Heart Failure

right sided heart failure signs and symptoms

-abdominal organs to become congested -peripheral tissue edema to develop -anorexia & nausea -RUQ pain liver engorgement -jugular vein distention

Heart failure lifestyle changes

-avoiding risky behaviors such as illicit drug --use and smoking -eating a heart-healthy diet -maintaining a healthy weight -staying physically active -reducing stress

causes of low-output heart failure

-coronary heart disease -hypertension -cardiomyopathy -other primary cardiac disorders

Hemodynamic monitoring parameters

-heart rate -arterial BP -central venous or right atrial pressure -pulmonary pressures -CO

Pulmonary edema

-medical emergency -a common consequence of heart failure. It is an abnormal accumulation of fluid in the interstitial tissue and alveoli of the lungs

How is Central venous pressure (CVP) monitored and what is the normal range?

-monitored using an invasive method, wherein a catheter is inserted into the internal jugular or subclavian vein, with the distal tip of the catheter positioned in the superior vena cava just above or just inside the right atrium. -The normal range for CVP is 2-8 cm H2O or 2-6 mmHg.

What drug considerations to African Americans with heart failure have?

-more favorably to treatment with the vasodilators isosorbide dinitrate and hydralazine -the medication BiDil is a combination of these medications that is marketed specifically to African American patients.

common causes of right sided heart failure

-often is caused by conditions that restrict blood flow to the lungs, such as acute or chronic pulmonary disease. -Left-sided heart failure also can lead to right-sided failure, as pressures in the pulmonary vascular system increase with congestion behind the failing left ventricle.

What kind of exercise should you do with heart failure?

-progressive activity program is prescribed to improve myocardial function. -Aerobic exercise 3-7 days per week -10 to 15-minute warm-up period -20 to 30 minutes of exercise at the recommended intensity -cool-down period.

5 main goals of a patient with heart failure?

-slow its progression -reduce cardiac workload -improve cardiac function -control fluid retention.

signs and symptoms of heart failure

-weight gain -edema -Nocturia -Paroxysmal nocturnal dyspnea -Severe heart failure may cause dyspnea at rest as well as with activity, signifying little or no cardiac reserve. -Both an S3 and an S4 gallop may be heard on auscultation.

How much sodium per day should a heart failure patient have?

1.5-2 g of sodium per day, a moderate restriction

high-output failure

If the increased blood flow cannot meet the oxygen demands of the tissues, compensatory mechanisms are activated to further increase CO, which in turn further increases oxygen demand. Thus, even though CO is high, the heart is unable to meet increased oxygen demands.

ACE & ARM Patient Teaching

-Take the drug at the same time every day to ensure a stable blood level. -Monitor BP and weight weekly. Report significant changes to your healthcare provider. -Avoid making sudden position changes. Lie down if you become dizzy or lightheaded, particularly after the first dose. -Report any signs of easy bruising and bleeding, sore throat, fever, edema, or skin rash. Immediately report swelling of the face, lips, or eyelids and any itching or breathing problems. -A persistent, dry cough may develop if you are taking an ACE inhibitor. Contact your healthcare provider if this becomes a problem. -Take captopril 1 hour before meals.

Phosphodiesterase inhibitors drugs

Inamrinone (Inocor) Milrinone (Primacor)

The healthcare provider orders digoxin for the client with congestive heart failure. What should the nurse include in the client's teaching concerning the administration of digoxin? Select all that apply.

"Digoxin can cause swelling of the face, lips, or tongue." "Digoxin can cause a fast, irregular heartbeat." The nurse should explain to the client that digoxin can cause allergic reactions, such as skin rash, itching or hives, swelling of the face, lips or tongue, changes in behavior, mood, or mental ability, changes in vision, confusion, a fast, irregular heartbeat, or feeling faint or lightheaded. Digoxin does not cause decreased respiratory rate, decreased urinary output, or seizures.

The 3 primary compensatory mechanisms

(1) the Frank-Starling mechanism; (2) neuroendocrine responses, including activation of the SNS and the renin-angiotensin system; and (3) myocardial hypertrophy.

normal mean pulmonary artery pressure

15 mmHg. Pulmonary artery pressure is increased in left-sided heart failure.

normal pulmonary artery pressure

25/10 mmHg

Normal heart rate for transplanted heart?

