Managing Heart Failure.ppt

1、Managing Heart Failure,By Lacey Buckler, RN, ACNP-BC, MSN Nursing made Incredibly Easy! May/June 2009 2.5 ANCC contact hours Online: 2009 by Lippincott Williams seen in acute heart injury such as MI Chroniclong-term syndrome in which a patient exhibits symptoms over a long period of time, usually as

2、 a result of a preexisting cardiac condition,Conditions That Can Lead to Heart Failure,Coronary artery diseaseprimary cause of heart failure in 60% of patients Cardiomyopathydisease of the myocardium; three types: dilated, hypertrophic, and restrictive Hypertensionincreases cardiac workload, leads t

3、o hypertrophy Valvular heart diseaseincreases pressure within the heart and cardiac workload,Picturing Dilated Cardiomyopathy,Picturing Left Ventricular Hypertrophy,Other Conditions That Contribute to Heart Failure,Increased metabolic rate Iron overload Hypoxia Severe anemia,Electrolyte abnormalitie

4、s Cardiac dysrhythmias Diabetes,Left-Sided Heart Failure Signs these drugs delay the onset of symptoms and decrease the risk of death and hospitalization.,Managing The Stages,Stage C includes patients with past or current heart failure symptoms associated with structural heart disease such as advanc

5、ed ventricular remodeling. Use appropriate treatments for Stages A and B. Modify fluid and dietary intake. Use additional drug therapies, such as diuretics, aldosterone inhibitors, and ARBs in patients who cant tolerate ACE inhibitors, digoxin, and vasodilators. Treat with nonpharmacologic measures

6、such as biventricular pacing, an ICD, and valve or revascularization surgery. Avoid drugs known to cause adverse reactions in symptomatic patients, including nonsteroidal anti-inflammatory drugs, most antiarrhythmics, and calcium channel blockers. Administer anticoagulation therapy to patients with

7、a history of previous embolic event, paroxysmal or persistent atrial fibrillation, familial dilated cardiomyopathy, and underlying disorders that may increase the risk of thromboembolism.,Managing The Stages,Stage D includes patients with refractory advanced heart failure having symptoms at rest or

8、with minimal exertion and frequently requiring intervention in the acute setting because of clinical deterioration. Improve cardiac performance. Facilitate diuresis. Promote clinical stability. Achieving these goals may require I.V. diuretics, inotropic support (milrinone, dobutamine, or dopamine),

9、or vasodilators (nitroprusside, nitroglycerin, or nesiritide). As heart failure progresses, many patients can no longer tolerate ACE inhibitors and beta-blockers due to renal dysfunction and hypotension and may need supportive therapy to sustain life (a left ventricular assist device, continuous I.V

10、. inotropic therapy, experimental surgery or drugs, or a heart transplant) or end-of-life or hospice care.,IHI Treatment Bundle,Assessment of left ventricular systolic function An ACE or an ARB when left ventricular EF is less than 40% Anticoagulant if patient has atrial fibrillation Smoking cessati

11、on counseling,Discharge instructions: activity, diet, medications, weight monitoring, reportable symptoms, follow-up appointments Seasonal flu shot Pneumococcal vaccine Optional beta-blocker therapy,Three Basic Treatment Strategies,Pharmacologic management Devices and surgical management Lifestyle m

12、anagement,Pharmacologic Management,Foundation is the ACE inhibitor Improves ventricular function Improves patient well-being Reduces hospitalization Increases survival If the patient is unable tolerate an ACE inhibitor, an ARB can be used A beta-blocker should be started on all patients with an EF l

13、ess than 40% due to mortality benefit shown in randomized control trials,Pharmacologic Management,An aldosterone antagonist may be added for patients whose EF is less than 35% and who are on an adequate ACE inhibitor Other drugs: hydralazine/isorbide, diuretics, and digoxin,Devices and Surgical Mana

14、gement,First option if the cause of heart failure can be treated surgically Several therapeutic options: pacing, an ICD, a ventricular assist device, an artificial heart, or a heart transplant Pacing or resynchronization therapy is recommended for patients with NYHA Class III or IV with QRS prolonga

15、tion who are experiencing symptoms despite medications,Devices and Surgical Management,An ICD may be used in patients with arrhythmias to prevent sudden cardiac death A left ventricular assist device may be used as a bridge to transplant or destination therapy End-stage heart failure patients may co

16、nsider heart transplant,Lifestyle Management,Adherence to treatment regime Symptom recognition Weight monitoring Diet and nutrition,Fluid intake Alcohol and smoking cessation Physical activity,Nursing Interventions,Administer medications and monitor response Weigh the patient daily at the same time

17、on the same scale, early in the day after urination; report a 2 to 3 lb gain in a day or 5 lbs in a week to the healthcare provider Auscultate lung sounds Monitor vital signs Identify and evaluate edema severity Examine skin turgor,Patient Teaching,The disorder, diagnosis, and treatment Signs and symptoms of worsening heart failure When to notify the healthcare provider The importance of follow-up care The need to avoid high-sodium foods The need to avoid fatigue,Patient Teaching,Instructions about fluid restrictions The need for the patient to weigh