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What is COPD? A RESPONSE Patients: typically greater than 45 years old. Respiratory symptoms include cough and TO ALTERED...

What is COPD? A RESPONSE Patients: typically greater than 45 years old. Respiratory symptoms include cough and TO ALTERED shortness of breath. Post-bronchodilator FEV1/FVC ratio < 0.7. RESPIRATORY History of cigarette smoking and/or exposure to other pollutants. FUNCTION A post bronchodilator ratio of FEV 1/FVC 65 years your doctor may recommend the following tests: Smoking AIDS Blood Tests: Used to confirm an infection Heart disease and try to identify the type of organism Diabetes causing the infection. However, precise Alcoholism identification isn't always possible. Asthma Chest X-ray: Helps your doctor diagnose COPD Bronchiectasis] pneumonia and determine the extent and Immunosuppressive disorders & therapy location of the infection. However, it can't tell Debility or stroke your doctor what kind of germ is causing the Coma pneumonia. Problems with swallowing Intravenous drug abuse Mena Victoria B. Conje - BSN4 - USJR  Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent RESPIRATORY PANDEMIC your lungs from moving enough oxygen into your bloodstream. Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough a mild to severe respiratory illness of and analyzed to help pinpoint the cause of the infection. sudden onset resulting from infection by an intluenza virus. Extremely contagious and spreads quickly Your doctor might order additional tests if you're to others. older than age 65, are in the hospital, or have Symptoms vary from person to person serious symptoms or health conditions. These may Occurs every year, usually in the fall and include: winter killing 36,000 people in U.S. CT scan. If your pneumonia isn't clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a SYMPTOMS more detailed image of your lungs. Pleural fluid culture. A fluid sample is Respiratory symptoms: taken by putting a needle between your ribs Sudden onset of: from the pleural area and analyzed to help cough determine the type of infection. sore throat difficulty breathing Fever TREATMENT Headache aching muscles Treatment for pneumonia involves curing weakness the infection and preventing complications. People Common Complications of Seasonal Flu who have community-acquired pneumonia usually Pneumonia can be treated at home with medication. Although Primary viral most symptoms ease in a few days or weeks, the Secondary bacterial feeling of tiredness can persist for a month or more Mixed viral and bacterial Specific treatments depend on the type and Exacerbation of existing disease severity of your pneumonia, your age and your Chronic pulmonary disease overall health. Cardiac conditions Less Common Complications The options include: Encephalopathy Antibiotics. Inese medicines are used to Myocarditis Pericarditis treat bacterial pneumonia. It may take time Myositis to identify the type of bacteria causing your Transverse myelitis pneumona and to choose the best antibiotic Reye's syndrome to treat it. If your symptoms don't improve, your doctor may recommend a difierent antibiotic. Cough medicine. This medicine may be used to calm your cough so that you can rest Because coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough completely. In addition, you should know that very few Home Treatment of the Flu studies have looked at whether Bed rest over-the-counter cough medicines lessen Hydration-with eight ounces of fluid every coughing caused by pneumoma. It you want hour to try a cough suppressant, use the lowest Acetaminophen, ibuprofen, naproxen dose that helps you rest. Avoid aspirin when dealing with children Fever reducers/ pain relievers. You may Seeking Medical Treatment for the Flu take these as needed for fever and Persistent fever discomfort. Productive cough Increasing difficulty breathing These include drugs such as aspirin, ibuprofen Improvement, followed by relapse (Advil, Motrin IB, others) and acetaminophen (Lylenol, others). Mena Victoria B. Conje - BSN4 - USJR  Symptoms are the same as the seasonal flu Will H5N1 become the next pandemic? PREVENTION Avian Flu not yet. Protecting Yourself: Pandemic Flu Yearly vaccinations current outbreaks of H5N1 Avian Flu in Wash your hands regularly poultry and birds are the largest ever Avoid touching eyes, nose and mouth documented Avoid close contact