Objective 8 and 9.txt

inability of the heart to pump sufficient blood to meet the needs of the tissues for O2 and nutrients

chronic or acute; fluid overload; myocardial disease (contraction, systolic or diastolic); some cases are reversible; progressive and lifelong; poor tissue perfusion

HTN, CAD, valvular disease involving the mitral or aortic valve; pulmonary congestion from increased pressure in pulmonary vessels

when heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation; preload increases and afterload increases as a result of increased peripheral resistence; ejection fraction drops from 50-70% to below 40%

fluid backs up into the pulmonary system

are candidates for implantable ICD

left ventricle cannot relax adequately during diastole; inadequate relaxation or stiffening prevents ventricle from filling with sufficient blood to ensure adequate cardiac output

caused by left ventricular failure, right ventricular MI or pulmonary HTN; right ventricle cannot empty completely, increased volume and pressure develop in the venous system and peripheral edema results

can occur when CO remains normal or above normal; caused by increased metabolic needs or hyperkinetic conditions like septicemia, high fever anemia and hyperthyroidism

sympathetic nervous system stimulation, renin angiotension system, other chemical responses, myocardial hypertrophy

a peptide produced and released by the ventricles when the patient has fluid overload as a result of HF

decreased CO, fatigue, weakness, oliguria, angina, confusion, dizziness, tachycardia, pallor, weak peripheral pulses, cool extremities, pulmonary congestion, hacking cough, dyspnea, crackles, wheezing, frothy pink tinged sputum, tachypnea, S3/S4 gallop

pulse strength and auscultate AP for 1 minute; respiratory-rate, rhythm, character, O2 sats, auscultate lungs, A&O X 3

systemic congestion

neck veins, ABD girth, dependent edema

electrolytes, HGB, HCT, BNP, UA, ABGs, echo, chest xray, ECG, pulmonary artery cath

health history, sleep and activity, knowledge and coping, physical exam, assess responses to meds

cardiogenic shock, dysrhythmias, thromboembolism, pericardial effusion, cardiac tamponade

promote, relieve, decrease, encourage, teach

bed rest, physical activity, exercise, pacing self, wait after eating, conserve energy, avoid weather conditions, positioning of self

assessment, daily weight, I&O, timing of meds, fluid intake, sodium restructions

sudden awakening with a feeling of breathlessness 2-5 hours after falling asleep; sitting upright and danging feet usually helps

usually start low in lung and work their way up

increased contractility, reduced HR, slowing of conduction through AV node, inhibit sympat while enhancing parasym

Dig and potassium levels can cause problems with dig

I: no symptoms with activity; II: symptoms with ordinary exertion; III: Symptoms with minimal exertion; IV: symptoms ar rest

diuretics

ACE inhibitors (pril), AR II blockers (Cozaar), cal channel blockers (Cardizem), phophop 3 (Primacor)

dig, dopamine used to increase contractility and thereby improve CO

count pulse before taking med, take at same time of day, don’t take with antacids, toxicity includes fatigue and muscle weakness and confusion and loss of appetite; have dig and K levels checked

orthostatic hypotension and headache is common side effect; sit and lie slowly

natriureses (loss of Na and vasodilation)

put in high fowlers-decrease venous return to the heart (preload) and help decrease lung congestion

multi-lumen catheter with the capacity to measure right atrial and indirect left atrial pressures or pulmonary artery wedge pressure

with right ventricular failure whereas low RA pressures usually indicate hypovolemia

15-26 systolic vs 5-15 diastolic

phlebostatic axis (4th intercostal space and 1/2way between front and back)

through vena cava or right atrium; normal CVP is 2-6; lower than 2 is reduced rt ventricular preload caused by hypovolemia, vomiting or overdiuresis and higher than 6 indicates right ventricular preload

blood clot, infection

assess pulmonary function

can use blood from this for ABGs, check pulses (may be tingling, usually in radial area)

pulmonary infarction, air embolism, ventricular dysrhythmias if catheter slips into right ventricle, infection, bleeding

air embolism, blood loss, pain, arteriospasm, tingling in arm, hold pressure for 10 minutes (NO PEEKING)