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.