90-110 bpm

brain natriuretic peptide

<100 pg/mL (Normal)

Beta-Adrenergic Blockers Nursing Considerations

Abrupt withdrawal is not advised. Monitor BP and pulses.

Frank-Starling mechanism

An increase in venous return increases ventricular filling and myocardial stretch, which increases the force of contraction.

Stage 4 Heart Failure (severe)

Any degree of physical activity results in increased discomfort. Patient exhibits symptoms of cardiac insufficiency at rest.

A physician orders digoxin elixir for a client with heart failure. Immediately before administering this drug, the nurse must check the client's

Apical pulse. Because digoxin may reduce the heart rate and heart failure may cause a pulse deficit, the nurse should measure the client's apical pulse before administering the drug to prevent further slowing of the heart rate. The serum sodium level doesn't affect digoxin's action. For a client with heart failure, the nurse should check urine output and measure weight regularly, but not necessarily just before digoxin administration.

congestive heart failure

CO falls, leading to decreased tissue perfusion. The body initially adjusts to the reduced CO by activating compensatory mechanisms to restore tissue perfusion. These compensatory mechanisms may result in vascular congestion.

Angiotensin II Receptor Blockers (ARBs) Drugs

Candesartan (Atacand) Valsartan (Diovan)

Beta-Adrenergic Blockers Drugs

Carvedilol (Coreg) Metropolol (Toprol-XL)

Cardiac tamponade

Compression of the heart caused by collected blood or fluid in the pericardium.

Causes of heart failure by impaired myocardial function.

Coronary heart disease Cardiomyopathies Rheumatic fever Infective endocarditis

Cardiac (Digitalis) Glycosides aka Positive inotropic agents (inotropic means modifying the force or speed of contraction of muscles

Digoxin (Lanoxin)

Angiotensin-Converting-Enzyme Inhibitors (ACE) Drugs

Enalapril (Vasotec) Lisinopril (Prinivil, Zestril) Captopril (Capoten) Fosinopril (Monopril) Quinapril (Accupril) Ramipril (Altace)

What are the chief causes of mortality in patients with a transplantation?

Infection and rejection

Stage 1 Heart Failure (mild) Interventions

Regular exercise Smoking cessation Treatment of hypertension Treatment of hyperlipidemia Discontinuation of alcohol or illegal drug use Low-sodium diet Possible addition of ACE inhibitor, ARB, or beta-adrenergic blocker to medication regimen

causes of increased CVP

Fluid overload Vasoconstriction Cardiac tamponade

A client prescribed propranolol calls the clinic to report a weight gain of 3 lbs (1.36 kg) within 2 days, shortness of breath, and swollen ankles. What is the nurse's best action?

Have the client come to the clinic in order to assess the lungs. The client needs to be assessed for the heart failure, a potential adverse effect of beta blockers. The other answer choices will not rule out the possibility of the development of pulmonary edema.

What are three phases of cardiac rehabilitation?

Phase 1 -Progress from bedrest to ambulation. -Perform activities of daily living (ADLs) independently. Phase 2 -Increase activity level, participation, and capacity. -Improve psychosocial status and treat anxiety and depression. -Provide education and support for risk factor reduction. Phase 3 -Transition to independent exercise and exercise maintenance.

Vasodilators

Hydralazine with isosorbide dinitrate (BiDil) Nesiritide (Natrecor) Sacubitril/valsartan (Entresto)

Causes of heart failure by Increased Cardiac Workload

Hypertension Valve disorders Anemias Congenital heart defects

causes of decreased CVP

Hypovolemia Shock

Vasodilators

Monitor BP, peripheral pulses, and urinary output. These drugs may cause severe hypotension. Nesiritide is administered intravenously. Monitor for dysrhythmias. Nesiritide may cause dysrhythmias. Do not use sacubitril/valsartan in pregnant women.

Are NSAIDs safe in heart failure patients?

NSAIDs can interfere with the effectiveness of heart failure medications. Nurses should teach patients to avoid NSAIDs whenever possible and to check for NSAIDs in any over-the-counter medications they may use.

Phosphodiesterase inhibitors patient teaching

Notify the healthcare provider if you experience abdominal pain or notice a skin rash or bruising.

Stage 3 Heart Failure (moderate)

Patient has increased physical limitations. Less than normal physical activity results in fatigue, shortness of breath, or palpitations. Patient is comfortable at rest.

Stage 1 Heart Failure (mild)

Patient has no limitation of physical activity. Patient has no shortness of breath noted with normal physical activity.

