Zusammenfassung der Ressource
HEART FAILURE (HF): CLINICAL SYNDROME
INVOLVING IMPAIRED CARDIAC PUMPING/
FILLING (HAYES, 2015)
- ETIOLOGY (MCMURRAY
ET AL., 2012)
- MOST COMMON
- HYPERTENSION
- CORONARY ARTERY
DISEASE
- DIABETES MELLITUS
- LESS COMMON
- RHEUMATIC HEART
DISEASE
- ANEMIA
- CARDIOMYOPATHY
- VALVULAR DISORDERS
- CONGENITAL HEART DISEASE
- PRECIPITATING
- MYOCARDITIS
- PULMONARY EMBOLISM
- PULMONARY DISEASE
- PAGET'S DISEASE
- HYPERVOLEMIA
- INFECTION
- HYPOTHORYDISM
- COMPLICATIONS
(MCMURRAY ET AL., 2012; HAYES, 2015)
- PLEURAL EFFUSION
- DYSRHYTHMIAS
- LEFT VENTRICULAR THROMBUS
- HEPATOMEGALY
- RENAL FAILURE
- TYPES
- LEFT SIDED HF (LEWIS
ET AL.,2010)
- SIGNS
- CRACKLES
- TACHYCARDIA
- LEFT-VENTRICULAR
HYPERTROPHY
- CHEYNE-STOKES
RESPIRATIONS
- SYMPTOMS
- FATIGUE
- DYSPNEA
- ORTHOPNEA
- DRY, HACKING COUGH
- PULMONARY EDEMA
- NOCTURIA
- PAROXYSMAL NOCTURNAL DYSPNEA (PND)
- ANXIETY
- RESTLESSNESS
- RIGHT SIDED HF (LEWIS
ET AL.,2010)
- SIGNS
- RV HYPERTROPHY
- MURMURS
- WEIGHT GAIN
- TACHYCARDIA
- PERIPHERAL EDEMA/GENERALIZED EDEMA
- HEPATOMEGALY
- SPLENOMEGALY
- ASCITES
- RIGHT-SIDED PLEURAL EFFUSION
- SYMPTOMS
- RIGHT UPPER
QUADRANT PAIN
- DEPENDENT EDEMA
- FATIGUE
- ANOREXIA/GI BLOATING
- NAUSEA
- PREVALENCE (HEART & STROKE
FOUNDATION, 2016a)
- 600,000 CANADIANS LIVING
WITH HF
- 50,000 DIAGNOSED
EACH YEAR
- INCREASED
HOSPITALIZATION
- $ 2.8
BILLION/YEAR
- PATHOPHYSIOLOGY
(LEWIS ET AL, 2010)
- SYSTOLIC (MOST COMMON)
- DECREASED IN LEFT
VENTRICULAR EJECTION
- CAUSES
- IMPAIRED CONTRACTILE
FUNCTION (I.E. MI)
- INCREASED AFTERLOAD (I.E.
HYPERTENSION
- CARDIOMYOPATHY
- MECHANICAL ABNORMALITIES (I.E.
