1. List the risk factors for chronic left-sided heart failure related to
coronary artery disease.
The risk factors are hypertension, diabetes, elevated lipids, tobacco use, and obesity.
2. Explain the cause of the com
...
1. List the risk factors for chronic left-sided heart failure related to
coronary artery disease.
The risk factors are hypertension, diabetes, elevated lipids, tobacco use, and obesity.
2. Explain the cause of the compensations for chronic heart failure.
Question is confusing and the answer based on the words written is chronic heart
failure. Chronic heart failure causes decreases in blood flow or ineffective blood flow
mechanisms. These situations cause the body to compensate to maintain homeostasis
which the body is built to do.
1. Frank –Starling mechanism: Increases contractile force leading to increased CO
2. Neuroendocrine responses including activation of the sympathetic nervous
system and renin-angiotensin system:
a) Decreased CO stimulates the sympathetic nervous system and
catecholamine release. Increased HR, BP, contractility, vascular
resistance, venous return.
b) Decreased CO and decreased renal perfusion stimulate renin-angiotensin
system. Vasoconstriction and increased BP
c) Angiotensin stimulates aldosterone release from adrenal cortex. Salt and
water retention by kidneys, increased vascular volume.
d) ADH is released from posterior pituitary. Water excretion inhibited.
e) Atrial natriuretic peptide and brain natriuretic peptide are released.
Increased sodium excretion, Diuresis, Vasodilation.
f) Blow flow is redistributed to vital organs (heart/brain). Decreased
perfusion of other organ systems. Decreased perfusion of skin and
muscles.
3. Myocardial hypertrophy: Increased cardiac work load causes myocardial muscle
to hypertrophy and ventricles to dilate. Increased contractile forced to maintain
CO.
3. Describe the manifestations and effects of right-sided and left-sided
heart failure.
Manifestations of right-sided heart failure are RV heaves, murmurs, jugular venous
distention, edema, weight gain, increased heart rate, ascites, anasarca, and
hepatomegaly. The effects are fatigue, anxiety, depression, depended bilateral
edema, right upper quadrant pain, anorexia and GI bloating, and nausea.
Manifestations of left-sided heart failure are L V heaves, pulsus alternans, increased
heart rate, PMI displaced inferiorly and posteriorly decreased PaO2, slight increase
PaCO2, crackles, S3 and S4 heart sounds, pleural effusion, changes in mental status,
restlessness, and confusion. The effects are weakness, fatigue, anxiety, depression,
dyspnea, shallow respirations up to 32 -40/min, paroxysmal nocturnal dyspnea,
orthopnea, dry hacking cough, nocturia, and frothy pink-tinged sputum.
4. List the goals in the interdisciplinary care of a patient with chronic
heart failure.
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Main goals and treatment of chronic heart failure or to treat the underlying cause and
contributing factors, maximize CO, provide treatment to alleviate symptoms, improve
ventricular function, improve quality of life, preserve target organ function, and improve
mortality and morbidity risks.
a. List the two hormones released by the heart muscle in
response to changes in blood volume.
Atrial natriuretic peptide B-type natriuretic peptide
5. Explain the nursing implications for the client receiving
echocardiography with Doppler flow studies.
Before the Procedure
1) Obtain and document the patient's history of drug allergies, surgeries, bleeding
disorders and medicine uses.
2) Address any anxieties and fears that the patient may have about the procedure.
3) Verify the patient's understanding of the procedure and obtain informed consent.
4) Review lab values as ordered and report any variances to the physician such as CBC
and coagulation studies.
5) apply electrographic electrodes if not already in place.
6) Help the patient remove and store any jewelry, denture; appliance and clothes.
7) Establish and assess adequate Intravenous access if needed for any drugs to be
used such as for sedation.
During the Procedure
1) Establish a low flow of oxygen by nasal cannula.
2) Initiate continuous oxygen saturation monitoring.
3) Assist the patient in a recumbent left lateral position.
4) Assist in positioning patient's head in flexed position if needed.
5) Keep patient comfortable and warm.
6) Assess cardiac rhythm, vital signs, and oxygen saturation at 1-3 min intervals.
7) Assess the patient for discomfort.
8) administer the right drug dosage for procedural sedation if needed and as specified
by the doctor.
8) Ensure that the patient fasts for 4-6 hrs before the procedure as directed by doctor.
After the Procedure
1) Assess cardiac rhythm, vital signs level of consciousness; oxygen saturation at east
every 15 min. until the patient is awake and his or her condition is stable.
2) Discontinue IV once patient is stable unless needed for other purpose.
3) Once patient is awake, progress diet as tolerated.
4) Assess patient for discomfort and any complications (respiratory, cardiac and
esophageal) and report findings to physician.
5) Charting. Your observations.
6. Define refractory heart failure.
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Patients with cardiac decompensation who fail to respond satisfactorily to routine
therapeutic measures
7. List the nursing implications and education needs for each of the
following categories of medication related to heart failure:
a. Angiotensin converting enzyme (ACE) inhibitors and
angiotensin receptor blockers (ARB)
Nursing implications: Assess blood pressure and pulse periodically during therapy,
signs of and angioedema. Monitor prescription refills for compliance, daily weights
electrolyte and renal function.
