Download - NURS291-Disorders of the Heart
-
8/2/2019 NURS291-Disorders of the Heart
1/87
Disorders Of The Heart
Terri Slifer Lynch,
MSN, RN, BC, CNE
-
8/2/2019 NURS291-Disorders of the Heart
2/87
Heart Failure
Heart failure is aclinical syndrome
Heart is unable to
pump sufficient bloodto meet the needs ofthe tissues
Heart failure is the
number 1 DRG forhospitalization inpeople over 65 years
-
8/2/2019 NURS291-Disorders of the Heart
3/87
Cultural Considerations
Higher prevalence in African Americans and
Native Americans
Directly related to the higher incidence and
prevalence of HTN and DM
Exacerbated by lack of access to health care
-
8/2/2019 NURS291-Disorders of the Heart
4/87
Etiology of Heart Failure
CAD
Cardiomyopathy
Systemic or pulmonary
hypertension
Valvular disease
Septal defects
Myocarditis
Dysrhythmias
Hypervolemia
Metabolic disorders
Autoimmune disorders
Anemia in the elderly
Cardiotoxic substances
-
8/2/2019 NURS291-Disorders of the Heart
5/87
Effects of Aging
Decreased compliance
Decreased response to
SNS stimulation
Decreased ability ofheart to increase CO
with exercise
Increased incidence ofdysrhythmias
-
8/2/2019 NURS291-Disorders of the Heart
6/87
Pathophysiology Of Heart Failure
Decreased amount of blood ejected fromventricles
Stimulation of SNS occurs causing tachycardia,vasoconstriction and increased contractility
Increased contractility and venous return lead toventricular hypertrophy
Activation of Renin-Angiotensin-AldosteroneSystem
-
8/2/2019 NURS291-Disorders of the Heart
7/87
Vascular volume and venous return increase which
increase blood volume and pressure in the heart
Release of atrial natriuretic peptide (ANP) and brainnatriuretic peptide (BNP)
Failure of compensatory mechanisms occurs
Blood backs up from LV into LA and pulmonaryvenous system
Blood backs up into the RV, RA and systemic venous
system
-
8/2/2019 NURS291-Disorders of the Heart
8/87
-
8/2/2019 NURS291-Disorders of the Heart
9/87
Blood backs up in left atrium and pulmonary veins
Increased hydrostatic pressure forces fluid out ofpulmonary capillaries into alveoli and interstitial
spaces Right ventricle dilates due to increased pulmonary
pressures (pulmonary HTN)
Engorgement of venous system extends backwards
into systemic veins and organs
-
8/2/2019 NURS291-Disorders of the Heart
10/87
If left ventricular failure occurs, ususlly right
ventricular failure will follow
Right ventricular failure can occur solely
without left ventricular failure cor
pulmonale
Heart failure can affect systolic function or
diastolic function
-
8/2/2019 NURS291-Disorders of the Heart
11/87
-
8/2/2019 NURS291-Disorders of the Heart
12/87
Clinical Manifestations Of Left
Ventricular Failure (LVF)
Dyspnea
Dyspnea on exertion (DOE)
Orthopnea
Paroxysmal nocturnal dyspnea (PND)
Cough
Crackles
Hypoxia, cyanosis Tachycardia, palpitations
-
8/2/2019 NURS291-Disorders of the Heart
13/87
S3, S4, murmurs
Weak, thready pulses
Fatigue, decreased exercise tolerance Pale, cool, clammy skin
Restlessness, anxiety, confusion
Nocturia
Edema and weight gain
-
8/2/2019 NURS291-Disorders of the Heart
14/87
-
8/2/2019 NURS291-Disorders of the Heart
15/87
Clinical Manifestations of Right
Ventricular Failure (RVF)
Elevated JVD
Positive HJR Hepatomegaly, splenomegaly
Ascites
Anorexia, nausea, constipation Sacral edema
Peripheral edema
-
8/2/2019 NURS291-Disorders of the Heart
16/87
Acute Pulmonary Edema
Life threatening situation
Large accumulation of fluid in lungs
Manifestations Severe dyspnea, sense of suffocation, orthopnea
Cough, large amounts of frothy, blood tinged sputum
Wheezing and coarse crackles
Cyanosis
Cool, clammy, diaphoretic skin
-
8/2/2019 NURS291-Disorders of the Heart
17/87
New York Heart Associations
Functional Classification of Heart Disease
Class I Ordinary activity does not
cause symptoms
Class II Slight limitation of ADLs Class III Comfortable at rest but any
activity causes symptoms
Class IV Symptoms at rest
-
8/2/2019 NURS291-Disorders of the Heart
18/87
