• Blood backs up into the body.
• This causes edema in the body, noticeable in dependent areas.

Heart Failure

• Inability of the heart to pump enough blood to meet body tissues' demands.
• Can lead to cardiomegaly (abnormally large heart.)

Pump - Heart Failure - Left: Causes

• Modifiable and non-modifiable risk factors should be identified and addressed in client education.
• Modifiable risk factors include hypertension (HTN), obesity, previous heart attacks (myocardial infarction), angina, diabetes, family history, and substance abuse.
• Non-modifiable risk factors include valvular disease, cardiomyopathy, congenital defects, coronary artery disease, and rheumatic heart disease.

Pump - Heart Failure - Right: Causes

• Left ventricular failure.
• Right ventricular myocardial infarction.
• Pulmonary hypertension.
• Chronic obstructive pulmonary disease.
• Acute respiratory distress syndrome.

Pump - Heart Failure - Compensation

• The body's compensation mechanisms can worsen the condition.
• These mechanisms include sympathetic nervous system stimulation, renin-angiotensin system activation, chemical responses (BNP), and hypertrophy.

Pump - Heart Failure - Signs and Symptoms – Left-sided heart failure

• Assess the periphery for indications of decreased cardiac output.
• Evaluate the lungs for signs of backward issues.
• Conduct assessments across all body systems (neuro, cardiac, lungs, GI/GU, skin) to gather comprehensive data.

Pump - Heart Failure - Signs and Symptoms – Right-sided heart failure

• Assess the periphery for indications of decreased cardiac output.
• Evaluate the lungs for signs of backward issues.
• Conduct assessments across all body systems (neuro, cardiac, lungs, GI/GU, skin) to gather comprehensive data.

Chronic Heart Failure: Clinical Manifestations

• Fatigue (F)
• Limitation of activities (A)
• Chest congestion and cough (C)
• Edema (E)
• Shortness of breath (S)

Pump - Heart Failure

• Additional diagnoses often include monitoring electrolytes, kidney function, and fluid balance (I & O).
• BNP (B-type natriuretic peptide) is crucial in assessing and monitoring heart failure.
• Other tests include urinalysis, EKG, and ABGs.

Pump - Goals and Interventions

• Improve perfusion and cardiac output.
• Enhance gas exchange in lungs and tissues.
• Minimize complications including pulmonary edema and peripheral edema.

Pathophysiology for Vascular

• Vascular diseases disrupt blood flow, either preventing it from reaching the body or returning to the heart.

6 Key Signs of Arterial Insufficiency

• Pain
• Pallor
• Pulselessness
• Paresthesia
• Paralysis
• Poikilothermia (coolness)

Peripheral Vascular Disease

• Alterations in blood flow through arteries and veins, often due to atherosclerosis.

Peripheral Artery

• Blood flow to the foot is compromised.
• Assess appearance of affected area with direct observation.

Peripheral Venous

• Blood flow out of the foot is compromised.
• Observe and assess affected area for signs.

Peripheral Artery/Venous - Stages, Assessment (ABI)

• stages: asymptomatic, intermittent claudication, ischemic rest pain, necrosis/gangrene
• assessment: Ankle-brachial index (ABI). ABI is calculated by measuring blood pressure in the arm and ankle and then dividing ankle systolic by arm systolic. An ABI of < 0.9 indicates peripheral arterial disease (PAD).

Peripheral Artery/Venous - Goals and Interventions

• Goal improve circulation.
• Interventions include proper exercise, position (no smoking), medications (e.g., aspirin, Plavix), controlling hypertension (HTN), surgery (e.g., stents, atherectomy, bypass surgery.) Surgery must be carefully followed by observation of circulation in the area.

Atherosclerosis

• Plaque buildup in artery walls restricts blood flow.
• Risk factors include high lipid levels.
• Symptoms are often subtle; include bruits, decreased pulses, cool extremities, and poor capillary refill.
• Interventions focus on decreasing plaque buildup and preventing future buildup.

Embolism - Venous or Arterial

• Disruption of blood flow due to a blood clot (embolus).
• Risk factors include surgery (especially on legs or hips), prolonged sitting, obesity, oral contraceptives, pregnancy, cardiac disease (e.g., congestive heart failure), and smoking.
• Symptoms include calf or groin pain, sudden swelling, redness, and warmth.
• Interventions focus on preventing clot formation and removing clots via medications or procedures.

Embolism Complications

• Pulmonary embolism — clot travels to the lungs, blocking vessels, causing tissue death, and decreased oxygen exchange.
• Stroke — clot travels to the brain, causing a cerebrovascular accident (CVA).

Client Teaching

• Identifying risk factors and preventive measures is crucial, including modifications to lifestyle, treatments, and dietary and medication management.

Buerger's Disease

• Inflammation of blood vessels, impairing blood flow, often due to tobacco use.

Varicose Veins

• Valves in veins become incompetent, causing blood pooling and vein enlargement.
• Causes include prolonged standing, age, family history, obesity, and heart disease.
• Symptoms include visible veins, leg heaviness, and pain.
• Treatment focuses on improving venous return. Options include compression stockings, exercise, elevation, medical procedures such as ligation, stripping, vein injections, and laser surgery.

Raynaud's Disease

• Vasospasm in blood vessels, restricting blood flow, primarily in response to cold temperatures or stress.
• Symptoms include discoloration and numbness in the affected area.
• Lifestyle modifications and appropriate medications are crucial.

Hypertension

• High blood pressure (BP) is elevated over the recommended values.
• Primary (essential) hypertension has no known cause.
• Secondary hypertension often stems from another medical condition.
• Risk factors for essential HTN include age over 60, obesity, smoking, African American ethnicity, stress, family history, high lipid levels, and sedentary lifestyle.
• Secondary hypertension commonly stems from diseases like kidney ailment, pregnancy, primary aldosteronism, and Cushing's syndrome.
• Lifestyle changes, including diet, exercise, and stress reduction, are generally the initial interventions.
• Medications include diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), calcium channel blockers, beta-blockers, renin inhibitors, central alpha agonists, with specific drugs outlined.
• Monitoring blood pressure (BP) is essential.
• Clients need education regarding potential complications related to hypertension and medications.
• Addressing lifestyle, including appropriate diet, is crucial.
• Complications such as hypertensive crisis (BP > 180/120 mmHg) can damage organs.

NGN NCLEX-RN Question (Specific)

• The highest risk for a client with chronic asthma and hypertension treated with lisinopril is a bronchospasm reaction.