with sick people Issue of concern- some cases of H5N1 virus in other kinds of animals, such ag pigs and Protecting Others: tigers Some human cases of contraction Stay at home when sick Cover your cough Impossible to predict next pandemic flu event Everything that we have covered What is a Pandemic Flu? Epidemic: serious outbreak in a single community, population or region Pandemic: an epidemic spreading around the world affecting hundreds of thousands of people, across many countries Pandemic flu: a pandemic that results from an influenza virus strain that humans have not been previously exposed to Avian (Bird) Influenza An infection occurring naturally among birds caused by avian influenza viruses (e.g. H5N1 virus) Birds Wild birds worldwide carry the virus - usually without illness Domesticated birds - can become ill and die Humans Can become infected. Most cases from close contact with infected poultry. There have been a total of 32 isolated local clusters with human-to-human transmission 2007- Total cases of human infection=348 resulting in 216 deaths (50+% case fatality MEDICATIONS rate) During Pandemic Flu What is it? An infection occurring naturally among birds Antiviral Medications (example: HSN1) ➔ can prevent complications if taken within first 48 hours of illness Wild birds are natural carriers-Sometimes ➔ may not be effective against a without illness pandemic flu virus Can infect domesticated birds-often ➔ extremely limited supply now resulting in illness, culling, and death. ➔ would be prioritized Humans can become infected. ➔ initial use probably only for Most cases due to close contact. treatment, not prophylaxis What to Know About Bird Flu Antiviral Medications Amatadine (Symmetrel) Occurs in wild birds and can sproad to Rimantadine (Flumadine) livestock and poultry Zanamivir (Relenza) Transnission to humans is vyy re Oseltamivir (Tamiflu) Highly monitored because of its high mortality rate Mena Victoria B. Conje - BSN4 - USJR Infection Control - Our Basic Protection Risk factors include: Hand Hygiene A family history Wash hands regularly with soap & water Prior blood clots in the lungs If no water available: 60%-95% HIV /AIDS alcohol-based sanitizer Sickle cell disease Cover your cough strategy Cocaine use Environmental cleaning COPD 1:10 bleach solution Sleep apnea EPA registered disinfectant Living in high altitudes Gloves & surgical masks Problems with heart like mitral valve The underlying mechanism typically involves: PULMONARY Inflammation and subsequent remodeling of the arteries in the lungs HYPERTENSION MEDICATIONS for treatments: 1. Epoprostenol 2. Trepostinil 3. Lloprost 4. Bosentan 5. Amrisentan 6. Macitentan 7. Sildenafil Pulmonary hypertension (PH or PHTN) ➔ LUNG transplantation may be an option in severe cases is characterized by elevated pulmonary arterial pressure secondary right heart ventricular failure. is a condition of increased blood pressure in CLASSIFICATION the arteries of the lungs. Symptoms include: Group I Pulmonary arterial hypertension (РАН) Shortness of breath Fainting Group II Pulmonary hypertension secondary to left Tiredness heart disease Chest pain Right-sided abdominal pain Group III Pulmonary hypertension due to lung Poor appetite disease, chronic hypoxia Lightheadedness Cyanosis Group IV chronic arterial obstruction Swelling of legs fast heart beat Group V Pulmonary hypertension with unclear or multifactorial mechanism Less common signs/ symptoms include non-productive cough and exercise-induced nausea and vomiting In terms of the diagnosis of pulmonary hypertension, it has five major types, and a series The condition may make it difficult to exercise. of tests must be performed to distinguish Onset is typically gradual. pulmonary arterial hypertension from venous, hypoxic, thromboembolic, or unclear multifactorial A patient is deemed to have pulmonary varieties. PAH is diagnosed after exclusion of other hypertension if the pulmonary mean arterial possible causes of pulmonary hypertension. pressure is greater than 25mmHg at rest, or greater than 30mmHg during exercise. Physical examination A physical examination is performed to look for typical signs of pulmonary hypertension (described CAUSE AND RISKS above), and a detailed family history is established The cause is often unknown. Mena Victoria B. Conje - BSN4 - USJR to determine whether the disease might be patients are responsive to calcium channel