What is the nurse's priority action for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention?

Reposition the client so the lower legs dangle off the bed. The client's presentation suggests congestive heart failure. Cardiac output is compromised. Dangling the legs will cause pooling of blood in the lower extremities, allowing some relief to the overloaded heart. Oxygenation will improve with improved cardiac output. Furosemide will decrease the fluid, but will take some time to work. Notifying the attending should occur after the client is rescued.

Diuretics drugs

Spironolactone (Aldactone) Furosemide (Lasix) Bumetanide (Bumex) Hydrochlorothiazide (HydroDIURIL)

Mean arterial pressure (MAP)

The average pressure in the arterial circulation throughout the cardiac cycle.

compensatory mechanisms

When the heart begins to fail, CO, SV, and ejection fraction all decrease. When this occurs, mechanisms compensate for impaired function and maintain CO.

acute failure

abrupt onset of a myocardial injury (e.g., massive MI) resulting in suddenly decreased cardiac function and signs of decreased CO.

The nurse is assessing a client with chronic heart failure who is demonstrating neurohormonal compensatory mechanisms. Which are expected findings on assessment? Select all that apply.

decreased cardiac output increased heart rate vasoconstriction in skin, GI tract, and kidneys fluid overload Heart failure can be a result of several cardiovascular conditions, which will affect the heart's ability to pump effectively. The body attempts to compensate through several neurohormonal mechanisms. Decreased cardiac output stimulates the aortic and carotid baroreceptors, which activates the sympathetic nervous system to release norepinephrine and epinephrine. This early response increases the heart rate and contractility. It also has some negative effects, including vasoconstriction of the skin, GI tract, and kidneys. Decreased renal perfusion (due to low CO and vasoconstriction) activates the renin-angiotensin-aldosterone process resulting in the release of antidiuretic hormone. This causes fluid retention in an attempt to increase blood pressure, and therefore cardiac output. In the damaged heart, this causes fluid overload. There is no parasympathetic response. Decreased pulmonary perfusion can be a result of fluid overload or concomitant pulmonary disease.

causes of Diastolic failure

decreased ventricular compliance caused by hypertrophic and cellular changes and impaired relaxation of the heart muscle.

Diastolic failure

the heart cannot completely relax in diastole, disrupting normal filling. Passive diastolic filling decreases, increasing the importance of atrial contraction to preload.

ventricular reduction surgery

the size of the damaged heart is reduced by excising a portion of the left ventricular wall. This procedure increases the ventricular diameter to a more optimal size. The efficiency of the remaining left ventricle improves, and the failing heart pumps more effectively.

A nurse is evaluating the labs of a client with heart failure. Which lab values are expected findings? Select all that apply.

hemoglobin 14.2 g/dL, hematocrit (Hct) 32.8% Serum sodium 130 mEq/L microalbuminuria and proteinuria Fluid volume overload present with heart failure causes the hematocrit to be low indicating a dilutional ratio of red blood cells to fluid. The serum sodium is low because of hemodilution. Microalbuminuria and proteinuria are present, indicating a decrease in renal filtration. Serum potassium and creatinine are within normal limits.

Causes of high output heart failure

hypermetabolic states (e.g., hyperthyroidism, infection, anemia, pregnancy)

causes of systolic failure

loss of myocardial cells due to ischemia and infarction, cardiomyopathy, or inflammation.

An older adult client with heart failure and 2+ pitting edema is prescribed furosemide. Due to the effects of furosemide, which additional medication should the nurse recommend to the client to supplement when taking furosemide?

potassium. Furosemide inhibits reabsorption of sodium and chloride, so the nurse should explain that a potassium replacement is needed. Calcium, phosphates, and magnesium should be unaffected when taking furosemide.

Chronic failure

progressive deterioration of the heart muscle as a result of cardiomyopathies, valvular disease, or coronary heart disease.

intra-aortic balloon pump (IABP)

serve as a bridge to transplantation or allow the myocardium to heal over an extended period of time

left-ventricular assist device (LVAD)

serve as a bridge to transplantation or allow the myocardium to heal over an extended period of time

Cardiogenic pulmonary edema

sign of severe cardiac decompensation (failure of compensatory mechanisms to restore tissue perfusion)

Cardiac output

the amount of blood pumped from the ventricles in 1 minute

systolic failure

when the ventricle fails to contract adequately to eject a sufficient volume of blood into the arterial system.

cardiomyoplasty

wrapping the latissimus dorsi muscle around the heart to support the failing myocardium. The muscle is stimulated in synchrony with the heart, providing a more forceful contraction and increasing CO.

