left + right sided heart failure

nursing assessment of left-sided HF

Decreased Cardiac Output Oliguria <400ml/24hrs Angina Confusion, restlessness Dizziness (orthostatic) Tachycardia, palpitations Pallor Weak peripheral pulses Cool extremities S3/S4 Heart sounds Pulmonary Congestion Hacking cough (worse at night) Dyspnea Orthopnea Paroxysmal- nocturnal dyspnea Crackles or wheezes Frothy, pink sputum Tachypnea

Drug therapy education

Digoxin Take apical pulse & hold if below 60 Chart 35-5 pg 691-other dig education (& Beta Blocker) Ace Inhibitors Move slowly when changing positions Report dizziness, lightheadedness & cough Diuretic Take in the morning, daily wt, fluid restriction Ace Inhibitor & Diuretic K+ level will be monitored every few months

Interventions for impaired gas exchange

Ventilation assistance Elevate HOB Auscultate breath sounds q1-4 hrs Pulse ox Administer prescribed O2 TC & DB Hemodynamic regulation Monitor rate, rhythm & pulses Fluid balance I&O, weight, reg. of IV flow rate Energy management, diet therapy, drug therapy nurse can give 2L of O2 if SaO2 below norm

sx of left-sided HF

Dyspnea Orthopnea Crackles Cough Fatigue Insomnia Tachycardia Anxiety Restlessness Confusion Dizziness Diaphoresis

HF Client Education

Exercise Walk several times/wk if HF stabilized Start with 200-400 ft/day Slowly increase time by 10 min/wk over several months Advancing too quickly if experiencing chest pain, pronounced dyspnea or fatigue the next day

causes of left-sided HF

HTN (75%) CAD (Approx 1/3 MI develop L sided Ht failure) Valvular disease Cardiomyopathy Substance abuse Congenital defects Inflammation Infection

Beta-adrenergic blockers

Metoprolol Usually begin after ACE inhibitor & diuretics have been stabilized for 2 weeks Monitor & hold for hypotension & bradycardia

S3 Heart Sounds (Systolic HF)

Results from increased atrial pressure leading to increased flow rates to ventricles causing blood in ventricles to slosh between walls just after systole congestive heart failure, cardiomyopathy

Human B-type natriuretic peptides

nesiritide Given as IV bolus Causes loss of sodium and vasodilation

Digoxin action/use/toxicity/

Increases contractility Reduces heart rate Hold if below 60 Mild diuretic effect Hypokalemia increases sensitivity to digitalis Dysrhythmia, anorexia, N&V, fatigue, changes in mental status

Symptoms of worsening HF- immediately report

3lbs weight gain/wk or 1-2 lbs overnight Decrease in exercise toleration lasting 2-3 days Cough lasting more than 3-5 days Excessive nocturnal urination Dyspnea or angina at rest Increased swelling of feet, ankles or hands

BNP (Brain Natriuretic Peptide) lab values

>400 indicative of severe CHF it is the hallmark of HF

drugs that reduce after load

Angiotensin-converting enzyme (ACE) inhibitors benazopril Arterial vosodilator First dose can cause rapid drop in BP Monitor BP for several hours after first dose & with each increase in dose Monitor electrolytes & creatinine May develop hyperkalemia if kidney not functioning well Prevents sodium & water retention Inhibits excretion of potassium Caution not to use salt substitutes

right sided HF sx

Anorexia, nausea Dependent edema Feet, legs, sacrum Weight gain (10-15 lbs before pitting edema) Distended abdomen Nocturia Increased or decreased BP Hepatomegaly Ascites Hepatojugular reflux Elevate HOB at least 45-90 degrees Enlarged spleen

Interventions during Pulmonary Edema

Assessment: Decreased SpO2 Crackles in lung bases Dyspnea at rest Disorientation/confusion Pink frothy sputum Immediate Intervention: Place in upright position with legs dangling Trap some excess fluid in lower extremities

causes of right sided HF

Left ventricular failure Right MI Pulmonary hypertension COPD Cystic Fibrosis Acute Respiratory Distress Syndrome (ARDS)

Diet therapy education

Low or restricted sodium Advise of foods containing Na Talk to healthcare provider before using salt substitute Use lemon, garlic & herbs to enhance flavor of low salt foods

Interventions for decreased cardiac output (nonsurgical)

Optimization of cardiac output (Stroke volume x heart rate) Hemodynamic Regulation Medication Diet Rest

Right Sided Heart Failure result

Peripheral congestion due to decreased ability of the right ventricle to pump blood out to the lungs.

sx of systolic and diastolic HF

Pulmonary Congestion Pulmonary Edema Decreased Tissue Perfusion Low Cardiac Output Scant urine

S4 Heart Sounds (Diastolic HF)

Seen in patients with STIFFENED ventricles where atrial blood slams into full ventricular chambers at beginning of systole Hypertension, aortic stenosis, ischemic or hypertrophic cardiomyopathy.

Risks in Use of Noninvasive Ventilation

Skin breakdown Eye irritation Irritated/dry mucous membranes Gastric distention & vomiting Increased risk of aspiration Claustrophobia

left sided heart failure

fluid in lungs, adventitious breath sounds Left-sided heart failure occurs when the left ventricle doesn't pump efficiently. This prevents your body from getting enough oxygen-rich blood. The blood backs up into your lungs instead, which causes shortness of breath and a buildup of fluid.