CHF Simulation: Preparation Questions

1. List the risk factors for chronic left-sided heart failure related to coronary artery disease. The risk factors are hypertension, diabetes, elevated lipids, tobacco use, and obesity. 2. Explain the cause of the compensations for chronic heart failure. Question is confusing and the answer based on the words written is chronic heart failure. Chronic heart failure causes decreases in blood flow or ineffective blood flow mechanisms. These situations cause the body to compensate to maintain homeostasis which the body is built to do. 1. Frank –Starling mechanism: Increases contractile force leading to increased CO 2. Neuroendocrine responses including activation of the sympathetic nervous system and renin-angiotensin system: a) Decreased CO stimulates the sympathetic nervous system and catecholamine release. Increased HR, BP, contractility, vascular resistance, venous return. b) Decreased CO and decreased renal perfusion stimulate renin-angiotensin system. Vasoconstriction and increased BP c) Angiotensin stimulates aldosterone release from adrenal cortex. Salt and water retention by kidneys, increased vascular volume. d) ADH is released from posterior pituitary. Water excretion inhibited. e) Atrial natriuretic peptide and brain natriuretic peptide are released. Increased sodium excretion, Diuresis, Vasodilation. f) Blow flow is redistributed to vital organs (heart/brain). Decreased perfusion of other organ systems. Decreased perfusion of skin and muscles. 3. Myocardial hypertrophy: Increased cardiac work load causes myocardial muscle to hypertrophy and ventricles to dilate. Increased contractile forced to maintain CO. 3. Describe the manifestations and effects of right-sided and left-sided heart failure.  Manifestations of right-sided heart failure are RV heaves, murmurs, jugular venous distention, edema, weight gain, increased heart rate, ascites, anasarca, and hepatomegaly. The effects are fatigue, anxiety, depression, depended bilateral edema, right upper quadrant pain, anorexia and GI bloating, and nausea.  Manifestations of left-sided heart failure are L V heaves, pulsus alternans, increased heart rate, PMI displaced inferiorly and posteriorly decreased PaO2, slight increase PaCO2, crackles, S3 and S4 heart sounds, pleural effusion, changes in mental status, restlessness, and confusion. The effects are weakness, fatigue, anxiety, depression, dyspnea, shallow respirations up to 32 -40/min, paroxysmal nocturnal dyspnea, orthopnea, dry hacking cough, nocturia, and frothy pink-tinged sputum. 4. List the goals in the interdisciplinary care of a patient with chronic heart failure. This study source was downloaded by from CourseH on :49:32 GMT -05:00 Main goals and treatment of chronic heart failure or to treat the underlying cause and contributing factors, maximize CO, provide treatment to alleviate symptoms, improve ventricular function, improve quality of life, preserve target organ function, and improve mortality and morbidity risks. a. List the two hormones released by the heart muscle in response to changes in blood volume. Atrial natriuretic peptide B-type natriuretic peptide 5. Explain the nursing implications for the client receiving echocardiography with Doppler flow studies. Before the Procedure 1) Obtain and document the patient's history of drug allergies, surgeries, bleeding disorders and medicine uses. 2) Address any anxieties and fears that the patient may have about the procedure. 3) Verify the patient's understanding of the procedure and obtain informed consent. 4) Review lab values as ordered and report any variances to the physician such as CBC and coagulation studies. 5) apply electrographic electrodes if not already in place. 6) Help the patient remove and store any jewelry, denture; appliance and clothes. 7) Establish and assess adequate Intravenous access if needed for any drugs to be used such as for sedation. During the Procedure 1) Establish a low flow of oxygen by nasal cannula. 2) Initiate continuous oxygen saturation monitoring. 3) Assist the patient in a recumbent left lateral position. 4) Assist in positioning patient's head in flexed position if needed. 5) Keep patient comfortable and warm. 6) Assess cardiac rhythm, vital signs, and oxygen saturation at 1-3 min intervals. 7) Assess the patient for discomfort. 8) administer the right drug dosage for procedural sedation if needed and as specified by the doctor. 8) Ensure that the patient fasts for 4-6 hrs before the procedure as directed by doctor. After the Procedure 1) Assess cardiac rhythm, vital signs level of consciousness; oxygen saturation at east every 15 min. until the patient is awake and his or her condition is stable. 2) Discontinue IV once patient is stable unless needed for other purpose. 3) Once patient is awake, progress diet as tolerated. 4) Assess patient for discomfort and any complications (respiratory, cardiac and esophageal) and report findings to physician. 5) Charting. Your observations. 6. Define refractory heart failure. This study source was downloaded by from CourseH on :49:32 GMT -05:00 Patients with cardiac decompensation who fail to respond satisfactorily to routine therapeutic measures 7. List the nursing implications and education needs for each of the following categories of medication related to heart failure: a. Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) Nursing implications: Assess blood pressure and pulse periodically during therapy, signs of and angioedema. Monitor prescription refills for compliance, daily weights electrolyte and renal function. Patient Education: take medication as directed at the same time each day, do not discontinue a standard therapy unrest directed by Dr. Hypotension risk change position slowly. May cause dizziness and inform patient avoid running our other activities until response of medication is known. Notify Dr. if allergic reaction are rash occurs. Monitor BP at least weekly and report if it changes to health care professional. b. Beta-adrenergic receptor blockers Nursing implications: monitor blood pressure and pulse, intake and output ratios and daily weight. Assess for signs and symptoms CHF, chest pain, and migraines. Patient education: instruct patient to continue taking medication even if feeling well. Abrupt withdrawal may cause life threatening arrhythmias, hypertension, where myocardial ischemia. Medication controls, but does not cure, hypertension. c. Diuretics Nursing Implications: Assess fluid status, patient for anorexia, muscle weakness, numbness, tingling, confusion, excess thirst, and paresthesia. Monitor daily weight, intake/output, edema, lung sounds, skin turgor, and mucous membranes, blood pressure and pulse, compliance, electrolytes, blood glucose, BUN, serum uric acid levels. Patient Education: Instruct patient take medication as directed, change positions solely to minimize orthostatic hypotension, monitor weight weekly report significant change. Contacts Health Care professional immediately if muscle weakness, cramps, not shut, dizziness, or numbness/tingling of extremities occur. Monitor blood pressure and pulse before medication administration. d. Positive inotrope agents Nursing Implications: Assess history, drug allergies, and contraindications. Assess blood pressure, apical pulse if less than 60 or greater than 120 hold dose notified Dr., heart and lung sounds. Notify if a Dr. If signs of toxicity are present such as anorexia, nvd, visual disturbances. Patient Education: Teach patients to look for signs of toxicity and to notify the Dr. If present. Teach patient to check blood pressure and apical pulse, and to report when less than 60 greater than 120 and hold medication. e. Sympathomimetic agents Nursing Implications: Use infusion pump to admin. Avoid abrupt discontinuation of meds. Change solutions and tubing q24h. Monitor liver function/ platelet counts. Monitor for signs and symptoms of pulmonary toxicity. Monitor continuous on ECG during IV therapy. Patient Education: Teach patient to monitor pulse daily and report abnormalities. Avoid drinking grapefruit juice during therapy. This study source was downloaded by from CourseH on :49:32 GMT -05:00 f. Phosphodiesterase inhibitors Nursing Implications: Assess heart rate and blood pressure continuously, discontinue if blood pressure drops excessively. Monitor intake and output and daily weight. Monitor ECG continuously during infusion due to potential for arrhythmias which can occur and are potentially life threatening. Monitor electrolytes and renal function frequently and correct hypokalemia prior to administration to decrease risk of arrhythmias. Hypotensive risk if overdose if manifests decrease or discontinue. Patient Education: Inform patient and family of reasons for administration. This drug is not here but temporary measure to control symptoms of heart failure. 8. List the interdisciplinary interventions for each of the following nursing diagnoses related to • chronic heart failure. a. Decreased cardiac output Assess mentation, heart rate and blood pressure, skin color and temperature, peripheral pulses, fluid balance and weight gain, heart sounds and lung sounds, urine output, chest pain, and response to the increased activity. Perform hemodynamic and continuous ECG monitoring. Administer doctor prescribed diuretics, Morphine, nitroprusside, Blood Pressure Medications. b. Excessive fluid volume Monitor for significant weight change, vital signs, distended neck veins and ascites, abdominal girth, heart and long sounds. Assess for presence of edema by palpating over tibia, ankles, feet, and sacrum. Monitor input and output closely. Administer diuretic medication as prescribed by doctor. Monitor serum electrolytes especially potassium. c. Activity intolerance Determine patient's perception of causes of fatigue or activity intolerance. Assess patient's level of mobility. Assess nutritional status. Assess need for ambulation aids: bracing, cane, walker, equipment modification for activities of daily living (ADLs). Assess patient's cardiopulmonary status before activity using the following measures: Heart rate Orthostatic BP changes Need for oxygen with increased activity How Valsalva's maneuver affects heart rate when patient moves in bed Monitor patient's sleep pattern and amount of sleep achieved over past few days. Observe and document response to activity. Assess emotional response to change in physical status. Determine patient's perception of causes of fatigue or activity intolerance. Assess patient's level of mobility. Assess nutritional status. Assess need for ambulation aids: bracing, cane, walker, equipment modification for activities of daily living (ADLs). Assess patient's cardiopulmonary status before activity using the following measures: Heart rate Orthostatic BP changes Need for oxygen with increased activity How Valsalva's maneuver affects heart rate when patient moves in bed Monitor patient's sleep pattern and amount of sleep achieved over past few days. Observe and document response to activity. Assess emotional response to change in physical status. d. Ineffective health maintenance Assess client's feelings, values, and reasons for not following prescribed plan of care. See Related Factors. Assess for family patterns, economic issues, and cultural patterns that influence compliance with a given medical regimen. Help client determine how to arrange a daily schedule that incorporates the new health care regimen Help client to choose healthy lifestyle and to have appropriate diagnostic screening tests. Obtain or This study source was downloaded by from CourseH on :49:32 GMT -05:00 design educational material that is appropriat