Pathophysiologic Diagram of a Heart Failure Pt by GregorAlfonsin C.

Pondoyo
Predisposing factors Age: 88 y.o. Hypertension DM 2 Precipitating factors Sedentary lifestyle Diet (high Na intake) Non-compliance to meds

Inc. blood viscousity

Aspirin

Inc. (peripheral) vascular resistance

Inc. Afterload

Inc. L. ventricular workload X-ray + for heart enlargement

Decrease blood flow to kidneys BUN= 24 mg/dL Prompts kidneys to secrete renin Inc. CO

Ventricular dilation

Inc. Wall stress

Hyperplasia Angiotensinogen (from Liver) Inc. O2 requirement Angiotensin 1 Remodeling

A. Converting Enzyme (Lungs)

Inc. force & rate of contraction

O2 via nasal cannula

Dec. contractility Low O2

Vasoconstriction

Angiotensin 2 Sympathetic activation Aldosterone release Inc. tubular Na reabsorption S3 gallop Tachyarrthymias Pale extremities 4 seconds capillary refill Trop T <0.1 ug/dL Low HCT & HGB

Inc. cell death

H2O conservation

Osmotic fluid reabsorption

Dec. ventricular contraction

Digoxin

Inc. amount of blood in L. ventricle Dec. capacity to receive blood from L. atrium Metoprolol&Ramipril, Dobutamine, Morphine, Isosorbidedinitrate

Blood goes back to L. atrium

Inc. L. atrial workload

Atrial dilation, remodeling, sympathetic activation

Inc. L. atrial pressure

Inability to receive full pulmonary blood Inc. R. ventricular workload

Inc. pulmonary pressure

Fluid movement from interstitium to alveoli

R. ventricular dilation, remodeling, sympathetic activation

Dec. capacity to receive blood from R. atrium

LEFT Manifestations SOB (3-pillow orthopnea) Use of accessory muscles when breathing RR-36cpm Productive cough Rales Pale extremities Loss of appetite due to SOB Activity intolerance/very fatigued Exhausted facie

Blood goes back to R. atrium

Inc. R. atrial workload

Atrial dilation, remodelling, sympathetic activation

Backward flow of blood from systemic circulation Arixtra Nexium Inability to receive full systemic blood

Systemic congestion

Inc. Preload

Spironolactone & Furosemide RIGHT Manifestations Bipedal edema Distended Jugular neck veins @ 45 degree position Anorexia Nausea Vomiting Headache Metoclopramide

+ urine output Low K& Na

Lactulose &Dolculax

KCL supplementations

Legend:

Phenomenon

Direction of Pathology

Manifestations

Treatment/Management

Possible (and very much applicable) Nursing Care Plans

Decreased cardiac output related to heart failure Impaired gas exchange related to fluid in alveoli Ineffective airway clearance Ineffective tissue perfusion related to cardiac output reduction Disturbed sleep pattern related to nocturia& inability to lie down & sleep comfortably Activity intolerance related to fatigue caused by oxygen imbalance Excess fluid volume related to heart failure & the secondary reduction in renal blood flow for filtration Risk for impaired skin integrity related to decreased tissue perfusion & secondary to activity intolerance Risk for anxiety related to hypoxic states & fear of death

Please email me for any suggestions or highly constructive criticisms for my pathophysiology @ arthascourge@gmail.com!!! Any idea on the subject will matter & this is also for me to know other peoples perspectives on the tackled subject!!!

Thanks:P