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Heart Failure, Fluids, and Diet
Carolyn Scroggins, MSN, RN, GNP
Role of Potassium Disturbed K+ metabolism r/t majority of
clinical arrhythmias
Na+ & Ca++ reverse K+ -induced depression of conduction
K+ only electrolyte clinically significant
anti-arrhythmic properties.
Healthy Left Side Heart Left heart receives blood as it returns from
the lungs
Pumps blood into the aorta, main artery of the body.
Then-- blood delivered via arteries to all organs, muscles & tissues.
Left Side Does the Hardest Work
What happens in Lt. Heart Failure LHF?
Body holds extra fluid, blood backs up into the lungs: 1. because left heart pumps blood away from heart to body
organs.2. During LHF, kidneys do not get enough blood, & are
fooled into reacting as if body does not have enough blood.
3. Therefore, they hold on to salt & water to keep it in the blood rather than passing it out into the urine.Resulting: excess fluid builds up in the body, putting an additional strain on heart.
4. This strain makes pumping function of the left side of heart worse, causing less blood to get to the kidneys =vicious cycle.
Causes of Left-sided failure Heart Attack Chronic blockages of the heart arteries High Blood Pressure Leaking or narrow heart valves Heart muscle infections Acute MI & Cardiomyopathy
Blocked Cardiac Arteries
Leaky Valve
Cardiomyopathy
Myocardial Infarction
What is this artery called?
Lt. Sided Heart Failure Symptoms
dyspnea, orthopnea, crackles, wheezing, hypoxia, respiratory acidosis, cough (frothy sputum), cyanosis, palpitations, arrhythmias, elevated blood pressure
dyspnea on exertion appears to be earliest symptom
complaints of paroxysmal nocturnal dyspnea (awakening from sleep with shortness of breath), or new-onset dyspnea on exertion should undergo evaluation for heart failure
Shortness of Breath
Assessment for Fine Crackles
Left Heart Failure
Cyanosis R/T Lt. Sided Heart Failure
Difficulty Breathing R/T Lt. Sided Heart Failure
Medications for Lt. Sided Heart Failure
DIURETICS ACE INHIBITORS BETA BLOCKERS DIGOXIN
Why Meds are Used: Diuretics relieve pulmonary & peripheral edema.
May also treat hypertension since they dilate blood vessels.
Potential Side effects: dizziness, severe leg cramps, high blood sugar levels, high cholesterol levels (NURSES WATCH FOR THIS)
Examples: Furosemide(Lasix,) Bumetanide(Bumex), Hydrochlorthiazide(HCTZ)
ACE Inhibitors Angiotensin Converting Enzyme (ACE)
Inhibitors block Angiotensin II formation, causes constriction of blood vessels. reduce strain on heart; relax smaller arteries &
lower BP. SE: dizziness. ACE inhibitors can prevent
increases in heart size. Potential Side effects: cough, dizziness,
worsening of some types of kidney disease Examples: Lisinopril (Prinivil), Enalapril
(Vasotec), Captopril (Capoten)
Vasodilators Med group-- relax blood vessels & lower
resistance against which the heart has to pump. Like ACE inhibitors or ARBs (Angiotensin
Receptor Blockers) they can cause low blood pressure & dizziness.
Potential Side effects: hypotension, dizziness, tachycardia, headache (NOTE: THIS IS WHY NURSES TAKE BLOOD PRESSURE BEFORE ADMINISTRATION)
Examples: Hydralazine, Isosorbide Dinitrate, Nitroglycerin
Beta Blockers
Some sympathetic tone on the heart beta-blockers reduce sympathetic
influences that stimulate heart rate beta-blockers--decrease heart rate,
contractility, conduction velocity, & relaxation rate.
Beta Blockers Drugs block the heart cell response to catecholamines
(norepinephrine, epinephrine) –
1. Catecholamines- responsible for CNS "fight or flight" response. Beta-Blockers may reduce heart’s energy needs, & over a long time may reduce heart size & improve heart function.
