Chronic heart failure

Chronic heart failure Clinical manifestation Dependent on age, underlying type and extent of heart disease, and which ventricle is affected FACES Fatigue Limitation of Activities Chest congestion/cough Edema Shortness of breath Fatigue Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Tachycardia Edema Dependent, liver, abdominal cavity, lungs Edema may be pitting in nature Sudden weight gain of >3 […]

Acute Decompensated Heart Failure

Acute Decompensated Heart Failure Clinical manifestation ADHF Sudden onset of signs and symptoms of HF Requires urgent medical care Pulmonary and systemic congestion due to increased left-sided and right-sided filling pressures Early → increased pulmonary venous pressure Increase in the respiratory rate Decrease in PaO2 Later → interstitial edema Tachypnea Further progression → alveolar edema […]

Compensatory mechanism – Counterregulatory mechanism

Compensatory mechanism Renin-Angiotensin-Aldosterone-System (RAAS) Neurohormonal response – RAAS Endothelin release (contractility) Cytokine release (Hypertrophy) Inadequate stroke volume and CO –  (Epi and NoreEpi) Ventricular remodeling Continuous activation of neuro-hormonal responses (RAAS and SNS) Hypertrophy of ventricular myocytes Ventricles larger but less effective in pumping Can cause life-threatening dysrhythmias and sudden cardiac death Dilation Enlargement of […]

Pathophysiology : Systolic heart failure

Pathophysiology Systolic heart failure HFrEF – HF with reduced EF Inability to pump blood forward Caused by Impaired contractile function Increased afterload Cardiomyopathy Mechanical abnormalities Decreased LV ejection fraction (EF) Diastolic heart failure HFpEF – HF with preserved EF Impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume […]

Heart Disease : Gender differences

Gender differences Men Men experience systolic failure more frequently than women. Men with asymptomatic systolic failure experience greater mortality benefit from ACE inhibitor therapy than women. Women Women experience diastolic failure more frequently than men. Women have a higher risk of ACE inhibitor–related cough than men. Women experience more digitalis-related death than men. Women with […]

Heart Failure

Heart Failure Complex clinical syndrome resulting in insufficient blood supply/oxygen to tissues and organs Involves diastolic or systolic dysfunction Ejection fraction (EF) is amount of blood pumped by LV with each heart beat Associated with CVDs Increase in incidence and prevalence Most common cause for hospital admission in adults over age 65 Risk factors Primary […]

Role of Nursing Personnel

Role of Nursing Personnel Registered Nurse (RN) Pre-procedure Assess for allergies, especially to contrast dye. Perform baseline assessment, including vital signs, pulse oximetry, heart and breath sounds, neurovascular assessment of extremities (e.g., distal pulses, skin temperature, skin color, sensation). Assess baseline laboratory values (e.g., cardiac biomarkers, creatinine). Teach patient and caregiver about procedure and post-procedure […]

Sudden cardiac death

Sudden cardiac death Nursing/Interprofessional care Diagnostic workup to rule out or confirm MI Cardiac biomarkers ECGs Treat accordingly Cardiac catheterization PCI or CABG 24-hour Holter monitoring Exercise stress testing Signal-averaged ECG Electrophysiologic study (EPS) Implantable cardioverter-defibrillator (ICD) Antidysrhythmic drugs LifeVest

Coronary revascularization: PCI – Coronary revascularization: CABG

Coronary revascularization: PCI Monitor for recurrent angina Frequent VS, including cardiac rhythm Monitor catheter insertion site for bleeding Neurovascular assessment Bed rest per institutional policy Coronary revascularization: CABG ICU for first 24–36 hours Pulmonary artery catheter Intra-arterial line Pleural/mediastinal chest tubes Continuous ECG ET tube with mechanical ventilation Epicardial pacing wires Urinary catheter NG tube […]

Nursing diagnoses : Decreased cardiac output

Nursing diagnoses Decreased cardiac output related to altered contractility and altered heart rate and rhythm Acute pain related to an imbalance between myocardial O2 supply and demand Anxiety related to perceived or actual threat of death, pain, and/or possible lifestyle changes Activity intolerance related to general weakness secondary to decreased cardiac output and poor lung […]