Heart Failure and Cardiomyopathy PDF - Nursing Study Guide

Cardiac output – blood pumping out the LV after each contraction = SV x HR Preload – volume of blood at the end of diastole Afterload – the resistance the left ventricle to circulate the blood Contractility/contraction How do these impact perfusion? – increase afterload à i...

Cardiac output – blood pumping out the LV after each contraction = SV x HR Preload – volume of blood at the end of diastole Afterload – the resistance the left ventricle to circulate the blood Contractility/contraction How do these impact perfusion? – increase afterload à increase cardiac workload  Heart Failure Pathophysiology: A syndrome characterized by fluid overload or inadequate tissue perfusion. indicates myocardial disease, in which there is a problem with the contraction of the heart (systolic failure) or filling of the heart (diastolic failure). LV cannot pump blood effectively to the aorta and systemic circulation RV is unable to accommodate the blood volume returning from venous circulation and cannot pump effectively Describe the difference in clinical manifestations between right-sided heart failure versus left-sided heart failure Complications: Pleural effusion (anemia), Dysrhythmias, Hepatomegaly, Cardiorenal syndrome, Anemia Right-Sided Heart Failure Signs Left-Sided Heart Failure Signs Left ventricular heaves Increased HR R ventricular heaves S3 and S4 heart sounds Increase HR Anasarca ABGs: increased PaO2, slight increased PaCO2 Ascites Confusion, restless Edema (eg. pedal, scrotal) Dry, hacking cough Hepatomegaly Crackles (pulmonary edema) JVD Pleural effusion Murmurs PMI displaced inferiorly and left midclavicular line (LV hypertrophy) Weight gain Pulsus alternans (alternating pulses: strong, weak) Symptoms Shallow respirations Anorexia and GI bloating Symptoms Anxiety, depression Anxiety, depression Fatigue Dyspnea Nausea RUQ Pain Fatigue, weakness Nocturia Orthopnea Paroxysmal nocturnal dyspnea  Assessment Signs/Symptoms SOB at rest, Fatigue, pallor, dyspnea, peripheral edema, tachycardia, edema, changes in urine output, skin changes (pallor, dusky cyanosis, shiny w edema), mental status changes (decrease blood flow to the brain, chest pain, weight changes, orthopnea, nausea, weight changes, Diagnostic palpatations Testing Nursing Interventions Labs: elevated BNP Assess, evaluate labs, gather H&P, (Norm 180mmHg and/or diastolic BP >120mmHg Bedrest Blurred vision Cardiac, lung, neuro and renal assessment Chest pain Confusion Dyspnea Causes Headache Nausea/vomiting Acute aortic dissection Nosebleeds Drug use (cocaine, amphetamines) Seizures Exacerbation of chronic htn Head injury Monoamine oxidase inhibitors are taken w/tyramine- containing foods Pheochromocytoma Preeclampsia, eclampsia Interventions Rebound htn (from abrupt withdrawal of some antihtn drugs Obtain baseline VS, including O2 saturation Start continuous BP and ECG monitoring Ongoing Auscultate heart and breath sounds Monitor VS, LOC, heart and breath sounds, neurologic Insert IV function, heart rhythm, and O2 saturation Admin IV antihypertensives Titrate the drug according to MAP or SBP as ordered Obtain baseline blood work Assess and record response to drugs Give O2 per agency protocol Measure urine output hourly Maintain the pt on bedrest Provide reassurance and emotional support to pt and caregiver Explain all interventions to patient and caregiver