Heart Failure Nursing Management PDF

Learning Outcomes 1. Demonstrate an in-depth understanding of the pathophysiology of alterations in oxygenation, perfusion, related to the complex cardiac conditions 2. Explain methods and techniques used to conduct a comprehensive nursing history and focused physical assessment, using a syst...

Learning Outcomes 1. Demonstrate an in-depth understanding of the pathophysiology of alterations in oxygenation, perfusion, related to the complex cardiac conditions 2. Explain methods and techniques used to conduct a comprehensive nursing history and focused physical assessment, using a systematic primary and secondary survey approach; 3. Identify and analyse diagnostic tests and investigations appropriate to diagnose health problems, related to the cardiovascular system. 4. Recognize the clinical cues for patient deterioration. 5. Apply a critical analysis of assessment findings and an in-depth understanding of clinical reasoning cycle to develop a therapeutic plan of care for patients experiencing a range of health problems. 6. Outline the collaborative management strategies for patients in the acute care setting and the role of the registered nurse within the team. 7. Examine a range of pharmacological agents used to treat health problems and the impact of polypharmacy on nursing care. OFFICI Anatomy of the heart OFFICI OFFICI  Cardiac output (CO): amount of Revision blood pumped by each ventricle in 1 minute Normal 4 to 8 L/min ⮚ CO = SV x HR Stroke volume (SV) : amount of blood ejected from the ventricle with each heartbeat Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI OFFICI OFFICI  https://youtu.be/GjqqEJEci 00 (video-7mins) OFFICI  Heart failure (HF) is an abnormal clinical syndrome that involves inadequate pumping and/or filling of the heart. ​ What is inability of the heart to provide sufficient blood to meet the oxygen needs of the tissues. ​ heart Acute or chronic failure? RISK FACTORS Primary causes—conditions that directly damage the heart​ Precipitating causes - increase the workload of the ventricles  Results in a reduction to Cardiac Output (CO) OFFICI Pathophysiology of heart failure Systolic HF inability to pump blood effectively Diastolic HF inability for ventricles to relax and fill Left, Right or Biventricular Heart Failure All result in reduced CO = low BP, poor renal perfusion OFFICI OFFICI Compensatory mechanisms Sympathetic nervous system Neurohormonal responses (Continuous activation RAAS) Ventricular dilation Ventricular hypertrophy Results in Ventricular remodeling https://youtu.be/x8aBKMYqGPY Compensated and decompensated heart failure- 7.5mins) OFFICI Dilated and hypertrophied heart chambers compared Fig. 35-1. A, Dilated heart chambers. B, Hypertrophied heart chambers. Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI Elsevier Australia, 2020 Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Pleural effusion Heart Dysrhythmias—atrial and failure— ventricular Complicati Left ventricular thrombus ons Hepatomegaly Renal failure OFFICI  Acute decompensated heart failure (ADHF)—Signs and symptoms Left ventricular Failure (LVF) increased pulmonary venous pressure→ interstitial oedema→ alveolar oedema ⮚ Anxious, pale, cyanotic ⮚ Cool, clammy skin ⮚ Dyspnoea ⮚ Orthopnoea ⮚ Tachypnoea ⮚ Use of accessory muscles ⮚ Cough with frothy, blood-tinged sputum ⮚ Crackles, wheezes, rhonchi ⮚ Tachycardia ⮚ Hypotension or hypertension Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI Elsevier Australia, 2020 Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Left-sided heart failure ⬤Most common form ⬤Results from left ventricular dysfunction ⬤Blood backs up into left atrium and pulmonary veins ⬤Increased pulmonary pressure causes fluid leakage → pulmonary congestion and oedema OFFICI OFFICI Elsevier Australia, 2020 Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Right-sided heart failure ⬤Right ventricular dysfunction ⬤Blood backs up into the right atrium and venous circulation ⮚ Jugular venous distension ⮚ Hepatomegaly, splenomegaly ⮚ Vascular congestion of GI tract ⮚ Peripheral oedema ⬤Most commonly caused by left-sided HF ⬤RV infarction & PE OFFICI OFFICI Right heart failure clinical manifestations OFFICI Let’s take a break OFFICI  Nursing Management of Heart Failure NSG2201, Week 9 Virginia Plummer OFFICI Nursing Assessment- Heart Failure SUBJECTIVE: Past medical history Medications Function Health Patterns OBJECTIVE Priority cardiovascular and respiratory system Full body systems assessment OFFICI Elsevier Australia, 2020 Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Chronic Fatigue heart Dyspnoea failure— Orthopnoea, Paroxysmal nocturnal dyspnoea, Cough clinical Tachycardia manifestati Oedema ons Weight changes Sudden weight gain of >1.4 kg in 2 days can indicate exacerbation of chronic HF (ADHF) Nocturia Skin changes, Behavioral changes, LOA Chest pain OFFICI  Goal: determine and treat Heart underlying cause failure— History and physical examination Diagnos Endomyocardial biopsy Echocardiography (Ejection tic fraction %) Chest X-ray studies ECG, stress testing Cardiac catheterisation Laboratory studies ABGs Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI Interprofessional care—Chronic HF Oxygen therapy Medication therapy Physical and emotional rest Structured exercise program Low-sodium diet If fluid restriction is required, < 2 L/day. Daily weights Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI Elsevier Australia, 2020 Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Health promotion Basic principles of Interprofessio care nal care — Use of self-management Chronic HF tools for symptom management Restrict salt (and water at times) Conserve energy OFFICI Heart Failure Treatment- early stages https://youtu.be/PJgRZA5mE0s (4mins 25sec) OFFICI Elsevier Australia, 2020 Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © RAAS inhibitors ACE inhibitors Angiotensin II receptor blockers Heart Aldosterone antagonists Failure— β-adrenergic blockers Medicatio Vasodilators n therapy Nitrates, Hydralazine Diuretics Positive inotropic agents Digitalis (be alert for digitalis toxicity) OFFICI Elsevier Australia, 2020 Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © ⬤Signs and symptoms of HF exacerbations ⬤Medication therapy Patient ⬤Dietary therapy Daily weight teaching— Limit sodium Chronic HF ⬤Activity/rest ⬤Home health nurses can be essential ⬤Can use electronic or telehealth monitoring OFFICI Valvular heart disease (VHD) What is /valvular heart disaese? Heart has: Two atrioventricular valves (mitral and tricuspid) Two semilunar values (aortic and pulmonary) These control unidirectional blood flow Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI Valve disorders Stenosis (constriction/narrowing) Forward blood flow is impeded Regurgitation (incompetence/insufficiency) Incomplete closure of valve leaflets Results in backward flow of blood Aortic stenosis (AS) and mitral regurgitation (MR) common in older adults OFFICI  Valvular stenosis and regurgitati on Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI Nursing assessment—Valvular disorders Past health history Clincal manifestations will depend on valve and disorder Palpitations, weakness, activity intolerance, dizziness, fainting Cough, haemoptysis, orthopnoea Angina or atypical chest pain Heart murmur Refer to Chater 35, Lewis's Medical Surgical Nursing text Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI Diagnostic studies— Valvular heart disease Patient’s history/physical exam Echocardiogram CT scan of chest Chest X-ray ECG Cardiac catheterisation Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI  Conservative management Medications to treat/control HF Interprofessi Anticoagulation therapy onal care— &Antiarrhythmia medications Percutaneous transluminal Valvular balloon valvuloplasty (PTBV) heart disease Surgical therapy Valve repair Valve replacement Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICI Sudden Cardiac Death- unexpected death from cardiac cause within 1 hour of symptom onset OFFICI THE END OFFICI