ACC/AHA Staging System
Stage A No structural abnormality of the heart No symptoms of HF
Stage B Structural abnormality of the heart No symptoms of HF
Stage C Structural abnormality of the heart
Some symptoms of HF Stage D
Structural abnormality of the heart Symptoms of HF that do not respond well to normal
treatment
-
8/2/2019 NURS291-Disorders of the Heart
19/87
Diagnostic Findings With Heart Failure
Echocardiogram with Doppler flow studies
Chest x-ray
ECG B-Type Natriuretic Peptide (BNP)
-
8/2/2019 NURS291-Disorders of the Heart
20/87
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
21/87
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
22/87
BUN and creatinine
T4 and TSH
Liver function tests
Stress testing or cardiac cath
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
23/87
Objectives In Treating Heart Failure
Identify and eliminate the precipitating cause
Reduce the workload on the heart
Enhance patient and family coping withlifestyle changes
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
24/87
Medical Management of Heart Failure
Exercise
Bed rest in upright position in acute and refractorystages
Regular exercise program
Oxygen therapy
Dietary restrictions
Sodium restriction Fluid restriction
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
25/87
Cardiac
resynchronization
(CRT) biventricular
pacing (Medtronic
InSyn)
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
26/87
Mechanical assist
devices VAD
Artificial heart
Transplantation
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
27/87
Pharmacologic Management of Heart
Failure
ACE inhibitors
Vasodilate
Promote diuresis
Drugs Vasotec, Captopril, Zestril,
Angiotensin II Receptor Blockers (ARBs)
Prescribed when patient intolerant of ACE-I
Drugs Diovan, Aticand
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
28/87
Beta1 Blockers
Decrease cytotoxic effects of constant stimulation
of SNS
Decrease workload by decreasing heart rate
Drugs - Coreg, Lopressor, Atenolol
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
29/87
Vasodilators
Cause venous dilation
Cause arterial dilation
Drugs Nitrates ie. Isordil (isosorbide) and other
meds ie. Apresoline (hydralazine); BiDil (
isosorbide & hydralazine combination)
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
30/87
Diuretics
Control Na and H2O retention
Three types Potassium sparingAldactone (spironalactone),
Inspra (eplerenone)
Loop diuretics Lasix (furosemide), Demadex
(torsemide) Thiazide diuretics Zaroxolyn (metolazone), HCTZ
(hydrochlorazide)
Monitor for hypotension, lyte imbalances and
dehydration, worsening renal failure
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
31/87
Cardiac glycosides
Increase force of myocardial contraction and
slow electrical conduction
Drugs Lanoxin (digoxin), Primacor, Inocor
Precautions with Lanoxin administration
Decreased renal function slows elimination
Will need to decrease dose with certain meds ie.amiodarone, erythromycin, quinidine
Usual dose 0.125 mg to 0.5 mg (PO,IV,IM)
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
32/87
Lanoxin toxicity Therapeutic level 0.5-2.0 ng/mL
Symptoms anorexia, N/V, fatigue, H/A, yellow
or green halos, new dysrhythmias
Reversal hold dose or administer Digibind(digoxin immune FAB)
Nursing considerations for Lanoxin administration
Assess heart rate for 1 min
Give after breakfast
Monitor for hypokalemia
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
33/87
Calcium channel blockers
Contraindicated with severe systolic dysfunction
Drugs Norvasc, Cardizem, Procardia
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
34/87
Natrecor (nesiritide)
Indicated for the IV treatment of clients with
acutely decompensated congestive heartfailure with dyspnea at rest
Manufactured from E-coli
Effects - dilates veins and arteries, suppresses
Aldosterone Administration - IV bolus, then drip for 48 hrs
Contraindications - systolic pressure
-
8/2/2019 NURS291-Disorders of the Heart
35/87
-