blockers heritable. A history of exposure to drugs such in the long term as benfluores (a fenfluramine derivative), dasatinib, cocaine, methamphetamine, ethanol leading to cirrhosis, and tobacco leading to emphysema is LUNG CANCER. considered significant. Use of selective serotonin reuptake inhibitors during pregnancy (particularly Malignant tumor of the lung that may be late pregnancy) is associated with an increased risk primary or metastatic of the baby developing persistent pulmonary The lungs are a common target for hypertension of the newborn. metastasis from other organs Bronchiogenic carcinoma spreads through Echocardiography direct extension and lymphatic If pulmonary hypertension is suspected based on dissemination the above assessments, echocardiography is performed as the next step. A meta-analysis of Doppler echocardiography for predicting the results TYPES of right heart catheterization reported a sensitivity and specificity of 88% and 56%, respectively. Thus, The four major types of lung cancer includes: Doppler echocardiography can suggest the presence of pulmonary hypertension, but right heart 1. small cell (oat cell) catheterization (described below) remains the gold 2. epidermal (squamous cell) standard for diagnosis of PAH. Echocardiography 3. Adenocarcinoma can also help to detect congenital heart disease as 4. large anaplastic carcinoma a cause of pulmonary hypertension. Diagnosis is made by a chest x-ray, which will Signs of pulmonary hypertension: show a lesion or mass, and bronchoscopy and CT scan of the chest are: Enlargement of sputum studies, which will demonstrate a positive the pulmonary trunk (measured at its cytology for cancer cells bifurcation). It is, however, a poor predictor of pulmonary hypertension in patients with Lung Cancer interstitial lung disease Cancerous cells that form in the lining of the lungs It can be in one or both of the lungs TREATMENT Can form cancerous tumors which can spread Treatment of pulmonary hypertension is determined by whether the PH is arterial, venous, hypoxic, thromboembolic, or miscellaneous. LUNG CANCER STAGES If it is caused by left heart disease, the treatment is to optimize left ventricular function by the use of medication or to repair/replace the mitral valve or aortic valve. Patients with left heart failure or hyposemic lung diseases (groups lI or Ill pulmonary hypertension) should not routinely be treated with vasoactive agents including prostanoids, phosphodiesterase inhibitors, or endothelin antagonists, as these are approved for the different condition called primary pulmonary arterial CAUSES hypertension. Cigarette smoking To make the distinction, doctors at a minimum will Exposure to environmental pollutants conduct cardiac catheterization of the right heart, Exposure to occupational pollutants echocardiography, chest CT, a six-minute walk test, and pulmonary function testing. Using treatments for other kinds of pulmonary hypertension in ASSESSMENT patients with these conditions can harm the patient and wastes substantial medical resources. Cough Dyspned High dose calcium channel blockers are useful in Hoarseness only 5% of IPAH (Idiopathic pulmonary arterial Hemoptysis hypertension) patients who are vasoreactive by Chest pain Swan-Ganz catheter. Of these, only half of the Anorexia and weight loss Weakness Mena Victoria B. Conje - BSN4 - USJR  Postoperative implementation DIAGNOSIS TEST Monitor vital signs CT scan Assess cardiac and respiratory status; Chest X-ray monitor for the absence and presence of Magnetic Resonance Imaging lung sounds PET scan Maintain chest tube drainage system, which Bone scan will drain air and/or blood that accumulates Sputum cytology in the pleural space Needle biopsy assess chest tube insertion site for crepitus (subcutaneous air) and drainage Administer oxygen as prescribed Check physician's orders regarding client IMPLEMENTATION positioning; complete lateral tuming avoided Monitor vital signs Monitor breathing pattern and breath sounds and for signs of respiratory impairment assess for tracheal deviation Administer analgesics as prescribed for pain management Place in Fowler's position for ease in breathing Administer oxygen as prescribed and humidification to moisten and loosen secretions Nonsurgical implementation Radiation therapy for localized intrathoracic lung cancers and for palliation of hemoptysis, obstructions, dysphagia, and pain Chemotherapy