Professional Documents
Culture Documents
HEART FAILURE Etiology/pathophysiology o abnormal condition characterized by circulatory congestion resulting from the hearts inability to act as an effective pump o cardiac output is diminished and peripheral tissue is not adequately perfused o congestion of the lungs and periphery may occur o acute or chronic o Left ventricular failure o most common; pulmonary edema o Right ventricular failure o usually caused by left ventricular failure; peripheral edema o CV d/o that lead to heart failure include: o Atherosclerotic heart disease o MI o HTN o Rheumatic heart disease o Congenital heart disease o Cardiomyopathy o Valvular diseases o Arrythmias o Noncardiovascular causes of heart failure include: o pregnancy and childbirth o increased environmental temp or humidity o severe physical or mental stress o thyrotoxicosis- too much thyroid hormones in the cell S/S: tachycardia, tremors, anxiety, wt loss, diarrhea, hypothyroidism o Right sided and Left sided heart failure o bc the 2 ventricles of the heart represent 2 separate pumping systems; it is possible for one to fail alone for a short period o most heart failure begins w/ Left ventricular failure and progresses to failure of both ventricles o acute pulmonary edema results from left ventricular failure o if pulmonary edema is not treated; death will occur from suffocation as the client literally drowns in own fluids o Forward and Backward failure o Forward failure- an inadequate output of the affected ventricle causes decreased perfusion to vital organs o Backward failure- blood backs up behind the affected ventricle, causing increased pressure in the atrium behind the affected ventricles o Low and High output failure o Low output failure: not enough cardiac output is available to meet the demands of the body o High output failure: when a condition causes the heart to work harder to meet the demands of the body o Systolic and Diastolic Failure Systolic failure leads to problems w/ contraction and the ejection of the blood o Diastolic failure leads to problems w/ the heart relaxing and filling w/ blood o Compensatory Mechanisms o act to restore cardiac output to near-normal levels o initially these mechanisms increase CO, but they eventually have a damaging effect on pump action o contribute to an increase in myocardial O2 consumption (myocardial reserve is exhausted and s/s heart failure develop) o include increased heart rate improved stroke volume, arterial vasoconstriction, sodium and water retention and myocardial hypertrophy o Stroke Volume- volume of blood pumped by the L and R ventricle in one contraction Clinical Manifestations/assessment p. 361 o decreased cardiac output (Box 8-4) o fatigue o angina o anxiety; restlessness o oliguria o decreased GI motility o pale, cool skin o weight gain o tachycardia o cyanosis o L ventricular failure o pulmonary congestion dyspnea paroxysmal nocturnal dyspnea cough frothy, blood-tinged sputum orthopnea- difficulty breathing when laying down pulmonary crackles o R ventricular failure o distended jugular veins o anorexia, nausea, abdominal distention o liver enlargement w/ RUQ pain o Ascites o edema in feet, ankles, sacrum; may progress up the legs into thighs, external genitalia, and lower trunk Diagnostic Tests o blood tests o EKG o CXR o Echo o Cardiac Catheter Medical management/nursing interventions o increase cardiac efficiency o digitalis o vasodilators o Ace inhibitors (decrease BP) o Bedrest; HOB elevated o Oxygen o
PULMONARY EDEMA Etiology/pathophysiology o accumulation of fluid in lung tissues and alveoli o complication of congestive heart failure (CHF) Clinical manifestations/assessment o restlessness o agitation o disorientation o diaphoresis o dyspnea and tachypnea o tachycardia o pallor/cyanosis o cough-large amts of blood tinged, frothy sputum o wheezing, crackles o cold extremities Medical management/nursing interventions o high fowlers position o morphine sulfate o oxygen o nitroglycerin- vasodilator o diuretics o inotropic agents: Dopamine o vasodilators VALVULAR HEART DISEASE Etiology/pathophysiology o heart valves are compromised and do not open and close properly o Stenosis o insufficiency o Causes may be: o congenital o Rheumatic fever Clinical manifestations/assessments o fatigue o angina o oliguria o pale, cool skin o weight gain o restlessness o abnormal breath sounds o edema Medical management/nursing interventions o restrict activities o low sodium diet o diuretics o Digoxin o Antidysrhythmics- convert to normal rhythm o Surgery o open mitral commissurotomy o valve replacement RHEUMATIC HEART DISEASE
Varicose Veins Etiology/pathophysiology tortuous veins; dilated vein w/ incompetent valves Clinical manifestations/assessment dark, raised, tortuous veins fatigue; dull aches cramping of the muscles heaviness or pressure of extremity edema, pain, changes in skin color, and ulcerations w/ venous stasis Medical management/nursing interventions elastic stockings rest elevate legs Sclerotherapy surgery vein ligation and stripping Venous Stasis Ulcers Etiology/pathophysiology Ulcerations of the legs from chronic deep vein insufficiency and stasis of blood in the venous system of the legs open necrotic lesion due to an inadequate supply of oxygenrich blood to the tissue Causes: Varicose veins, burns, trauma, sickle cell anemia, diabetes mellitus, neurogenic d/o, and hereditary factors Clinical Manifestations/assessments pain ulceration w/ dark pigmentation edema Medical management/nursing interventions Diet: increased protein; Vit A and C and zinc debridement of necrotic tissue Antibiotics Unna boot Electrical Waves o P waves o contraction of the atria o (depolarization of the atria) o QRS complex o shows the depolarization/contraction of the ventricles o atria relax as the ventricles contract o T waves o the relaxation of the ventricles o T-wave- relaxation of the ventricles relaxation phase (repolarization of ventricles) o o o Na+= maintains fluid balance K+= req. for relaxation of cardiac muscle Ca++= nec. for contraction cardiac muscle