Alterations in Oxygenation

Management of Patients with Complications from Heart Disease

Heart Failure

The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients A syndrome characterized by fluid overload or inadequate tissue perfusion The term HF indicates myocardial disease, in which there is a problem with the contraction of the heart (systolic failure) or filling of the heart (diastolic failure). Some cases are reversible. Most HF is a progressive, lifelong disorder managed with lifestyle changes and medications.

Clinical Manifestations

Right-sided failure

RV cannot eject sufficient amounts of blood, and blood backs up in the venous system. This resuts in perpheral edema, hepatomegaly, ascites, anorexia, nausea, weakness, and weight gain.
LV cannot pump blood effectively to the systemic circulation. Pulmonary venous pressures increase, resulting in pulmonary congestion with dyspnea, cough, crackles, and impaired oxygen exchange.

Left-sided failure

Chronic HF is frequently biventricular.

Medical Management of HF

Eliminate or reduce etiologic or contributory factors. Reduce the workload of the heart by reducing afterload and preload. Optimize all therapeutic regimens. Prevent exacerbations of HF. Medications are routinely prescribed for HF.

Medications

Angiotensin-converting enzyme inhibitors Angiotensin II receptor blockers Beta-blockers (Inderal) Diuretics Digitalis Other medications

Nursing Process: The Care of the Patient with HF: Assessment

Health history Sleep and activity Knowledge and coping Physical exam

Mental status Lung sounds: crackles and wheezes Heart sounds Fluid status/signs of fluid overload

Daily weight and I&O

Assess responses to medications

Nursing Process: The Care of the Patient with HF: Diagnosis

Activity intolerance and fatigue Excess fluid volume Anxiety Powerlessness Noncompliance

Nursing Process: The Care of the Patient with HF: Planning

Goals may include promoting activity and reducing fatigue, relieving fluid overload symptoms, decreasing anxiety or increasing the patients ability to manage anxiety, encouraging the patient to make decisions and influence outcomes, teaching the patient about the self-care program.

Activity Intolerance

Bed rest for acute exacerbations Encourage regular physical activity; 30-45 minutes daily Exercise training Pacing of activities Wait 2 hours after eating before doing physical activity. Avoid activities in extremely hot, cold, or humid weather. Modify activities to conserve energy. Positioning; elevation of HOB to facilitate breathing and rest, support of arms

Fluid Volume Excess

Assessment for symptoms of fluid overload Daily weight I&O Diuretic therapy; timing of meds Fluid intake; fluid restriction Maintenance of sodium restriction

Patient Teaching

Medications Diet: low-sodium diet and fluid restriction Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, including daily weight Exercise and activity program Stress management Prevention of infection Know how and when to contact health care provider Include family in teaching

Pulmonary Edema

Acute event in which the LV cannot handle an overload of blood volume. Pressure increases in the pulmonary vasculature, causing fluid to move out of the pulmonary capillaries and into the interstitial space of the lungs and alveoli. Results in hypoxemia Clinical manifestations: restlessness, anxiety, dyspnea, cool and clammy skin, cyanosis, weak and rapid pulse, cough, lung congestion (moist, noisy respirations), increased sputum production (sputum may be frothy and blood-tinged), decreased level of consciousness

Management of Pulmonary Edema

Prevention Early recognition: monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention Place patient upright and dangle legs. Minimize exertion and stress. Oxygen Medications

Diuretic (furosemide)

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