Immunotherapy directed at enhancing ar effective immune response, which favorably affects the course of the disease Surgical Implementation Laser therapy - to relieve endobronchial obstruction Thoracentesis and pleurodesis - to remove pleural fluid and relieve hypoxia Thoracotomy with lobectomy - Surgical removal of one lobe of the lung for tumors confined to a single lobe Thoracotomy with pneumonectomy : Surgical removal of the lung Thoracotomy with segmented resection: surgical removal of a lobe segment for clients unable to tolerate lobectomy or pneumonectomy Mena Victoria B. Conje - BSN4 - USJR  A RESPONSE ACUTE ISCHEMIC TO ALTERED TISSUE HEART DISEASE Coronary heart disease and PERFUSION coronary artery disease are more common names for Conditions Related to Altered Tissue Perfusion ischemic heart disease. ACUTE ISCHEMIC HEART DISEASE HEART FAILURE is chest pain or discomfort CARDIOGENIC SHOCK that recurs when part of the HYPERTENSICE CRISIS heart muscle does not CARDIOMYOPATHY receive enough blood. ARRHYMIAS "Ischemic" means a body part is not getting HEART enough blood flow and, thus, oxygen. Plaque buildup on the walls of the coronary arteries causes ischemic heart disease. Symptoms of ischemic heart disease occur more often during periods of excitement or physical exertion but can also occur suddenly and without warning. According to the Centers for Disease Control and Prevention (CDC), ischemic heart disease is the most common form of heart disease in is a hollow muscular organ in the space the United States. It is also the leading cause between the lungs and the diaphragm of heart attack. called mediastinum. weighs approximately 300 g or 10.6 oz This disease most often occurs when pumps blood to the tissues, supplying cholesterol particles in the blood build up on them with oxygen and other nutrients. the walls of the arteries that supply blood to the has 3 layers heart muscle. Eventually, deposits called inner layer or endocardium plaques may form. These plaques are a result middle layer or myocardium of inflammation. exterior layer or epicardium the heart is encased in a thin, fibrous These deposits cause the arteries to narrow. sac called the pericardium. This narrowing can block the flow of blood. This reduces the amount of oxygenated blood The space between 2 layers ( pericardial reaching the heart muscle. This process is space) is normally filled with about 20 ml of called atherosclerosis. fluid- which lubricates the surface of the heart and reduces friction during systole. Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. What does "ischemic" mean? "Ischemic" means that is not getting enough blood flow and, because of this, not enough oxygen will be supplied. When this happens to the heart, it is called ischemic heart disease. This disease is also known as coronary heart disease and coronary artery disease. Mena Victoria B. Conje - BSN4 - USJR If you have ischemic heart disease, you may have chest pain or discomfort during exertion Serious symptoms that or excitement. These are times when the heart might indicate a life requires greater blood flow. threatening condition "Angina" the name for this type of chest pain. Ischemic heart disease can The signs and symptoms of this disease may cause a heart attack. Seek develop slowly as plaques gradually block the immediate medical care arteries. However, sometimes the symptoms (call 911) for any of these arise quickly if an artery suddenly becomes serious symptoms, including: blocked. chest pain or pressure, typically on the Some people with ischemic heart disease have left side of the body, which may radiate no symptoms at all. This is called "silent to the jaw, neck, shoulder, or arm ischemia." clammy skin nausea with or without vomiting A heart attack can be the first sign of a problem rapid breathing or shortness of breath for someone who has schemia. Other people dizziness or near fainting may first have severe chest pain and shortness of breath. Lifestyle changes, medications, and sometimes surgery can successfully treat ischemic heart disease. You can reduce your risk of this disease by following heart-healthy practices. This includes eating a low-fat, low-sodium diet, being physically active, not smoking, and maintaining a moderate body weight. CAUSES SYMPTOMS In ischemic heart disease, narrowing Ischemic heart disease decreases the amount coronary arteries reduce the amount of of blood