VALVULAR HEART DISEASE
- DIASTOLIC
- IMPAIRED ABILITY
OF VENTRICLES TO
FILL
- CAUSES
- LEFT
VENTRICULAR
HYPERTROPHY
- AORTIC
STENOSIS
- HYPERTROPHIC
CARDIOMYOPATHY
- PREDIMONINANTLY WOMEN
- DUE TO HYPERTENSION AND
MYOCARDIAL FIBROSIS
- SEEN IN OLDER ADULTS
- MIXED SYSTOLIC AND
DIASTOLIC
- COMPENSATORY MECHANISM
- DILATION OF HEART CHAMBERS
- HYPERTROPHY
- SNS ACTIVATION
- NEUROHORMONAL RESPONSE
- VENTRICULAR REMODELLING
- TREATMENT
(MCMURRAY ET AL.,
2012; HAYES, 2015)
- DRUG THERAPY
- ACE INHIBITORS
- ANGIOTENSIN RECEPTOR BLOCKERS (ARB)
- ALDOSTERONE RECEPTOR ANTAGONISTS
- BETA BLOCKERS
- ANGIOTENSIN II RECEPTOR BLOCKER
- DIURETICS
- THIAZIDE (FIRST CHOICE)
- LOOP DIURETICS I.E. FUROSEMIDE
- SPIRONOLACTONE (K+ SPARING)
- DIGITALIS
- DIGITALIZATION PROTOCOL
- THERAPEUTIC LEVEL (0.8-2.0 UG/L)
- MAINTENANCE DOSE (0.125-0.25 MG ONCE DAILY)
- DIVIDED INTO 3 SEPARATE DOSES OVER 24 HOUR PERIOD
- ACTIONS
- INOTROPIC (INCREASES FORCE OF HEART)
- DROMOTROPIC (PROLONGS REFRACTORY PERIOD)
- CHRONOTROPIC (DECREASES HR)
- NURSING IMPLICATIONS
- MONITOR APICAL PULSE 1 MIN
- ASSESS FOR ELECTROLYTE DEPLETION
- POTASSIUM LEVELS (3.5-5.0 MMOL/L)
- ASSESS FOR DIGOXIN TOXICITY
- ANTIDOTE: DIGIBIND
- DAILY WEIGHT + I&O
- VASODILATORS
- CARDIAC REHABILITATION
- MEDICALLY SUPERVISED PROGRAM
- IMPROVE PHYSICAL, SOCIAL AND MENTAL FUNCTION
- STABILIZE, SLOW, REVERSE PROGRESSION OF HF
- SURGERY & DEVICES
- CARDIAC TRANSPLANTATION
- BIVENTRICULAR PACING
- CARDIAC RESYNCHRONIZATION THERAPY
- IMPLANTABLE CARDIOVERTER DEFRIBILLATOR
- LEFT VENTRICULAR ASSIST DEVICE (LIMA
ET AL., 2015)
- NURSING AND COLLABORATIVE
MANAGEMENT (LEWIS ET AL., 2010)
- EVALUATION
- LESS ANXIETY
- REALISTIC PROGRAM OF
ACTIVITY
- REDUCED OR ABSENT EDEMA
- ADHERES TO MEDICATION AND DIETARY REGIMEN
- AMBULATORY AND HOME
CARE (LEWIS ET AL, 2010
- EXPLAIN PHYSIOLOGICAL CHANGES
THAT OCCURED
- ASSIST CLIENT IN ADAPTING TO PSYCHOLOGICAL
AND PHYSIOLOGICAL CHANGES
- INTEGRATE CLIENT'S FAMILY AND SUPPORT
SYSTEM IN CARE PLANS
- HEALTH PROMOTION
- SMOKING CESSATION
- FLU AND PNEUMONIA VACCINATIONS
- PACEMAKERS/ANTIDYSRHYTHMIC AGENTS
- CONTTROL OF UNDERLYING HEART DISEASE (I.E.
CONTROL OF HYPERTENSION OR VALVE
REPLACEMENT
- ACUTE INTERVENTION
- CLIENT-CENTRED TREATMENT PLANS
- SYMPTOM MANAGEMENT
- OXYGEN THERAPY
- SALT RESTRICTION
- ENERGY CONSERVATION
- SUPPORT SYSTEMS
- SURGICAL WOUND CARE
- CHEST TUBE (DRAINAGE)
- NURSING DIAGNOSES
- ACTIVITY INTOLERANCE
- EXCESS FLUID VOLUME
- IMPAIRED GAS EXCHANGE
- ANXIETY
- DEFICIENT KNOWLEDGE
- PATIENTS WHO DO NOT
SPEAK ENGLISH
(BRENNAN, 2015)
- INTERPRETER/TRANSLATOR
- PLANNING (COEN &
CURRY, 2016)
- DECREASE IN SYMPTOMS I.E.