Potential Side Effects: decreased ventricular function, slow heart rate, worsening of asthma symptoms. (NOTE: NURSES MUST TAKE APICAL PULSE)
Examples: Carvedilol (Coreg,), Metoprolol (Toprol XL)
side effects of beta blockers
SE--beta-blockers r/t cardiac mechanisms & include:
bradycardia reduced exercise capacity heart failure Hypotension atrioventicular (AV) nodal conduction block.NOTE: (These side effects result from excessive
blockade of normal sympathetic influences on the heart)
Beta Blockers/CCB
When beta-blocker is given in conjunction with calcium-channel blockers (e.g., verapamil) = additive effects in producing electrical & mechanical depression.
beta-blockers--contraindicated in heart failure patients.
beta-blockers--contraindicated in pts. with bradycardia & partial AV block.
Digitalis Increases strength of heart's contractions,
reducing resistance in blood vessels. Decreases heart rate in heart failure
patients & may decrease edema. Potential Side effects: nausea & slow or
fast heart beating Examples: Digoxin (Lanoxin)
Aldosterone Blockers Aldosterone-- adrenal hormone responds to
decrease in renal blood flow & other factors in heart failure.
May contribute to cardiac fibrosis. Blockade of aldosterone effects may improve
outcomes in advanced heart failure. Potential Side effects: fatigue, headache, low
blood pressure, nausea Examples: Spironolactone( Aldactone )
Healthy Right Side Heart Right heart receives blood from veins. Blood is returning from organs & low in oxygen. Right side heart pumps blood to the lungs,
where it picks up oxygen & delivers throughout the body.
Right heart begins to fail, blood & fluid back up into abdomen, legs & ankles.
Tenderness in upper right abdomen. Loss of appetite, bloating, tired feeling.
Cause of Right Sided Heart Failure
Left ventricle does not pump blood efficiently,
Leads to pressure buildup behind the left side of the heart
Eventually causes the right side of the heart to fail.
Symptoms Rt. Heart Failure (cor pulmonale: rt.ventricle hypertrophy)
dependent peripheral edema hepatomegaly splenomegaly jugular vein distention ascites & kidney congested=decrease filtering weight gain arrhythmias, nausea, vomiting, anorexia, fatigue, dizziness, syncope, weakness
Dependent Edema
Dependent Edema
Pitting EdemaEdema of ankles & feet-- common manifestation of right-sided heart failure.
"Pitting" edema refers to the failure of the skin & soft tissue to immediately resume its normal contour upon release of pressure.
Ascites R/T Rt. Sided Heart Failure
Medications for Right-Sided Heart Failure
Diuretics: Furosemide or bumetanide help moderate to severe symptoms.
Hydrochlorothiazide, chlorthalidone, and chlorothiazide used for mild symptoms.
Spironolactone, prevents salt retention & helps with severe heart failure.
ACE inhibitors, Angiotensin Receptor Blockers Beta-blockers (such as metoprolol or carvedilol) can help prevent death
DigitalisNURSES NOTE: MEDICATIONS OFTEN INDICATE
DEGREE OF HEART FAILURE
Anti-Anginal Medications
Procardia (nifedipine)--Treats high blood pressure. migraine headaches, Raynaud's syndrome, cardiomyopathy, & congestive heart failure.
calcium channel-blocker—relaxes blood vessels of the heart
Calcium Channel Blockers
Calcium channel blockers-- class of drugs that block entry of calcium into the muscle cells of heart & arteries.
The entry of calcium into these cells that causes heart to contract & arteries to narrow. By blocking the entry of calcium, CCBs decrease contraction of heart & dilate (widen) the arteries.
CALCIUM CHANNEL BOCKERS (CCB)
By dilating arteries, CCBs reduce pressure in the arteries, making it easier for heart to pump blood, resulting in heart needing less oxygen.
By reducing heart's need for oxygen, CCBs relieve or prevent angina.
For what conditions are CCBs used?
high blood pressure angina abnormal heart rhythms (e.g.,
atrial fibrillation). used after a heart attack, among pts who
cannot tolerate beta-blocking drugs (high-risk for hypotension or bradycardia) , have atrial fibrillation, or require treatment for angina.
HEALTH HEART DIETS
CALORIE CONTROLLED LOW-CHOLESTEROL FAT-RESTRICTED SODIUM-RESTRICTED
Note pg. 311 DHO Book FOR DIETS FLUID RESTRICTIONS ACCORDING
TO DAILY WEIGHT
Enlarged Liver
Enlarged Spleen
Enlarged Spleen
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