flowing through the coronary arteries. oxygenated blood flowing to the heart muscle. These arteries carry oxygen-rich blood to the Without enough blood flow, the heart muscle heart muscle. does not receive the amount of oxygen it needs to function properly. Reduced blood and oxygen to the heart can cause varying symptoms. Symptoms can differ Ischemic heart disease occurs most often in from person to person. people who have atherosclerosis. This is a buildup of plaque on the walls of the coronary When symptoms occur, common symptoms arteries. However, the reduced blood supply include can also be due to blood clots, coronary artery chest pain spasms, or severe illnesses that increase the chest pressure heart's need for oxygen. shortness of breath may feel as if pain, pressure, heaviness, or tightness starting in the chest is spreading to the arms, back, or other areas may feel like gas or indigestion occur repeatedly in similar episodes occur when the heart must work harder, usually during physical esertion subside with rest or medicine usually last a short time, about 5 minutes or less Mena Victoria B. Conje - BSN4 - USJR  statins, which lower cholesterol RISK FACTORS A number of factors increase the risk of PROCEDURES developing ischemic heart disease. Not all people with risk factors will get ischemic heart Procedures to treat ischemic heart disease disease. If medicines alone are not enough to relieve severe symptoms, your doctor may Risk factors for ischemic heart disease include: recommend: Diabetes family history of heart disease 1. Coronary angioplasty high cholesterol or triglycerides 2. Stent placement procedure high blood pressure 3. Coronary artery bypass graft (CABG) obesity 4. Surgery. physical inactivity smoking and other tobacco use sleep apnea A coronary angioplasty is a procedure used to widen blocked or Reducing risk of ischemic heart disease narrowed coronary arteries (the main You may be able to lower your risk of ischemic blood vessels supplying the heart). heart disease by: The term "angioplasty" means using a carefully managing your diabetes if you balloon to stretch open a narrowed or have the condition blocked artery. getting regular physical activity keeping your cholesterol below the target level maintaining normal blood pressure quitting smoking and other tobacco use reducing the amount of cholesterol and fat in your diet TREATMENT This section discusses medications and procedures that treat ischemic heart disease as well as lifestyle changes that can improve this condition. Medications to treat ischemic heart disease Stent placement is a catheter-based procedure to remove plaque and restore Drug therapy is a common treatment for blood flow in clogged arteries. ischemic heart disease and includes: angiotensin-converting enzyme CABG is a surgery that helps restore inhibitors, which lower blood pressure blood flow to the heart by routing blood and relax blood vessels flow through transplanted arteries. angiotensin receptor blockers, which lower blood pressure and relax blood What you can do to improve your ischemic vessels heart disease anti-ischemic agents, such as ranolazine (Ranexa) In addition to medicines and antiplatelet drugs, which prevent blood procedures, you may be able to improve your clots from forming ischemic heart disease with lifestyle changes. beta-blockers, which lower the heart These are the same healthy habits that may rate help reduce the risk of ischemic heart disease. calcium channel blockers, which reduce workload on the heart muscle nitrates, which dilate the blood vessels Mena Victoria B. Conje - BSN4 - USJR  However, the heart failure may also cause by other disorders. COMPLICATIONS The causes of heart failure can be Possible complications of ischemic heart divided into three groups: disease include: Abnormal loading conditions arrhythmia, which is an irregular heart Abnormal muscle function rhythm Conditions or diseases that limit chronic angina ventricular filling congestive heart failure recurrent heart attack 1. Abnormal loading conditions is HEART FAILURE (CHF) associated with any condition that Heart Failure, also known as consertive increases either the pressure or the heart failure, is a significant cardiac functional volume load of the ventricle. The effects disorder that can result in reduced oxygen of increasing volume on the ventricle delivery to the body's organs and tissues. can be explained by the