Heart Failure and Mech Assist Devices student Notes 472 24 25.docx

**Xavier University** **College of Nursing** **NURS 472** **[Care of Patients with Heart Failure and Mechanical Assist Devices]** **[Heart Failure]:** a clinical syndrome (has other things that contribute to HF causes) due to structural/functional [impairment of the ventricle that impairs its ab...

**Xavier University** **College of Nursing** **NURS 472** **[Care of Patients with Heart Failure and Mechanical Assist Devices]** **[Heart Failure]:** a clinical syndrome (has other things that contribute to HF causes) due to structural/functional [impairment of the ventricle that impairs its ability to pump blood or fill effectively ] -High prevalence in the United States -High mortality -Important risk factors: HTN, DM, atherosclerosis **Heart Failure Classifications** **-Acute vs. Chronic HF *(describe both onset and severity of HF sx/ symptoms)*** -Acute HF occurs over days to hours & immediate/ emergent intervention is necessary -Can transition to chronic HF if acute HF causative factor can be resolved -Chronic HF occurs over months to years, pt lives with baseline sx -Periods of compensation (sx improve/ resolve) -Acute decompensation is possible**[acute decompensated HF (ADHF)]** **-Left vs. Right HF** -Left-sided HF = failure of the left ventricle to fill or empty properly -HFrEF = EF \< 40% -poor pumping causes ventricle to not empty =\> decreased CO -HFpEF = EF \> 50 % -impaired relaxation & filling of ventricles =\> Decreased CO -Right-sided HF = failure of the right ventricular to pump adequately -NYHA Functional Classification: classifies HF based on how symptoms impair the patient's activity -Class I (no limitation) to Class IV (symptoms present event at rest) -ACC/AHA stages: A through D -NYHA Functional classes only apply to ACC/AHA Stages C and D -Regardless of the type of HF, there is insufficient \_\_\_cardiac output\_\_\_ **[Causes of HF: ]** (Increased demand overall, structural defects) -Anatomic or functional abnormalities of the coronary vessels, myocardium, or cardiac values *Ex- ischemic heart disease, MI, valvular heart disease* -We will focus primarily on **ADHF and also discuss Chronic HF** **[Assessment of Patients with HF]** ***Presentation can vary depending on the type of HF*** **-History:** Symptoms may be nonspecific and include orthopnea, DOE, PND (paroxysmal nocturnal dyspnea), dizziness/lightheadedness, chest pain/pressure -Co-morbid diseases -atherosclerosis, diabetes/ DM, hypertension, CAD, COPD -Medications -CCB for HTN -\> depress myocardial function can decrease EF & worsen HF sx -Psychosocial issues and Substance abuse: drugs---such as alcohol and cocaine -cognotive decline; financial hardships; unreliable transportation; isolation/ depression **-Physical Exam:** General---often ill appearing -VS: variable -CV Exam: -Heart: -Abdomen: -Extremities: edema, typically bilateral, dependent, pitting **-Relevant labs:** -CBC: assess for anemia or infection -Iron studies: anemia workup -Thyroid function tests: rule out as cause -Electrolytes: assess effects of diuresis, in particular \_potassium level (Mag & Na also)\_\_\_\_ -important to get a baseline -*Pts with HF might also have hyponatremia on presentation* -BUN and creatinine: renal function -BNP: elevation indicates elevated PAOP -LFTs -Lipid panel **-Relevant Diagnostics** ***Used to establish baseline, identify potential reversible etiologies, evaluate effectivness of treatment & assess changes in condition*** -ECG: dysrhythmias (AF, ventricular, PVCs), conduction deficits (bundle branch blocks), diagnosis of ischemia and MI -ECHO (TTE or TEE) -CXR -Others: MUGA, exercise testing **-Hemodynamics:** not routine due to risks -Indications: -Patient not responding to therapy for HF -Complex fluid status -Pulse oximetry monitoring **[Management of Acute Decompensation of Heart Failure (ADHF)]** -**A**irway, **B**reathing, **C**irculation **-Airway and Breathing** -**[Diuresis:]** IV diuretics to reduce pulmonary edema -Monitor weights; I/O; Electrolytes -Other diuretics: -Adjuncts to diuretics: vasopressin receptor antagonists (Tolvaptan) -Evaluation: **-Circulation:** **-**Determine adequacy of perfusion to organ systems: **-brain- confusion change in LOC** **-kidneys; increased BUN/ creatine** **-GI; ileus & liver failure** (Don't spend bunch of time on this one) **-Patients with [Decreased] Preload:** usually related to \_\_excessive volume removal \_\_\_\_ **-Increase Contractility:** -Inotropes---drugs that directly increase \_\_\_contractility\_\_\_\_ -Choice of inotrope depends on patient situation -Optimizing Heart Rate and Rhythm: necessary for adequate CO **-Mechanical Support for ADHF:** IABP and LVAD  -**Intra-aortic Balloon Pump (IABP)** Counterpulsation TEMPORARY ballon pump Goal help improve cardiac output -Monitoring: -**Ventricular Assist Devices** (i.e. LVADs) -Education needs **Care of Patients with Chronic HF** -Pharmacological Therapy: -Includes (see pharm packet for more information): -ACE or ARB -Alternatively: -Non-Pharm therapy: -Implantable cardioverter--defibrillator: for syncopal episodes or survivor of sudden death -Biventricular pacing (CRT): For patients with reduced EF and prolonged QRS -Self-Care -Sodium restriction: refer to recent guidelines -fluid restriction: see guidelines -alcohol cessation -Exercise -medication adherence: Barriers? -Monitor weight -Patient Education: what to include? -See sample d/c instructions on canvas and in textbook