NR 324 EXAM 2 MEDICAL SURGICAL STUDY GUIDE|BEST FOR 2022 EXAM

NR 324 EXAM 2 MEDICAL SURGICAL STUDY GUIDE HEART FAILURE Assessment of left and right CAD: Left Sided Heart Failure ( • Most common • Prevents normal forward flowing blood • Blood backs up into the left atrium, and then to the pulmonary vein ◦ Pressure increases, fluid leaks from the pulmonary capillary bed into the interstitium and then the alveoli ◦ Results in pulmonary congestion and edema • Signs ◦ LV heaves ◦ Alternating pulses (strong, weak): ◦ Increased HR ◦ Decreased PaO2, slight increase PaCO2 (result poor oxygen exchange) • Crackles (pulmonary edema) • S3/S4 sounds • Pleural effusion • Changes in mental status, restlessness, confusion • Orthopnea, shallow respirations, dry hacking cough • Nocturia o **Frothy, pink-tinged sputum (advanced pulmonary edema) Right Sided Heart Failure • RV fails to contract effectively • Backup of blood into the right atrium, and then venous circulation • Venous congestion in systemic circulation results in ◦ JVD ◦ Hepatomegaly ◦ Splenomegaly ◦ Vascular congestion of GI tract ◦ Peripheral edema: blood returning is blocked/backed up • Can result from acute conditions such as RIGHT VENTRICULAR INFARCTION or P.E. • CorPulmonale: right ventricular dilation and hypertrophy caused by pulmonary disease • Primary cause: Left-sided HF ◦ Left side HF results in pulmonary congestion, increased pressure in the blood vessels of lungs (pulmonary HTN) ◦ Chronic pulmonary HTN puts increased right ventricular afterload and results in right-sided hypertrophy and HF • Signs/Symptoms ◦ RV heaves, murmurs ◦ JVD: 30-45 degree angle to be able to see ◦ Edema (pedal, scrotum, sacrum) ◦ Weight gain ◦ Increased HR ◦ Ascites: abdomen ◦ Anasarca (massive generalized body edema): 2+ everywhere ◦ Hepatomegaly (liver enlargement): ◦ RUQ pain, anorexia, GI bloating o o • Fatigue: earliest symptoms of chronic HF, caused by decreased CO, impaired perfusion to vital organs, decreased oxygenation to the tissues, and anemia • Dyspnea: Paroxysmal nocturnal dyspnea: reabsorption of fluid from dependent body areas when patient is flat • Tachycardia: body trying to compensate • Edema ◦ Occur in dependent body areas (Peripheral), liver (hepatomegaly), abdominal cavity (acities) and lungs (pulmonary edema and pleural effusion) • Nocturia ◦ Decreased CO will have impaired renal perfusion and decreased urine output during the day ◦ When they lie down at night, fluid moves back into circulatory system • Skin ◦ Tissue capillary oxygen extraction is increased, skin may appear dusky ◦ Lower extremities shiny and swollen, diminished or absent hair growth ◦ Chronic swelling brown areas • Behavioral Changes ◦ Decreased cerebral perfusion leads to restlessness, confusion, decreased attention span or memory ◦ Seen in late stages • Chest Pain ◦ Decreased coronary artery perfusion from decreased CO and increased myocardial work • Weight Changes ◦ Fluid retention ◦ Renal failure and fluid rentetion ◦ Ascities, hepatomegaly causes anorexia and vomiting ◦ Cachexia: muscle wasting and fat loss • Renal insufficiency and failure • Liver cells die, fibrosis occurs, and cirrhosis can develop o ◦ Nursing care in hospital: Table 35-6 • Goals: Decrease in symptoms, decrease in peripheral edema, increase in exercise tolerance, adherence with medical regimen, no complications • Measures to manage BP or cholesterol with medication, diet, and exercise • Valvular disease: have valve replacement planned before lung congestion develops • CAD patients should consider coronary revascularization procedures • Dysrythmias: antidysrhythmic drugs or pacing therapy • Vaccinations against flu and pneumonia • Treatment and quality of life goals • Symptom management controlled by self management tools: daily weights, drug regimens, diet, exercise • Salt and sometimes water must be restricted • Conserve energy • Support systems