analogy that the It can affect both men and women heart muscle is like a rubber band. although it occurs more often than men with a When the rubber band is stretched, it poorer prognosis. contracts with more force. The heart The term heart failure indicates muscle does the same. myocardial disease in which there is a Preload - refers to the stretch of the problem with contraction of the heart (systole ventricular myocardial fibers before dysfunction) or filling of the heart (distole ventricular contraction. It is determined dysfunction) that may or may not cause by the condition of the heart valves, pulmonary or systemic congestion. especially mitral valve, blood volume, Heart failure is not a disease itself, ventricular wall and venous tone. instead a term refers to clinical syndrome characterized by manifestations of volume Conditions that increase preload: overload, inadequate tissue perfusion and poor exercise tolerance 1. Regurgitation of mitral or tricuspid valve 2. Hypervolemia ETIOLOGY AND RISK FACTORS: 3. Congenital heart defects 4. Ventricular septal defect The performance of the heart depends on four 5. Atrial septal defect essential components: 6. Patent ductus arteriosus 7. 1. Contractility (inotropic state) of the Preload = volume of blood received by heart the heart. Basically, preload is stretch. 2. Preload (amount of blood in the ventricle at the end of the diastole) Afterload = pressure or resistance the 3. Afterload (the pressure against which heart has to overcome to eject blood. the left ventricles ejects) Afterload is squeeze. 4. Heart rate Terms used to describe cardiac function 2. Abnormal muscle function is a certain Terms Function conditions interfere with myocardial force that the ventricle must develop contractility and effect the inherent Afterload during systole in under to eject the contractility of cardine muscle: stroke volume 1. MI Cardiac Stroke volume X heart rate 2. Myocarditis- inflammation of output the myocardium Inotropic A measure of contractility 3. Cardiomyopathy-diseases of state the heart muscles Stroke the amount of blood ejected from the 4. Ventricular aneurysm volume ventricle with each contraction these disorder impair the contractile function of the myocardial fibrils (small fibers) which Mena Victoria B. Conje - BSN4 - USJR reduces ventricular emptying and stroke ➔ Increase venous pressure leads to JVD volume. and increase capillary hydrostatic pressure throughout the venous system. 3. Conditions that precipitate heart failure. The American College of Cardiology and American Heart Association have heart failure can be precipitated by: clarification of heart failure. conditions that increase cardiac and systemic oxygen demand, Stage A. Patients at high risk for reduce the ability of the heart to contract developing left ventricular dysfunction or increase the workload of the heart. but without structural heart. disease or symptoms of heart failure. Conditions that increase demand for oxygen delivery include: Stage B. Patients with left ventricular dysfunction or structural heart disease 1. Physical or emotional stress that has not developed symptoms of 2. Dysthythmia heart failure. 3. Infection 4. Anemia Stage C. Patients with left ventricular 5. Thyroid disorders dysfunction or structural heart disease 6. Pregnancy with current or prior symptoms of heart failure. Piaget disease - Thiamine deficiency can precipitate heart failure because it reduces Stage D. Patients with refractory myocardial contractility, causing tachycardia end-stage heart failure requiring and ventricular dilatation specialized interventions CLASSIFICATION PATHOPHYSIOLOGY Heart failure is classified into two types: left-sided heart failure and right-sided heart Heart failure results from a variety of failure. cardiovascular conditions, including chronic hypertension, coronary artery disease, and Left-Sided Heart Failure valvular disease. ➔ Left-sided heart failure or left ventricular As HF develops, the body activates failure have different manifestations with neurohormonal compensatory mechanisms: right-sided heart failure. Systolic HF results in decreased blood volume ➔ being ejected from the ventricle. ➔ Pulmonary congestion occurs when The sympathetic nervous system is then the left ventricle cannot effectively pump stimulated to release epinephrine and blood out of the ventricle into the norta norepinephrine. Decrease in renal perfusion