8/2/2019 NURS291-Disorders of the Heart
36/87
Medical Management Of
Pulmonary Edema
Sit patient in high Fowlers with legs and feet
dependent
Oxygen
Morphine
Diuretics
Foley Other meds as with heart failure
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
37/87
Nursing Diagnoses For The Client
With Heart Failure
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
38/87
Nursing Interventions For The
Client With Heart Failure
Monitor and manage potential complications
Assess cardiovascular status frequently
Vital signs
Heart sounds
Degree of JVD & HJR
All peripheral pulses
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
39/87
Assess respiratory status frequently
Lung sounds
Assess degree of dyspnea
Assess O2 sats
Assess renal status
I&O
BUN & Cr Assess for nocturia
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
40/87
Assess GI system
HJR
Ascites
Appetite and constipation
Monitor fluid status closely
Daily weights
I&O Peripheral and sacral edema
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
41/87
Reduce fatigue
Promote activity tolerance
Control anxiety Assess for depression
Referrals
Teach client and family
li d il hi l d
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
42/87
Client and Family Teaching Related
to Heart Failure
Weigh daily
2-3 gm Na diet
Fluid restrictions
Meds and side effects
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
43/87
http://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
44/87
Pneumococcal and flu vaccines recommended
Stop smoking, no ETOH
Signs and symptoms to report to physician Weight gain
Loss of appetite
Syncopy or palpitations
Worsening SOB Persistent cough
Increasing fatigue
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpg -
8/2/2019 NURS291-Disorders of the Heart
45/87
Web Sites
Heart Failure Society of America www.hfsa.org
Heart Failure Online www.heartfailure.org
Heart Failure Treatment Guidelines from the
AHA/ACC www.acc.org
AHA www.hearthub.org
http://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.southernhealth.com.au/imaging/images/29_chest.jpghttp://www.hfsa.org/http://www.heartfailure.org/http://www.acc.org/http://www.hearthub.org/http://www.hearthub.org/http://www.acc.org/http://www.heartfailure.org/http://www.heartfailure.org/http://www.hfsa.org/http://www.hfsa.org/ -
8/2/2019 NURS291-Disorders of the Heart
46/87
Expected Outcomes
Maintains or improves cardiac function
Maintains or increases activity tolerance
Adheres to self-care program
Absence of complications
-
8/2/2019 NURS291-Disorders of the Heart
47/87
-
8/2/2019 NURS291-Disorders of the Heart
48/87
Cardiomyopathy
Disease of the myocardium which affects its
function
Three major types of cardiomyopathy
Dilated - DCM
Hypertropic - HCM
Restrictive
-
8/2/2019 NURS291-Disorders of the Heart
49/87
Dilated Cardiomyopathy
Contractility decreasesand ventricles dilate.
Affects systolic function. Etiology ischemia, viral
myocarditis, toxins,alcohol, pregnancy
-
8/2/2019 NURS291-Disorders of the Heart
50/87
Clinical manifestations same as with LVF
Dx tests ECHO, endomyocardial biopsy, ECG,
chest x-ray, blood chemistries
Tx same as with LVF; tx dysrhythmias; heart
transplant
-
8/2/2019 NURS291-Disorders of the Heart
51/87
Hypertropic Cardiomyopathy
Myocardium increases in
size and mass
Reduces inner cavity ofventricles and ventricles
take longer to relax and
fill. Affects diastolic
function
Etiology genetic, HTN,
and hypoparathyroidism
-
8/2/2019 NURS291-Disorders of the Heart
52/87
Appears most often in young adults
Clinical manifestations sudden cardiac death;dyspnea, palpitations, dizziness
Dx tests radionuclide scans, ECHO, chest x-ray,ECG
Tx Beta blockers and Ca channel blockers. Avoidmeds that decrease preload (diuretics) or increasecontractility (Lanoxin). Tx dysrhythmias - mayinsert ICD
-
8/2/2019 NURS291-Disorders of the Heart
53/87
Restrictive Cardiomyopathy
Ventricle walls arerigid and do notstretch normallyduring filling. Cardiacoutput decreases.Affects diastolicfunction.
