081-PP02L021 ELO B_Heart Failure and Pulmonary Edema _V 2.0_.pdf

DISORDERS OF THE HEART NP02L021 ELO B · Version 2.0 Heart Failure and Pulmonary Edema Foundations and Adult Health Nursing, 8th ed., pp. 1546-1555 Introduction to Critical Care Nursing, 8th ed., pp. 314-322 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the...

DISORDERS OF THE HEART NP02L021 ELO B · Version 2.0 Heart Failure and Pulmonary Edema Foundations and Adult Health Nursing, 8th ed., pp. 1546-1555 Introduction to Critical Care Nursing, 8th ed., pp. 314-322 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the heart without error. LEARNING STEP ACTIVITY Explain the etiology of heart failure and pulmonary edema. HEART FAILURE ETIOLOGY Circulatory congestion caused by the heart’s inability to pump effectively Heart's inability to pump sufficient blood to meet the body's metabolic needs Does not mean heart has stopped or is about to stop working Means heart is not able to pump blood the way it should Can affect one or both sides of the heart PATHOPHYSIOLOGY Pulmonary edema Peripheral edema Tiredness and shortness of breath Progression of heart failure is a result of the chronic release of the catecholamine The sympathetic nervous system responds CAUSES Congenital defects Diseases of that directly affect the heart and blood vessels: Atherosclerosis Arteriosclerosis Myocardial Infarction Diabetes Mellitus Hypertension Valvular heart disease Inflammatory heart disease Conditions that increase cardiac workload CLINICAL MANIFESTATIONS Decreased cardiac output Symptoms of either right or left sided heart failure When the vascular system becomes overloaded with fluid, cardiac output is reduced Edema in dependent areas One liter of fluids equal to 1kg (2.2 lbs.) LEFT VENTRICULAR HEART FAILURE ETIOLOGY Inability of left ventricle to effectively pump enough oxygenated blood to meet the demand of body tissues First signs & symptoms of left HF are related to decreased cardiac output Second consequence of left HF is pulmonary congestion Often occurs first because the left ventricle is most often affected by coronary atherosclerosis and hypertension If untreated, left ventricular failure progresses to right sided failure RIGHT VENTRICULAR HEART FAILURE ETIOLOGY Inability of right ventricle to effectively pump enough to meet the needs of body tissues Decreased pulmonary circulation Can be due to left sided heart failure: Chronic pulmonary disease (cor pumonale) Pulmonary hypertension Inability of the right ventricle to pump blood forward into the lungs Results in peripheral extremities ASSESSMENT SUBJECTIVE OBJECTIVE Activity intolerance Anxiety Increasing edema Restlessness Weight gain Confusion Ask how heart failure affects Oliguria activities of daily living Abnormal BUN/Cr Peripheral Edema Jugular vein distention DIAGNOSIS Diagnosis is made by patient symptoms and history Confirmation made with diagnostic tests Chest x-ray Electrocardiography (ECG) Echocardiography Exercise stress testing Cardiac catheterization Pulmonary artery catheterization Serum electrolytes Liver function tests BNP (B-type natriuretic peptide) MEDICAL MANAGEMENT Goal is directed toward reducing workload of heart Medications Digoxin Vasodilators Elevate head of bed to 45 degrees Provide rest and management of anxiety Placing biventricular pacemaker warranted in some cases NURSING INTERVENTIONS Monitor vital signs Assess for signs of respiratory distress or pulmonary edema Monitor urinary output Measure abdominal girth Daily weights Provide extra pillows for sleep Provide skin care if patient has edema PATIENT TEACHING Teach patient to: Recognize signs and symptoms of worsening heart failure Avoid fatigue and plan for rest periods with activity Dietary restrictions Medications that they will be taking at home Change positions slowly When to call the provider The importance of follow up visits About outside resources to manage coping with condition (Ex. cardiac rehabilitation program) PULMONARY EDEMA ETIOLOGY/PATHOPHYSIOLOGY The accumulation of extravascular fluid in the lungs and alveoli An