and the systemic circulation. causes renin release, and then promotes the ➔ Pulmonary venous blood volume and formation of angiotensin I. pressure increase, forcing fluid from Angiotensin I is converted into the pulmonary capillaries into the angiotensin II by ACE which constricts the pulmonary tissues and alveoli, causing blood vessels and stimulates aldosterone pulmonary interstitial edema and release that causes sodium and fluid retention. impaired gas exchange There is a reduction in the contractility of the muscle fibers of the heart as the workload Right-Sided Heart Failure increases. ➔ When the right ventricle fails, congestion in the peripheral tissues and the viscera ➔ Compensation: The heart predominates. compensates for the increased workload ➔ The right side of the heart cannot eject by increasing the thickness of the heart blood and cannot accommodate all the muscle blood that normally returns to it from the Causes: Systemic diseases are venous circulation. usually one of the most common causes of heart failure. Mena Victoria B. Conje - BSN4 - USJR  Coronary artery disease. Atherosclerosis of the coronary arteries is the primary cause of HF, and PREVENTION coronary artery disease is found in more than 60% of the patients with HF. Prevention of heart failure mainly lies in Ischemia. Ischemia deprives heart cells lifestyle management of oxygen and leads to acidosis from Healthy diet, Avoiding intake of fatty the accumulation of lactic acid. and salty foods greatly improves the Cardiomyopathy. HF due to cardiovascular health of an individual cardiomyopathy is usually chronic and Engaging in cardiovascular exercises progressive. thrice a week could keep the Systemic or pulmonary hypertension. cardiovascular system up and running Increase in afterload results from smoothly hypertension, which increases the workload of the heart and leads to Smoking cessation. Nicotine causes hypertrophy of myocardial muscle fibers vasoconstriction that increases the pressure Valvular heart disease. Blood has along the vessels. increasing difficulty moving forward, increasing pressure within the heart and increasing cardiac workload. CONGESTIVE CLASSIFICATION HEART FAILURE RIGHT-SIDED HEART FAILURE The clinical manifestations produced y the different types of HF are similar and Occurs if the heart can't pump enough therefore do not assist in differentiating the blood to the lungs to pick up oxygen. types of HF. The signs and symptoms can be Failure of the right ventricle may occur related to the ventricle affected. in response to left-sided CHF or as a result of pulmonary embolism. Left-sided HF Right ventricular failure results in Dyspnea or shortness of breath may peripheral edema and venous be precipitated by minimal to moderate congestion of the organs. activity. Cough. The cough associated with left LEFT-SIDED HEART FAILURE ventricular failure is initially dry and Left-side heart failure occurs if the heart nonproductive. can't pump enough oxygen-rich blood to Pulmonary crackles. Bibasilar the rest of the body. crackles are detected earlier and as it Failure of the left ventricle causes either worsens, crackles can be auscultated pulmonary congestion or a disturbance across all lung fields. in the respiratory control mechanisms. Low oxygen saturation levels. Oxygen These problems in turn precipitate saturation may decrease because of respiratory distress. The degree of increased pulmonary pressures. distress varies with the client's position, activity, and level of stress. Right-sided HF Enlargement of the liver result from venous engorgement of the liver. Accumulation of Fluid in the peritoneal COMPLICATIONS cavity may increase pressure on the Many potential problems associated with HF stomach and intestines and cause therapy relate to the use of diuretics gastrointestinal distress. Loss of appetite results from venous Hypokalemia. Excessive and repeated engorgement and venous stasis within diuresis can lead to hypokalemia. the abdominal organs. Hyperkalemia. Hyperkalemia may occur with the use of ACE inhibitors, ARBe, or spironolactone. Mena Victoria B. Conje - BSN4 - USJR  Prolonged diuretic therapy might lead to myocardial ischemia/detecting viable hyponatremia and result in myocardium. disorientation. Fatigue, apprehension, weakness and muscle cramps. Cardiac catheterization: Abnormal Dehydration and hypotension. Volume pressures are indicative and help depletion