Patient Education: take medication as directed at the same time each day, do not
discontinue a standard therapy unrest directed by Dr. Hypotension risk change position
slowly. May cause dizziness and inform patient avoid running our other activities until
response of medication is known. Notify Dr. if allergic reaction are rash occurs. Monitor
BP at least weekly and report if it changes to health care professional.
b. Beta-adrenergic receptor blockers
Nursing implications: monitor blood pressure and pulse, intake and output ratios and
daily weight. Assess for signs and symptoms CHF, chest pain, and migraines.
Patient education: instruct patient to continue taking medication even if feeling well.
Abrupt withdrawal may cause life threatening arrhythmias, hypertension, where
myocardial ischemia. Medication controls, but does not cure, hypertension.
c. Diuretics
Nursing Implications: Assess fluid status, patient for anorexia, muscle weakness,
numbness, tingling, confusion, excess thirst, and paresthesia. Monitor daily weight,
intake/output, edema, lung sounds, skin turgor, and mucous membranes, blood
pressure and pulse, compliance, electrolytes, blood glucose, BUN, serum uric acid
levels. Patient Education: Instruct patient take medication as directed, change positions
solely to minimize orthostatic hypotension, monitor weight weekly report significant
change. Contacts Health Care professional immediately if muscle weakness, cramps,
not shut, dizziness, or numbness/tingling of extremities occur. Monitor blood pressure
and pulse before medication administration.
d. Positive inotrope agents
Nursing Implications: Assess history, drug allergies, and contraindications. Assess
blood pressure, apical pulse if less than 60 or greater than 120 hold dose notified Dr.,
heart and lung sounds. Notify if a Dr. If signs of toxicity are present such as anorexia,
nvd, visual disturbances.
Patient Education: Teach patients to look for signs of toxicity and to notify the Dr. If
present. Teach patient to check blood pressure and apical pulse, and to report when
less than 60 greater than 120 and hold medication.
e. Sympathomimetic agents
Nursing Implications: Use infusion pump to admin. Avoid abrupt discontinuation of
meds. Change solutions and tubing q24h. Monitor liver function/ platelet counts. Monitor
for signs and symptoms of pulmonary toxicity. Monitor continuous on ECG during IV
therapy.
Patient Education: Teach patient to monitor pulse daily and report abnormalities. Avoid
drinking grapefruit juice during therapy.
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f. Phosphodiesterase inhibitors
Nursing Implications: Assess heart rate and blood pressure continuously, discontinue if
blood pressure drops excessively. Monitor intake and output and daily weight. Monitor
ECG continuously during infusion due to potential for arrhythmias which can occur and
are potentially life threatening. Monitor electrolytes and renal function frequently and
correct hypokalemia prior to administration to decrease risk of arrhythmias. Hypotensive
risk if overdose if manifests decrease or discontinue.
Patient Education: Inform patient and family of reasons for administration. This drug is
not here but temporary measure to control symptoms of heart failure.
8. List the interdisciplinary interventions for each of the following nursing
diagnoses related to • chronic heart failure.
a. Decreased cardiac output
Assess mentation, heart rate and blood pressure, skin color and temperature, peripheral
pulses, fluid balance and weight gain, heart sounds and lung sounds, urine output,
chest pain, and response to the increased activity. Perform hemodynamic and
continuous ECG monitoring. Administer doctor prescribed diuretics, Morphine,
nitroprusside, Blood Pressure Medications.
b. Excessive fluid volume
Monitor for significant weight change, vital signs, distended neck veins and ascites,
abdominal girth, heart and long sounds. Assess for presence of edema by palpating
over tibia, ankles, feet, and sacrum. Monitor input and output closely. Administer diuretic
medication as prescribed by doctor. Monitor serum electrolytes especially potassium.
c. Activity intolerance
Determine patient's perception of causes of fatigue or activity intolerance. Assess
patient's level of mobility. Assess nutritional status. Assess need for ambulation aids:
bracing, cane, walker, equipment modification for activities of daily living (ADLs).
Assess patient's cardiopulmonary status before activity using the following measures:
Heart rate Orthostatic BP changes Need for oxygen with increased activity How
Valsalva's maneuver affects heart rate when patient moves in bed Monitor patient's
sleep pattern and amount of sleep achieved over past few days. Observe and document
response to activity. Assess emotional response to change in physical status.
Determine patient's perception of causes of fatigue or activity intolerance. Assess
patient's level of mobility. Assess nutritional status. Assess need for ambulation aids:
bracing, cane, walker, equipment modification for activities of daily living (ADLs).
Assess patient's cardiopulmonary status before activity using the following measures:
Heart rate Orthostatic BP changes Need for oxygen with increased activity How
Valsalva's maneuver affects heart rate when patient moves in bed Monitor patient's
sleep pattern and amount of sleep achieved over past few days. Observe and document
response to activity. Assess emotional response to change in physical status.
d. Ineffective health maintenance
Assess client's feelings, values, and reasons for not following prescribed plan of care.
See Related Factors. Assess for family patterns, economic issues, and cultural patterns
that influence compliance with a given medical regimen. Help client determine how to
arrange a daily schedule that incorporates the new health care regimen Help client to
choose healthy lifestyle and to have appropriate diagnostic screening tests. Obtain or
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