Ventricular hypertrophy

-Increased cardiac workload causes myocardial muscle to hypertrophy and ventricles to dilate. -Increased contractile force to maintain CO -Increased myocardial oxygen demand -Cellular enlargement

Heart Failure Pharmalogic Therapy Classes

-Angiotensin-Converting-Enzyme Inhibitors -Angiotensin II Receptor Blockers -Beta-Adrenergic Blockers -Diuretics -Vasodilators -Cardiac (Digitalis) Glycosides -Antidysrhythmics -Phosphodiesterase inhibitors

What are the early manifestations of digitalis toxicity?

-Anorexia -Nausea and vomiting -Headache -Altered vision -Confusion -Some cardiac dysrhythmias

What is the only clearly effective surgical treatment for end-stage heart failure

-Heart transplantation -88% of cardiac transplantation patients are living 1-year posttransplantation -75% are living 5-years posttransplantation

Stage 2 Heart Failure (mild) Interventions

-ACE inhibitor or ARB -beta-adrenergic blocker -Surgical options: coronary artery repair, valve repair or replacement

Stage 3 Heart Failure (moderate) Interventions

-Addition of diuretic, ACE inhibitor, ARB, and/or beta-adrenergic blocker to medication regimen -Possible addition of aldosterone inhibitor, digitalis, hydralazine, or nitrates -Further restriction of dietary sodium -Weight monitoring -Fluid restriction, as needed -Discontinuation of drugs that worsen condition -Surgical options: biventricular pacing, implantable cardioverter-defibrillator (ICD)

Cardiac (Digitalis) Glycosides Nursing Considerations

-Assess apical pulse before administering. Withhold digitalis, and notify the healthcare provider if heart rate is below 60 bpm and/or manifestations of decreased CO are noted. Record apical rate on medication record. -Evaluate the ECG for scooped (spoon-shaped) ST segment, AV block, bradycardia, and other dysrhythmias (especially PVCs and atrial tachycardias). -Report manifestations of digitalis toxicity: anorexia, nausea and vomiting, abdominal pain, weakness, vision changes (e.g., diplopia, blurred vision, yellow-green or white halos seen around objects), and new-onset dysrhythmias. -Assess potassium, magnesium, calcium, and serum digoxin levels before giving digitalis. Hypokalemia can precipitate toxicity even when the serum digitalis level is in the "normal" range (adult: 0.5-2 ng/mL, 0.5-2 nmol/L [SI units]; infants: 1-3 ng/mL). -Monitor patients with renal insufficiency or renal failure and older adults for digitalis toxicity. -Prepare to administer digoxin immune Fab (Digibind) for digoxin toxicity.

What are the diagnostic tests for heart failure?

-Atrial natriuretic peptide (ANP), also called atrial natriuretic hormone, and brain natriuretic peptide (BNP) -serum electrolytes -urinalysis, blood urea nitrogen (BUN), and serum creatinine -livre function tests -thyroid function tests -arterial blood gas (ABG -chest x ray -electrocardiography -echocardiography with doppler flow studies

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) Diagnostic Tool for Heart Failure

-Atrial natriuretic peptide (ANP), also called atrial natriuretic hormone, and brain natriuretic peptide (BNP) are hormones released by the heart muscle in response to changes in blood volume. -Blood levels of these hormones increase in heart failure. BNP levels, in particular, have been shown to positively correlate with pressures in the left ventricle and the pulmonary vascular system. -The level of BNP in the blood increases as the symptoms of heart failure worsen and decreases when the heart failure stabilizes. -BNP levels may be elevated in women and patients over age 60 who do not have a diagnosis of heart failure.