from excessive fluid loss may differentiate right- versus left-sided heart lead to dehydration and hypotension. failure, as well as valve stenosis or insulficiency. Also assesses patency of coronary arteries Contrast injected into the ventricles reveals abnormal site and ASSESSMENT AND ejection fraction/altered contractility. DIAGNOSTIC FINDINGS Transvenous endomyocardial biopsy HF may go undetected until the patient may be useful in some patients to presents with signs and symptoms of determine the underlying disorder, which pulmonary and peripheral edema as myocarditis or amyloidosis. ECG: Ventricular or atrial hypertrophy, Liver enzymes: Elevated in liver axis deviation, ischemia, and damage congestion/ failure patter may be present Dysrhythmias, e g, tachycardia, atrial fibrillation, Digoxin and other cardiac drug levels: conduction delays, especially left bundle Determine therapeutic range and branch block frequent premature correlate with patients response ventricular contractions (PVCs) may be present. Persistent ST-T segment Bleeding and clotting times: abnormalities and decrease QRS Determine therapeutic range, identify amplitude maybe present. those at risk for excessive clot formation. Chest Xray: May show enlarged cardiac shadow, reflecting chamber Electrolytes: May be altered because dilation/hypertrophy, or changes in blood of fluid shifts/decreased renal function, vessels, reflecting increased pulmonary diuretic therapy. pressure. Abnormal contour, e.g., bulging of left cardiac border, may Pulse oximetry: Oxygen saturation may suggest ventricular aneurysm. be low, especially when acute HF is imposed on chronic obstruction Bonograms( echocardiography, pulmonary disease(COPD) or chronic Doppler and transesophageal HF. echocardiography): May reveal an enlarged chamber dimensions, Arterial blood gases (ABG): Left alterations in valvular function/structure, ventricular failure is characterized by the degrees of ventricular dilation and mild respiratory alkalosis (early) or dysfunction. hypoxemia with an increased Pco2 (late). Heart Scan: (multi-gated acquisition (MUGA]: Measures cardiac volume BUN/creatinine: Elevated BUN during both systole and diastole, suggested decreased renal perfusion. measures ejection fraction, and Elevation of both BUN and creatinine is estimates wall motion. indicative of renal failure. Exercise or pharmacological stress Serum albumin/transferrin: May be myocardial perfusion ( Persantine or decreased as a result of reduced protein Thallium scan)Determine Presence of intake or reduced protein synthesis in myocardial ischemia and wall motion congested liver. abnormalities. Complete blood count (CBC): May Positron emission tomography (PST) reveal anemia, polycythemia, or dilution scan: Sensitive test for evaluation of changes indicating water retention. Levels of white blood cells (WBCs) may Mena Victoria B. Conje - BSN4 - USJR  be elevated. reflecting recent/acute MI, pericarditis, or other inflammatory or infectious states. ESR: May be elevated, indicating acute inflammatory reaction. Thyroid studies: Increased thyroid activity suggests thyroid hyperactivity as precipitator of HF. NURSIMG MANAGEMENT Despite advances in the treatment of HIP, morbidity and mortality remain high. Nurses hare a major impact on outcomes for patients with HF. NURSIMG ASSESSMENT The nursing assessment for the patient with HF focuses on observing for the effectiveness of therapy and for the patient's ability to understand and implement self-management strategies. Health History : ➔ Asses the signs and symptom such as dyspnea, shortness of breath, fatigue, edema. ➔ Assess for sleep disturbances, specially sleep suddenly interrupted by shortness of breath ➔ Explore the patient's understanding of HF, self management strategies, and the ability and willingness to adhere to those strategies Physical Examination ➔ Auscultate the lungs for presence of crackles and wheezes ➔ Auscultate the heart for the presence of an S3 heart sound. ➔ Assess JVD for presence of distention. ➔ Evaluate the sensoriums and level of consciousness. ➔ Assess the dependent parts of the patient's body for perfusion and edema. ➔ Assess the liver for hepatojugular reflux. ➔ Measure the urinary output carefully to establish a baseline against which to assess the effectiveness of diuretic therapy. ➔ Weigh the patient daily in the hospital or at home Mena Victoria B. Conje - BSN4 - USJR