Post on 04-Apr-2018
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Alterations in
OxygenationManagement of Patients with
Complications from Heart Disease
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Heart Failure
The inability of the heart to pump sufficientblood to meet the needs of the tissues foroxygen and nutrients
Asyndrome characterized by fluid overload or
inadequate tissue perfusion The term HF indicates myocardial disease, in
which there is a problem with the contraction ofthe heart (systolic failure) or filling of the heart
(diastolic failure). Some cases are reversible. Most HF is a progressive, lifelong disorder
managed with lifestyle changes and medications.
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Clinical Manifestations
Right-sided failure RV cannot eject sufficient amounts of blood, and
blood backs up in the venous system. This resuts inperpheral edema, hepatomegaly, ascites, anorexia,
nausea, weakness, and weight gain. Left-sided failure
LV cannot pump blood effectively to the systemiccirculation. Pulmonary venous pressures increase,
resulting in pulmonary congestion with dyspnea,cough, crackles, and impaired oxygen exchange.
Chronic HF is frequently biventricular.
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Medications
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor blockers
Beta-blockers (Inderal) Diuretics
Digitalis
Other medications
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Nursing Process: The Care of the
Patient with HF: Assessment
Health history
Sleep and activity
Knowledge and coping
Physical exam Mental status
Lung sounds: crackles and wheezes
Heart sounds Fluid status/signs of fluid overload
Daily weight and I&O
Assess responses to medications
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Nursing Process: The Care of the
Patient with HF: Diagnosis
Activity intolerance and fatigue
Excess fluid volume
Anxiety Powerlessness
Noncompliance
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Nursing Process: The Care of the
Patient with HF: Planning
Goals may include promoting activity andreducing fatigue, relieving fluid overloadsymptoms, decreasing anxiety or
increasing the patients ability to manageanxiety, encouraging the patient to makedecisions and influence outcomes,
teaching the patient about the self-careprogram.
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Activity Intolerance
Bed rest for acute exacerbations
Encourage regular physical activity; 30-45 minutes daily
Exercise training
Pacing of activities
Wait 2 hours after eating before doing physical activity.
Avoid activities in extremely hot, cold, or humid weather.
Modify activities to conserve energy.
Positioning; elevation of HOB to facilitate breathing andrest, support of arms
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Fluid Volume Excess
Assessment for symptoms of fluidoverload
Daily weight
I&O
Diuretic therapy; timing of meds
Fluid intake; fluid restriction Maintenance of sodium restriction
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Patient Teaching
Medications Diet: low-sodium diet and fluid restriction Monitoring for signs of excess fluid, hypotension,
and symptoms of disease exacerbation,including daily weight
Exercise and activity program Stress management Prevention of infection Know how and when to contact health care
provider Include family in teaching
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Pulmonary Edema
Acute event in which the LV cannot handle anoverload of blood volume. Pressure increases inthe pulmonary vasculature, causing fluid tomove out of the pulmonary capillaries and into
the interstitial space of the lungs and alveoli. Results in hypoxemia Clinical manifestations: restlessness, anxiety,
dyspnea, cool and clammy skin, cyanosis, weak
and rapid pulse, cough, lung congestion (moist,noisy respirations), increased sputum production(sputum may be frothy and blood-tinged),decreased level of consciousness
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Management of Pulmonary Edema
Prevention
Early recognition: monitor lung sounds and forsigns of decreased activity tolerance and
increased fluid retention Place patient upright and dangle legs.
Minimize exertion and stress.
Oxygen Medications
Diuretic (furosemide)
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Thank you for listening