acute, extensive, life-threatening complication CLINICAL MANIFESTATIONS Patient will exhibit signs of severe respiratory distress when the pulmonary edema occurs Frothy, blood-tinged sputum FWS- Frothy white secretions RBC- Red blood cell IE- Interstitial edema PULMONARY EDEMA Assessment: Like heart failure examination Subjective: Vague uneasiness Restlessness Agitation Objective: Disorientation, Diaphoresis, Severe Dyspnea, Tachypnea, Tachycardia, Pallor and cyanosis, Cough, productive with pink frothy sputum, Audible wheezes, Crackles, Cold extremities ASSESSMENT Subjective: Vague uneasiness, restlessness, agitation Objective: Disorientation, diaphoresis, severe dyspnea, tachypnea, tachycardia, pallor and cyanosis, cough, productive with pink frothy sputum, audible wheezes, crackles, cold extremities Note: Assessment findings are like the symptoms of heart failure. DIAGNOSTIC TESTS Chest radiograph Arterial blood gas MEDICAL MANAGEMENT Simultaneous treatment: Promote oxygenation Improve cardiac output Reduce pulmonary congestion Place patient in high Fowler’s position Morphine Sulfate 10-15 mg Oxygen 40-60% nonrebreather face mask Strict intake and output monitoring Foley catheter Medications Diuretics Inotropic drugs NURSING INTERVENTIONS Place patient in upright position with lower extremities lower than heart Assess pulmonary status Auscultate for adventitious lungs sounds Monitor vital signs Provide emotional support Administering oxygen effectively Assess for edema Monitor serum electrolyte levels Monitor digoxin levels Monitor renal and liver function NURSING IMPLICATIONS Monitor BP, HR and EKG Assess for further heart failure and digoxin toxicity Monitor serum electrolytes Maintain strict intake and output Patient Teaching: Advise patient to inform nurse immediately if chest pain; dyspnea; or numbness, tingling, or burning of extremities occurs. Instruct patient to notify nurse immediately of pain or discomfort at the site of administration. CHECK ON LEARNING A patient arrives in the emergency department with severe dyspnea, agitation, cyanosis, audible wheezes, and a cough with blood-tinged sputum. 1. What does the nurse anticipate this patient’s medical diagnosis will be? 2. What are the objective signs to support your answer? CHECK ON LEARNING A patient is discharging after a myocardial infarction. When providing home care considerations with regards to an exercise program the nurse should apply which statement? a. Encouragement to begin vigorous exercise the following day after discharge. b. Encouragement to begin a 2- to 12- week walking program. c. Encouragement to begin bedrest the following day after discharge. d. Encouragement to work through a program to achieve a pace above the prescribed rate set by the cardiologist. CHECK ON LEARNING A patient is on a low dose dobutamine drip for heart failure. She had been feeling “better” but now has a feeling of tightness in her chest, palpitations, as well as a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (previous HR was 86 per minute and BP 120/80 mm Hg). What is the nurse’s immediate concern for this patient? a. She is experiencing normal adverse effects of dobutamine therapy. b. She may be experiencing an allergic reaction to the dobutamine. c. The medication may be causing a worsening of a preexisting cardiac disorder. d. The dosage of the dobutamine should be increased to better control these symptoms. CHECK ON LEARNING Turn to page 1553 in Foundations and Adult Health Nursing, 8th Ed., “Nursing Care Plan 48.1.” Take 15 minutes to answer the critical thinking questions. Annotate the specific nursing interventions that you would perform and the scientific rationale behind why you would implement that intervention. CHECK ON LEARNING The nurse is caring for a patient who has right ventricular heart failure. After therapy, the nurse sees that the patient has lost 5 pounds of weight. Assuming that all the weight represents fluid loss, how much fluid has the patient lost? Why is this patient losing this fluid? REVIEW OF MAIN POINTS Heart Failure Pulmonary Edema QUESTIONS?