Etiology - Amylodiosis,Sarcoidosis
-
8/2/2019 NURS291-Disorders of the Heart
54/87
Clinical manifestations fatigue, activity intolerance,dyspnea and other symptoms of LVF
Dx tests same as other cardiomyopathies
Tx similar to hypertropic cardiomyopathy; txdysrhythmias and tx underlying cause
-
8/2/2019 NURS291-Disorders of the Heart
55/87
-
8/2/2019 NURS291-Disorders of the Heart
56/87
Rheumatic Endocarditis
Results directly from group A beta-hemolytic strep
Can be prevented if strep infection treated early
Myocardium, valves and pericardium are affected
Contractility is decreased
Valve leaflets develop vegetative bodies which can
embolize
-
8/2/2019 NURS291-Disorders of the Heart
57/87
Clinical manifestations Signs of rheumatic fever (fever, rash, migratory joint
pain)
Signs of carditis
Signs of heart failure
Dx tests Positive throat culture; elevated ESR,CBC, ECHO, ASO positive
Tx Prevention is best treatment Limited activity, treat heart failure if present
Penicillin or mycin drugs (clindamycin, erythromycin) ifPenicillin allergy
NSAIDS for joint pain
-
8/2/2019 NURS291-Disorders of the Heart
58/87
Infective Endocarditis
Infection of theendocardium andvalves
Etiology staph,strep, fungi,entrococcci
Increased risk inpatients with valvedisorders and IV drugabusers
-
8/2/2019 NURS291-Disorders of the Heart
59/87
Clinical manifestations malaise,intermittent fever and
chills, night sweats,Roth spots, splinterhemorrhages in nails,Janeway lesions,Oslers nodes,murmur, HF, stroke,pulmonary embolus
-
8/2/2019 NURS291-Disorders of the Heart
60/87
Dx blood cultures, CBC, transesophagealECHO (TEE)
Prevent in patients with valve disorders with
prophylactic antibiotics before and afterinvasive procedures (Amoxicillin, Duricef,Cleocin)
Tx - parenteral antibiotics for 6 wks (Penicillin,EES, Clindamycin, Vancomycin)
-
8/2/2019 NURS291-Disorders of the Heart
61/87
Myocarditis
Inflammation of myocardium results in
degeneration and dilation
Thrombi form on endocardial lining (mural
thrombi)
Etiology viruses, mumps, parasites, bacteria,
toxins, radiation
-
8/2/2019 NURS291-Disorders of the Heart
62/87
Clinical manifestations asymptomatic or
fever, fatigue, tachycardia, palpitations,
dyspnea, symptoms of HF
Dx ECHO, endomyocardial biopsy, chest x-ray, ECG, elevated cardiac biomarkers
-
8/2/2019 NURS291-Disorders of the Heart
63/87
Tx
Tx underlying cause
Bed rest
Tx heart failure
Anti-inflammatory or immunosuppressive
medications
-
8/2/2019 NURS291-Disorders of the Heart
64/87
Pericarditis
Inflammation of thepericardial sac
Fibrinous adhesions or
exudate can form inpericardial sac
Etiology viruses,bacteria, fungi,
myocardial injury,collagen diseases, drugreaction, radiation,neoplasms, ESRD
-
8/2/2019 NURS291-Disorders of the Heart
65/87
Clinical manifestations chest pain,pericardial friction rub, fever, chills, dyspnea
Dx ECG changes, elevated ESR and possibly
WBC, enzymes negative,ECHO Tx
Tx cause
NSAIDS, analgesics, steroids
-
8/2/2019 NURS291-Disorders of the Heart
66/87
Complications of Pericarditis
Pericardial effusion
Cardiac tamponadesigns and symptoms
Pulsus paradoxus
Muffled heart sounds
Tachycardia
Narrow pulse pressure
Distended neck veins
Drop in BP
Chronic constrictivepericarditis
Treatment of Complications of
-
8/2/2019 NURS291-Disorders of the Heart
67/87
Treatment of Complications of
Pericarditis
Pericardiocentesis
Pericardiectomy
-
8/2/2019 NURS291-Disorders of the Heart
68/87
Valvular Disorders
Stenosis valve does not open completely
Regurgitation valve does not close properly
-
8/2/2019 NURS291-Disorders of the Heart
69/87
Mitral Valve Prolapse (MVP)
Portion of a leaflet balloons backward duringsystole
Valve may not remain closed and regurgitation
can occur Clinical manifestations fatigue, dyspnea,
chest pain, anxiety, dizziness, syncope,palpitations (atrial or ventriculardysrhythmias)
-
8/2/2019 NURS291-Disorders of the Heart
70/87
Dx ECHO with Doppler flow studies
Tx
Beta blockers
Eliminate caffeine, alcohol, and smoking