SOB, FATIGUE
- DECREASE IN PERIPHERAL EDEMA
- INCREASE IN EXERCISE TOLERANCE
- ADHERENCE TO DRUG REGIMEN
- NO COMPLICATIONS R/T HF
- NURSING
ASSESSMENT
- SUBJECTIVE
DATA
- PAST MEDICAL HISTORY
- MEDICATIONS
- SYMPTOMS
- OBJECTIVE DATA
- INTEGUMENTARY
- COOL, DIAPHORETIC SKIN
- RESPIRATORY
- TACHYPNEA
- BLOOD TINGED SPUTUM
- CRACKLES
- CARDIOVASCULAR
- TACHYCARDIA
- MURMURS
- JUGULAR VEIN DISTENTION
- GASTRONINTESTINAL
- ABDOMINAL DISTENTION
- ASCITES
- NEUROLOGICAL
- RESTLESSNESS
- CONFUSION
- END-OF-LIFE/PALLIATIVE CARE
(MCKELVIE ET AL., 2011)
- RELIEVE PAIN/SYMPTOMS
- MEDICATIONS
- COMPLEMENTARY THERAPIES
- MASSAGE THERAPY
- ACUPUNCTURE
- PHYSIOTHERAPY
- MANAGING DISABILITY
- MEAL PREPARATION
- CLEANING
- TRANSPORTATION
- ASSISTIVE DEVICES
- ADDRESSING PSYCHOLOGICAL,
SOCIAL AND SPIRITUAL ISSUES
- DEPRESSION
- ANXIETY
- SOCIAL SUPPORT
- SPIRITUAL SUPPORT
- CLINICAL COUNSELLING
- CAREGIVER
SUPPORT
- BEREAVEMENT
SUPPORT
- LEGAL/ETHICAL ISSUES (HEART
&STOKE FOUNDATION, 2016)
- ADVANCED DIRECTIVES
- DO NOT RESUSCITATE
(DNR)
- POWER OF
ATTORNEY
- CULTURAL
DIFFERENCES
- CHAPLAINCY AND SPIRITUAL CARE
- PERSONAL & FAMILY VALUES
- PATIENT/CAREGIVER TEACHING
(MCMURRAY ET AL., 2012)
- TAILORED TO INDIVIDUAL CLIENT
- HEALTH PROMOTION
- EXERCISE/REST
- KEEP ACTIVE
- SLEEP WELL
- DRUG THERAPY
- BE AWARE OF
ADVERSE EFFECTS
- DIETARY THERAPY (WOODS, 2016)
- SALT
RESTRICTION: LESS
THAN 2000 MG
PER DAY
- DAILY
WEIGHTS:
GAIN/LOSS ≥
2 KG WITHIN
2 DAYS
- FLUID
RESTRICTION: ≤
THAN 1.5-2 L/DAY
- REDUCE
ALCOHOL
INTAKE
- REDUCE
CAFFEINE
INTAKE
- END-OF-LIFE PLANNING
- ONGOING
MONITORING
- BE
AWARE
OF S&S
- RECOGNIZE
COGNITIVE
IMPAIRMENT
- RECOGNIZE S&S
OF DEPRESSION
- OTHER
- AVOID EXTREME
COLD/HEAT
- KEEP REGULAR
APPOINTMENTS
- SMOKE
CESSATION
- RESTRICT ALCOHOL CONSUMPTION
- DIAGNOSTIC
STUDIES (LEWIS ET
AL, 2010; HAYES, 2015)
- ECHOCARDIOGRAM
- STRESS TESTING
- CARDIAC CATHETERIZATION
- EJECTION FRACTION
- HEMODYNAMIC ASSESSMENT
- CHEST RADIOGRAM
- HISTORY AND PHYSICAL EXAMINATION
- LABORATORY DATA
- URINE TEST
- BLOOD AND BRAIN
NATRIURETIC PEPTIDE TEST
- CALCIUM LEVELS
- CHOLESTEROL LEVELS
- GLUCOSE TEST
- LEVEL OF CLOTTING COMPONENT
(I.E. FIBRINOGEN)
- CORONARY ANGIOGRAM
- SLEEP STUDY
- DOPPLER ULTRASOUND
- MONITORING
- HOLTER
- EVENT
- MOBILE TELEMETRY