PATHOPHYSIOLOGY:

SIGN AND SYMPTOMS

-heart failure may present accurately as a result of CONGESTIVE HEART FAILURE and
myocardial ischemia secondary to myocardial infarction.-the PULMONARY EDEMA  Fatigue
cardiac muscle is weakened that is why CO is decreased.  SOB
The decreasing cardiac output then triggers and increased in  Distended neck veins
systemic vascular resistance and afterload and fluids begin  Weakness
to shoot back through the pulmonary veins and fills the lungs.
 Dizziness
In CHF with acute pulmonary edema this will be the terminal
 Syncope
event if the systemic vascular resistance is not promptly
 Anxiety
reversed.
 Decrease exercise tolerance

Interventions
 Continually assess for signs and symptoms of precipitating heart failure. Nursing Diagnoses
 Monitor for signs of bleeding due to anticoagulation and blood thinning  Decreased Cardiac Output
therapies.  Risk for ineffective coping
 Try to find underlying cause and treat the cause.  PC: Pulmonary Embolism
 Monitor ST segment continuously to determine changes in myocardial tissue  Risk for infection
perfusion.  Ineffective tissue perfusion
 Assess that urine output hourly, alert physician if less than 30 ml/hr.  Acute pain
 Maintain the patient in the semi-fowlers position to lessen the work of  Impaired gas exchange
breathing and facilitate venous return.  Impaired verbal communication
 Continuously monitor O2 and assess vital signs.
(Ackley & Ladwig, 2011)
(Ignatavicius &Workman, 2010; Urden, Stacy, & Lough, 2008)

Risk Factors Medications Treatments

 Coronary artery disease
 Male gender
 History of hypertension,diabetes mellitus,
valvular disease, and myocardial infarction.
 Alcohol, cardiac surgery, kidney conditions,
pericarditis, myocarditis, viruses.
 Congenital heart defects, sleep apnea,
(Ignatavicius &Workman, 2010; Urden et al., 2008)
.
 Loop diuretics.
 Vasodilators- should be used to lower the systemic
vascular resistance and therefore decrease the
cardiac afterload.
 Beta-blockers should be used to decrease the
preload and afterload placed on the heart.
 Anticoagulation therapy drugs
 ACE inhibitor regimen should be started because of
their effect on slowing even reversing left ventricular
remodeling over time.
 The first priority of treatment is airway management. This is judged by the severity of the
presenting symptoms. Could include supplemental oxygen via nasal cannula or mask,
noninvasive ventilation or in this patient’s case endotracheal intubation.
 Urinary catheter should be placed to closely monitor renal function and allow patient to
rest.
 A 12-lead ECG to assess for cardiac abnormalities.
 IV access to provide prompt medication administration.
 Frequent vital sign assessments to monitor for a decline in cardiac function.
(Ignatavicius &Workman, 2010; Urden et al., 2008)

(Urden et al., 2008)