Heart Failure Adult Health II

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Heart FailureAdult Health II

• Cheryl McConnell RN MSN

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Pathophysiology

• Ineffective pump
• Cannot meet metabolic demands
• Compensatory mechanisms activated
• ? Heart rate and BP
• ? Cardiac output
• ? Aldosterone and ADH release
• Ventricular hypertrophy

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Causes of Heart Failure

• ? Cardiac Function
• CAD
• Myopathies
• Infective/Inflammatory disorders
• ? Cardiac Work
• HTN
• Valvular Disease
• Anemias
• Congenital
• Non Cardiac
• FVE
• PE
• ? metabolic disorders

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Incidence

• Five million in US
• 550,000 new cases annually
• Affects 10 of adults gt 75 y/o
• Death usually within 8 years of diagnosis
• ? risk of sudden death

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Types of Heart Failure

• Systolic versus Diastolic
• Left versus Right
• High Output
• Acute versus Chronic

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Diagnostics for Heart Failure

• ANF BNP
• CXR
• ABGs
• Lytes, LFTs
• EKG
• Echo
• Hemodynamic Monitoring

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Hemodynamic Monitoring

• Invasive assessment of cardiac function
• BP
• MAP
• CVP
• Pulmonary pressures
• PAP
• PCWP
• CO
• Stroke volume

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Signs and Symptoms of Heart Failure

• Left Sided ----- ? cardiac output
• Fatigue
• Activity intolerance
• Syncope
• Orthopnea
• S3
• Cyanosis
• Ultimate Left Sided failure ? Cardiogenic shock
  and Pulmonary Edema

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Signs and Symptoms of Heart Failure

• Right Sided ---- ? blood in R ventricle
• JVD
• Liver enlargement
• GI distress
• Ascites
• Peripheral edema

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More Signs and Symptoms

• Nocturia
• PND
• Dysrhythmias
• Pleural effusions

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Treatment of Heart Failure

• ACE inhibitors
• Beta blockers
• Diuretics
• Inotropics
• Vasodilators
• Nitroprusside
• Sympathomimetic agents
• Dopamine
• Dobutrex
• Phosphodiesterase Inhibitors
• Inocor
• Primacor
• Antidysrhythmics agents

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More Treatment of Failure

• Diet
• 1.5 2 gm sodium diet
• Activity level
• Intra aortic balloon pump
• Transplant
• Cardiomyoplasty

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Nursing Care of the ClientWith Heart Failure

• Auscultation of heart and breath sounds
• Hemodynamic monitoring
• Maintenance
• Titration of meds
• Strict I O
• Abdominal girth
• Energy conservation
• Cardiac rehabilitation