Heart failure complications

-Congestive hepatomegaly and splenomegaly -ascites -gastrointestinal problems -Impaired Liver function (prolonged right-sided heart failure) -dysrhythmias -Pleural effusions

common causes of Left sided heart failure

-Coronary heart disease -hypertension

Neuroendocrine response Physiology, Effect on Body Systems, & Complications continued

-Decreased CO and decreased renal perfusion stimulate the renin-angiotensin system. -Angiotensin stimulates aldosterone release from the adrenal cortex. -Antidiuretic hormone (ADH) is released from the posterior pituitary. -Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are released. -Blood flow is redistributed to vital organs (heart and brain). -Vasoconstriction and increased BP -Salt and water retention by the kidneys -Increased vascular volume -Water excretion inhibited -Increased sodium excretion -Diuresis -Vasodilation -Decreased perfusion of other organ systems -Decreased perfusion of skin and muscles -Increased myocardial work -Renal vasoconstriction and decreased renal perfusion -Increased preload and afterload -Pulmonary congestion -Fluid retention and increased preload and afterload -Pulmonary congestion -Renal failure -Anaerobic metabolism and lactic acidosis

Neuroendocrine response Physiology, Effect on Body Systems, & Complications

-Decreased CO stimulates the SNS and catecholamine release. -Increased heart rate, BP, and contractility -Increased vascular resistance -Increased venous return -Increased vascular resistance -Tachycardia, with decreased filling time and decreased CO -Increased myocardial work and oxygen demand

Left sided heart failure signs and symptoms

-Dizziness and syncope -dyspnea -shortness of breath -cough -orthopnea -cyanosis -inspiratory crackles (rales) and wheezes may be heard in lung bases. -An S3 gallop

ACE & ARM Nursing Considerations

-Do not give these drugs in the second and third trimesters of pregnancy. -Carefully monitor patients who are volume-depleted or have impaired renal function. -Use an infusion pump when administering ACE inhibitors intravenously. -Monitor BP closely for 2 hours following the first dose and as indicated thereafter. -Monitor serum potassium levels; ACE inhibitors can cause hyperkalemia. -Monitor WBC count for potential neutropenia.

Diuretics Patient Education

-Drink at least 6-8 glasses of water per day. -Take the diuretic at times that will be least disruptive to your lifestyle, usually in the morning and early afternoon if a second dose is ordered. Take with meals to decrease gastric upset. -Monitor BP, pulse, and weight weekly. Report significant weight changes to your healthcare provider. -Report any of the following to your healthcare provider: severe abdominal pain; jaundice; dark urine; abnormal bleeding or bruising; flulike symptoms; and signs of hypokalemia, hyponatremia, or dehydration (e.g., thirst, salt craving, dizziness, weakness, rapid pulse). -Avoid sudden position changes because they may cause dizziness or feelings of faintness. -Unless you are taking a potassium-sparing diuretic, integrate potassium-rich foods into your diet. Limit sodium use.

Acute pulmonary edema signs and symptoms

-Dyspnea -shortness of breath -labored respirations are acute and severe -orthopnea -Cyanosis is present -skin is cool, clammy, and diaphoretic -productive cough with pink, frothy sputum develops -RBCs, and plasma proteins in the alveoli and airways -Crackles are heard throughout the lung fields on auscultation. As the condition worsens, lung sounds become harsher. -restless and highly anxious -severe hypoxia may cause confusion or lethargy.

Stage 4 Heart Failure (severe) Interventions

-Evaluation for available options -Possible interventions: heart transplant, VADs, surgery, research therapies, continuous infusion of IV heart pump medication, palliative or hospice care

Paroxysmal nocturnal dyspnea

-Frightening sudden episode of shortness of breath occurring at night during sleep. -occurs when edema fluid that has accumulated during the day is reabsorbed into the circulation at night, causing fluid overload and pulmonary congestion.

What are the complementary health approaches for heart failure?

-Hawthorn increases the force of myocardial contraction, dilates blood vessels, and has a natural ACE inhibitor. (Adding extract of hawthorn to standard heart failure medications might worsen early disease progression. Hawthorn should not be used without consultation with the primary care provider and experienced herb practitioner.) -coenzyme Q10 (improves mitochondria function and energy production. -magnesium -thiamine

Diuretics nursing considerations

-Obtain baseline weight and vital signs. -Monitor BP, intake and output, weight, skin turgor, and edema as indicators of fluid volume status. -Assess for volume depletion, particularly with loop diuretics (furosemide, ethacrynic acid, and bumetanide): dizziness, orthostatic hypotension, tachycardia, and muscle cramping. -Report abnormal serum electrolyte levels to the healthcare provider. Replace electrolytes as indicated. -Do not administer potassium replacements to patients receiving a potassium-sparing diuretic. -Evaluate renal function by assessing urine output, BUN, and serum creatinine. -Administer IV furosemide slowly, no faster than 20 mg/min. -Evaluate for signs of ototoxicity. Do not administer this drug or ethacrynic acid concurrently with aminoglycoside antibiotics (e.g., gentamicin), which are also ototoxic.

