MedicalSurgical Nursing Concepts Practice 3 rd edition Chapter

Heart Failure Etiology Older Adult care Pathophysiology Ø Ø Right- or left-sided heart failure

Copyright © 2017, Elsevier Inc. All rights reserved. 1

Goals of Treatment Reduce the demand for oxygen and the workload of the heart.

Pathophysiology of Congestive Heart Failure After a Myocardial Infarction Congestion Increased pressure Copyright ©

Factors that Precipitate Heart Failure Anemia Systemic infection (sepsis) Fluid overload Pulmonary embolism Thyroid

Comparison of Left-Sided and Right. Sided Heart Failure Selected etiology Pathophysiology Signs and symptoms

Systolic and Diastolic Failure Problems occur in either the filling or ejection phase of

Treatment Medical intervention Heart-healthy diet Cardiac resynchronization therapy (CRT) Left ventricular assist devices (LVADs)

Heartmate Left Ventricular Assist Device Courtesy of Thoratec, Pleasanton, CA. Copyright © 2017, Elsevier

Nursing Management Assessment (data collection) Ø Ø Left-sided failure versus right-sided failure Older adult

Cardiac Conduction Disorders (Dysrhythmias) Etiology Pathophysiology Signs and symptoms Life-threatening cardiac dysrhythmias Diagnosis and

Cardiac Conduction System From Aehlert B: EKGs made easy, ed. 2, St. Louis, 2002,

Evaluating an Electrocardiographic Rhythm Strip Obtain a strip with at least 10 large graph

Treatment Drug therapy Cardioversion Cardiac pacemakers Ø Patient teaching Radiofrequency catheter ablation Automatic implantable

Thoracic Placement of Permanent Pacemaker and Transvenous Pacing Wires A, Reproduced with permission of

Infective Endocarditis Etiology Pathophysiology Signs and symptoms Diagnosis Treatment Older adult consideration Copyright ©

Pericarditis Effusion Cardiac tamponade Friction rub Dressler’s syndrome Pulsus paradoxus Diagnosis Ø Ø Pericardiocentesis

Effects of Pericardial Effusion From Gould BE: Pathophysiology for health professions, ed. 2, Philadelphia,

Cardiomyopathy Etiology Signs and symptoms Diagnosis Medical treatment Heart transplant Copyright © 2017, Elsevier

Three Main Types of Cardiomyopathy Dilated Hypertrophic Restrictive Copyright © 2017, Elsevier Inc. All

Nursing Management for Infectious and Inflammatory Heart Disease Thorough history and physical examination Medications

Cardiac Valve Disorders Mitral valve prolapse (MVP) Mitral stenosis Mitral regurgitation (insufficiency) Aortic stenosis

Treatment of Valve Disorders Medical treatment Surgical treatment Ø Ø Reparative procedures Valve replacement

Mechanical and Biologic Tissue Valves for Valve Replacement From Bonow RO, Mann DL, Zipes

Common Therapies and Their Nursing Implications Oxygen therapy Pharmacologic agents Ø Digitalis toxicity Dietary

Classic Symptoms of Digitalis Toxicity Yellow-green halos around lights, nausea, diarrhea, and confusion Physiologic

Community Care Thorough heart and lung assessment Ø Ø Ø Identify beginning signs of

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Heart Failure Etiology Older Adult care Pathophysiology Ø Ø Right- or left-sided heart failure Systolic failure or diastolic failure Signs, symptoms, and diagnosis Treatment Copyright © 2017, Elsevier Inc. All rights reserved. 2

Goals of Treatment Reduce the demand for oxygen and the workload of the heart. Strengthen the heart’s pumping action. Relieve venous congestion in the lungs. Minimize sodium and water retention in the tissues. Copyright © 2017, Elsevier Inc. All rights reserved. 4

Factors that Precipitate Heart Failure Anemia Systemic infection (sepsis) Fluid overload Pulmonary embolism Thyroid disorders Dysrhythmias Pericarditis, myocarditis, or endocarditis Thiamine deficiency Chronic pulmonary disease Physical, emotional, or environmental stress Copyright © 2017, Elsevier Inc. All rights reserved. 6

Systolic and Diastolic Failure Problems occur in either the filling or ejection phase of the cycle. Determination of ejection fraction can be done with echocardiography or left heart catheterization and is a key feature in determining the correct treatment. Copyright © 2017, Elsevier Inc. All rights reserved. 10

Treatment Medical intervention Heart-healthy diet Cardiac resynchronization therapy (CRT) Left ventricular assist devices (LVADs) Ventricular restoration surgery Complementary and alternative therapies Copyright © 2017, Elsevier Inc. All rights reserved. 11

Nursing Management Assessment (data collection) Ø Ø Left-sided failure versus right-sided failure Older adult care Nursing diagnosis and planning Implementation Evaluation Copyright © 2017, Elsevier Inc. All rights reserved. 13

Cardiac Conduction Disorders (Dysrhythmias) Etiology Pathophysiology Signs and symptoms Life-threatening cardiac dysrhythmias Diagnosis and treatment Copyright © 2017, Elsevier Inc. All rights reserved. 14

Evaluating an Electrocardiographic Rhythm Strip Obtain a strip with at least 10 large graph squares. Calculate the rate. Measure the distance between the P waves. Measure the PR interval. Measure the QRS duration. Copyright © 2017, Elsevier Inc. All rights reserved. 16

Treatment Drug therapy Cardioversion Cardiac pacemakers Ø Patient teaching Radiofrequency catheter ablation Automatic implantable cardiac defibrillators (ICDs) Copyright © 2017, Elsevier Inc. All rights reserved. 17

Thoracic Placement of Permanent Pacemaker and Transvenous Pacing Wires A, Reproduced with permission of Medtronic, Inc. B, From Lewis SL, Heitkemper MM, Dirksen SR, et al: Medicalsurgical nursing: assessment and management of clinical problems, ed. 8, St. Louis, 2011, Mosby. Copyright © 2017, Elsevier Inc. All rights reserved. 18

Cardiac Valve Disorders Mitral valve prolapse (MVP) Mitral stenosis Mitral regurgitation (insufficiency) Aortic stenosis Aortic regurgitation (insufficiency) Copyright © 2017, Elsevier Inc. All rights reserved. 25

Mechanical and Biologic Tissue Valves for Valve Replacement From Bonow RO, Mann DL, Zipes DP, Libby P: Braunwald’s heart disease: a textbook of cardiovascular medicine, ed. 9, Philadelphia, 2012, Saunders. Copyright © 2017, Elsevier Inc. All rights reserved. 27

Common Therapies and Their Nursing Implications Oxygen therapy Pharmacologic agents Ø Digitalis toxicity Dietary controls Ø Heart-healthy lifestyle recommendations Copyright © 2017, Elsevier Inc. All rights reserved. 28

Classic Symptoms of Digitalis Toxicity Yellow-green halos around lights, nausea, diarrhea, and confusion Physiologic changes resulting from age, electrolyte imbalances (particularly hypokalemia or hypercalcemia), renal impairment, metabolic disturbances, and certain heart conditions can predispose a patient to digitalis toxicity. Copyright © 2017, Elsevier Inc. All rights reserved. 29

Community Care Thorough heart and lung assessment Ø Ø Ø Identify beginning signs of heart failure. Monitor heart rates and rhythms closely. Replace fluids and electrolytes early in the course of the illness. Patient teaching Copyright © 2017, Elsevier Inc. All rights reserved. 30