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Cardio Lecture Notes: Congestive Heart Failure
Cardio Lecture Notes: Congestive Heart Failure
With decreased cardiac output, mechanisms within the body help to increase
the cardiac output; this does more harm than good.
* Blood Vessels: Constrict to raise BP but in turn it makes the heart work
harder because there is more peripheral resistance.
The major cause of ® sided heart failure is left sided heart failure.
Exception: MI’s that affect the ® ventricle can cause ® sided heart
failure.
**Lung disease increases carbon dioxide levels in the blood (COPD) and
causes Pulmonary Arterial Vasoconstriction which increases the force in
which the ® ventricle has to pump blood to the lungs-- results in an
enlargement of the ® ventricle (Pulmonary HTN due to vasoconstriction
of the pulmonary artery).
X-ray would show an enlarged ® ventricle.
When the ® ventricle fails, blood backs up in the venous system and you
systemic symptoms-- Peripheral symptoms:
® side heart failure exhibits urinary frequency d/t increased
urinary output.
1. Weight Gain: from edema (heart can no longer circulate the blood so the
body allows it to seep from the intravascular system into tissues to try to get
rid of some circulatory fluid volume. Daily weight!!!!
2. Pitting edema in the feet and ankles. Seems to disappear over night (while
lying flat). it actually redistributes the edema while sleeping. When up and
walking (gravity) you see edema again.
Diagnostic Findings:
1. Limited Activity
Bed rest (maybe with bathroom privileges)
2. Drugs--
Digoxin: given to slow the heart rate and increase the strength
of myocardial contractions.
Lasix
Sedatives (for dyspnea & anxiety)
Aspirin or anticoagulants to prevent thrombi from decreased
circulation.
3. Low sodium diet: Water follows salt--so the more sodium you eat the
more fluid you hold.
Surgical Management
Nursing Management
12. Monitor lab-- Potassium for diuretics (encourage KCL foods such as
potatoes, OJ, bananas, prunes, raisins)
Potassium-Sparing Diuretics
1. Aldactone
2. Midamor
3. Dyrenum
* Salt Substitutes are high in potassium.
Lasix is classified as a loop diuretic--it depletes potassium.
Mannatol is classified as an osmotic diuretic-- used for head trauma.
Client and Family Teaching
13. Notify MD if 2lb. Weight gain (1 liter of fluid) (weigh every day)
14. Rest periods between activity.
15. Teach Client to take their pulse and blood pressure.
16. Take medication as prescribed.
17. Notify physician if pulse is <60 or >120.
Pulmonary Edema
S/s
(See left sided heart failure--respiratory S/S)
Diagnostic Findings
Chest X-ray shows pulmonary infiltration
ABG: severe hypoxemia/hypercapnia (high CO2)
Medical Management
3. VAD
IABP (balloon pump)
Nursing Management
1. IV Access Line
2. Oxygen/ Pulse Ox
5. F/C to help assess response to diuretics, and I/O but the best way is daily
weight.
6. HOB elevated
*Valsava: bear down and hold breath (Vagal Stimulation) to decrease BP &
Pulse