Venous Pressure Monitoring

-Pressures are elevated in right-sided heart failure. -CVP and right atrial pressure are primarily used to monitor fluid volume status. -To measure venous and atrial pressures, a catheter is inserted in the internal jugular or subclavian vein.

Serum electrolytes Diagnostic Tool for Heart Failure

-Serum osmolarity -Sodium, -potassium -chloride -calcium -magnesium

Heart Failure risk factors?

-Sleep Apnea -CAD -cigarette smoking -obesity -substance abuse -hypertension -diabetes -cardiomyopathy -heart valve disease -65 years of age and older -African Americans -overweight -patients with a history of MI -Children diagnosed with congenital heart defects -Congenital heart defects cause the heart to work harder, weakening the heart muscle, which can lead to heart failure.

Cardiac (Digitalis) Glycosides Patient Education

-Take your pulse daily before taking your digoxin. Do not take digoxin if your pulse is below 60 bpm or if you are weak, fatigued, lightheaded, dizzy, short of breath, or having chest pain. Instead, notify your healthcare provider immediately. -Contact your healthcare provider if you develop manifestations of digitalis toxicity: palpitations, weakness, loss of appetite, nausea, vomiting, abdominal pain, blurred or colored vision, or double vision. -Avoid using antacids and laxatives, which decrease digoxin absorption. -Notify your healthcare provider immediately if you develop manifestations of potassium deficiency: weakness, lethargy, thirst, depression, muscle cramps, or vomiting. -Incorporate potassium-rich foods into your diet: fresh orange or tomato juice, bananas, raisins, dates, figs, prunes, apricots, spinach, cauliflower, and potatoes.

Frank-Starling mechanism Physiology, Effect on Body Systems, & Complications

-The greater the stretch of cardiac muscle fibers, the greater the force of contraction. -Increased contractile force leading to increased CO -Increased myocardial oxygen demand -Limited by overstretching

What is Central venous pressure (CVP) & the normal CVP range?

-an invasive method, wherein a catheter is inserted into the internal jugular or subclavian vein, with the distal tip of the catheter positioned in the superior vena cava just above or just inside the right atrium. -The normal range for CVP is 2-8 cm H2O or 2-6 mmHg.

The nurse is caring for a client admitted for pneumonia with a history of hypertension and heart failure. The client has reported at least one fall in the last 3 months. The client may ambulate with assistance, has a saline lock in place, and has demonstrated appropriate use of the call light to request assistance. Using the Morse Fall Scale (see chart), what is this client's total score and risk level?

60, high risk Several factors designate this client as a high fall risk based on the Morse Fall Scale: history of falling (25), secondary diagnosis (15), plus IV access (20). The client's total score is 60. There is also concern that the client's gait is at least weak if not impaired due to hospitalization for pneumonia, which may add to the client's fall risk. After evaluating the client's risk, the nurse must develop a plan and take action to maximize the client's safety.

Heart failure

The inability of the heart to pump adequate blood to meet the metabolic demands of the body.

Pulmonary Artery Pressure Monitoring

The pulmonary artery catheter is often called a Swan-Ganz catheter, after the physicians who developed it. It is inserted into a central vein and threaded into the right atrium. A small balloon at the tip allows the catheter to be drawn into the right ventricle and, from there, into the pulmonary artery

Stage 2 Heart Failure (mild)

Patient has some physical limitations due to fatigue, shortness of breath, or palpitations. Patient is comfortable at rest.

Phosphodiesterase inhibitors nursing considerations

Use an infusion pump to administer these agents. Monitor hemodynamic parameters carefully. Avoid discontinuing these drugs abruptly. Change solutions and tubing every 24 hours. Inamrinone is given as an IV bolus over 2-3 minutes, followed by an infusion of 5-10 mg · kg−1 · min−1. Inamrinone may be infused full strength or diluted in normal or half-strength saline. Do not mix this drug with dextrose solutions. After dilution, inamrinone can be piggybacked into a line containing a dextrose solution. Monitor liver function and platelet counts; inamrinone may cause hepatotoxicity and thrombocytopenia.

Causes of heart failure by Acute Noncardiac Conditions

Volume overload Hyperthyroidism Fever, infection Massive pulmonary embolus