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M6 13-005

Exam 4: Cardiovascular System- Heart Failure/ Pulmonary Edema

Heart Failure Results from the heart's inability to meet the demands of the body's metabolic needs.
Inefficient Circulation This leads to congestion of body organs with blood and tissue fluid.
Neurohormonal A hormone secreted by or acting on a part of the nervous system.
Catecholamines Epinephrine and Norepinephrine
Toxic Effect, Negative Effect Hormones of the sympathetic nervous system exert a _______ _______ & produce a _______ ________ on the failing heart.
Causes of CHF Congenital Defects, Diseases of the heart & Blood Vessels
Diseases of the Heart and Blood Vessels Artherosclerosis, Arteriosclerosis, MI, DM, HTN, Valvular heart disease.
Diseases that Increase Cardiac Output Infection, Stress, Hyperthyroidism, Pregnancy, Anemia
Renin activates angiotensin I formation ACE converts angiotensin 1 to angiotensin II (potent vasoconstrictor)
ACE converts angiotensin 1 to angiotensin II (potent vasoconstrictor) II also includes aldosterone secretion from the adrenal gland (NA & H2o retention)
II also includes aldosterone secretion from the adrenal gland (NA & H2o retention) Increase blood pressure
Causes of CHF factors Increase strain on the heart b/c interference with blood supply to heart. Increase in workload to pump blood through narrowed, stiffened vessels.
Conditions that Increase Cardiac Output Infection, stress, hyperthyroidism, Preganancy, Anemia
Heart Failure Clinical Manifestations Decreased cardiac output. LEFT ventricular failure. RIGHT sided failure.
Left Ventricular Failure (Lungs) Increased pressure in the left side of the heart backs up to the pulmonary system.
Cardiac Output The amount of blood the heart pumps out in 1 minute. 4-8l/min
Left Ventricular Failure (Fluid) Increased permeability to the capillaries causes fluid to be pushed into the pulmonary capillary bed resulting in pulmonary edema and pleural effusions
Left Ventricular Failure Inability of the left ventricle to effectively pump enough blood to meet needs of body tissues.
S/S Left Ventricular Failure Decreased Cardiac output. Pulmonary congestion. (Coughing, tiredness, Swelling in ankles and thighs).
Why does Left Ventricular Failure often occur 1st? The left ventricle is most often affected by coronary atherosclerosis and HTN
Right Ventricular Failure Most often caused by left-sided failure, but Chronic Pulmonary Disease & Pulmonary HTN also cause this.
Right Sided Heart Failure Results in fluid accumulation in systemic circulation (Poor Venous Return). -> RV unable to pump blood to lungs b/c of increased pulmonary pressures -> Patients retain Sodium which worsens edema
Dependent Edema Edema of ankles when patient is standing or sitting. May shift to sacral region when prone.
Pitting edema When pressure is applied, pressure area becomes indented. When pressure is released, indentation disappears over time.
RIGHT Ventricular Failure S/S Nocturia, Organ Dysfunction (Hepatomegaly w/ right upper quadrant pain, ABD edema (farts, anorexia, nausea, ABD distention), wieght gain, JVD
Heart Failure Subjective Data Dyspnea, Orthopnea, Cough
Heart Failure Objective Data Decrased Cardiac Output, Right Sided failure on digestive organs, cyanosis.
Dx Tests for CHF Chest X-ray, Electocardiography (ECG), Echocardiography, Exercise Stress testing, Cardiac Catheterization
Lab Tests of CHF ABG (hypoxemia & acidosis), LFT, Serum Electrolytes & Enzymes (Na, Mg, K, BUN, Creat)
Digitalis Preparations (Cardiac Glycosides) Improve cardiac output and increase contractile force of ventricles. Also slows heart rate.
Heart Failure Drug Therapy Diuretics, Nitrates, ACE Inhibitors
Diuretics Reduce excess fluid and sodium stored in tissues
Nitrates Peripheral vascular resistance, increase left ventricular output, increase left ventricular emptying, and increase cerebral and renal blood flow.
ACE Inhibitors Decrease peripheral vascular resistance, improve cardiac output and studies have shown to extend and improve the lives of the patient with heart failure.
1L of fluid 1kg or 2.2 lbs
1+ trace Slight, rapid
2+ Mild 4mm (0-1/4 in), 10-15 seconds
3+ Moderate 6mm (1/4-1/2 in), 1-2 Minutes
4+ Severe 8mm (1/2-1 in), 2-5 Minutes
Nursing Management for Heart Failure Prevent Disease Progression, and Complications
Pulmonary Edema Accumulation of fluid in the air sacs (alveoli) in the lungs caused primarily/ most often by heart failure.
Process of pulmonary edema Blood from L side backs up into the lungs-> 1.Fluid accumulates in the interstitial lung tissue and alveoli 2.decrease gas exchange -> Resp. Distress; frothy sputum; may be blood tinged
Clininal Manifestations of Pulmonary Edema Frothy Sputum: produced from air mixing with fluid in the alveoli. Blood tinged: from cells busting into the alveoli.
Pulmonary Edema s/s Restlessness, agitation, severe dyspnea, tachypnea, tachcardia, cyanosis, cough, wheezes, crackles, cold extremities
Pulmonary Edema Dx Tests Physical exams, CXR, ABG sampling
Pulmonary Edema Medical Management Improve Oxygenation, Cardiac Output, Reduce Pulmonary Congestion
Morphine (10-15mg) Titrate IV Decrease pt anxiety, slow respirations, reduce venous return, dilate pulmonary blood vessels
Pulmonary Edema Management (Oxygen 40-60 (100)% Non-rebreather face mask; intubation PRN to promote oxygenation, and increase tidal volume
Pulmonary Edema Management (Nitroglycerin SL) INcrease myocardial blood flow
Pulmonary Edema Management (Diuretics) reduce pulmonary edema and increase renal excretion
Inotropic Agents (Dobutamine/Dobutrex) or (Amrinone/Inocor) increase myocardial contractility without increasing mycardial oxygen consumption
Nitroprusside/Nitropress vasodilator to improve myocardial contraction and reduce pulmonary congestion
Nursing Intervention for Pulmonary Edema Improve Oxygenation and cardiac Output
Intropic Agents Action Stimulates Best 1 (myocardial)-adrenergic receptors with relatively monitor effect on heart rate or peripheral blood vessels
Inotropic Agents Therapeutic Effects Increased cardiac output, blood pressure and improved renal blood flow
Inotropic Agents Indication: Dobutamine (Dobutrex) Inotropic support in CHF, Cardiogenic Shock
Inotropic Agents Indication: Dopamine (Inotropic) Hypotension associate with shock, renal insufficiency
Inotropic Agents Side Effects Headache, SOB, CV: HTN, Increased HR, Premature Ventricular Contractions, Angina Pectoris, Arrythmias, Nypotension, palpations. N/V
Inotropic Agents Nursing Implications Monitor BP, HR, ECG, PCWP, Cardiac Output, CVP and urinary Output continuously during administraion
Inotropic Agents Laps Considerations Monitor K concentrations during therapy, may cause Hypokalemia. Monitor electrolytes, BUN, Creat and PT weekly during prolonged therapy.
Created by: jtzuetrong