Mitral Regurgitation or Mitral
-
8/2/2019 NURS291-Disorders of the Heart
71/87
Mitral Regurgitation or Mitral
Insufficiency
Leaflets do not close properly and blood
leaks backward
Pressure increases in left atrium and bloodbacks up into lungs
Etiology - MI, heart enlargement, rheumatic
endocarditis Clinical manifestations asymptomatic or
symptoms of LVF, palpitations (atrial fib or
PVCs), systolic murmur
-
8/2/2019 NURS291-Disorders of the Heart
72/87
Dx ECHO withDoppler flow , TEE,cardiac cath
Tx tx LVF, mitralvalve replacement(MVR) orvalvuloplasty
Prophylacticantibiotics forinvasive procedures
-
8/2/2019 NURS291-Disorders of the Heart
73/87
Mitral Stenosis
Leaflets are thickened and contracted
Flow of blood from left atrium into left
ventricle is obstructed
Left atrium dilates and hypertropies
Blood backs up into lungs and eventually the
right side of heart
-
8/2/2019 NURS291-Disorders of the Heart
74/87
Clinical manifestations Diastolic murmur,
fatigue, dyspnea, hemoptyosis, cough,
crackles, atrial fib
Dx ECHO, cardiac cath
Tx tx LVF, valvuloplasty or MVR,
anticoagulants if AF persists
-
8/2/2019 NURS291-Disorders of the Heart
75/87
Aortic Stenosis
Narrowing of aortic valve orifice or
calcification of leaflets
LV hypertrophies, dilates, and contractility
eventually decreases
Blood backs up into lungs and right heart
-
8/2/2019 NURS291-Disorders of the Heart
76/87
Clinical manifestations angina, dizziness orsyncope, DOE, narrowed pulse pressure,dysrhythmias, systolic murmur, and possibly a
thrill Dx ECHO, TEE, cardiac cath
Tx Bed rest, aortic valve replacement (AVR),valvuloplasty, prophylactic antibiotics forinvasive procedures
Aortic Regurgitation or Aortic
-
8/2/2019 NURS291-Disorders of the Heart
77/87
Aortic Regurgitation or Aortic
Insufficiency
Backflow of blood into LV from aorta during
diastole
Increased blood volume in LV causes LV to
contract more forcefully and hypertropy
Blood backs up into LA and lungs
-
8/2/2019 NURS291-Disorders of the Heart
78/87
Clinical manifestations sensations of forceful heartbeat especially in the head and neck, head bobbing
(Mussets sign), marked visible carotid pulsations,
water-hammer pulse, widened pulse pressure,
diastolic murmur, fatigue, DOE, signs of heart failure
Dx ECHO, TEE, cardiac cath
Tx AVR or valvuloplasty, prophylactic antibiotics
-
8/2/2019 NURS291-Disorders of the Heart
79/87
Valvuloplasty
Commisurotomy
procedure to separatefused leaflets
-
8/2/2019 NURS291-Disorders of the Heart
80/87
Annuloplasty repair of the valve annulus
-
8/2/2019 NURS291-Disorders of the Heart
81/87
Chordoplastyrepairof chordae tendineae
V l R l
-
8/2/2019 NURS291-Disorders of the Heart
82/87
Valve Replacement
Open heart procedure requiring heart lung
bypass
Classic approach
Minimally invasive robtic approach
Patients age, contraindications to
anticoagulants and underlying cause are
considered
-
8/2/2019 NURS291-Disorders of the Heart
83/87
Two types of valve
prostheses
Mechanical valves
Ball-and-cage or disc
design
More durable
Valves are susceptible
to thromboemboli
-
8/2/2019 NURS291-Disorders of the Heart
84/87
Biologic tissue grafts
Xenograft porcine or
bovine
Homograft (allograft) - fromhuman pericardial tissue
Autograft (autologous)
use patients pulmonic valve
Complications Related To Valve
http://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpg -
8/2/2019 NURS291-Disorders of the Heart
85/87
p
Replacement
Hemorrhage
Thromboembolism
Infection
Dysrhythmias
Hemolysis of RBCs
Heart failure
Educational Needs of Client With
http://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpg -
8/2/2019 NURS291-Disorders of the Heart
86/87
Valve Replacement
Wound care, diet, meds, activity restrictions
Long term anticoagulant therapy if mechanical
valve used
Prophylactic antibiotic therapy if mechanical
valve used
http://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpghttp://www.teamt.us/images/Tissue_Valve.jpg -
8/2/2019 NURS291-Disorders of the Heart
87/87