Interventions Interventions for Clients with for Clients with

Cardiac Cardiac ProblemsProblems

Heart FailureHeart Failure

• Also called pump failure, general Also called pump failure, general term for the inadequacy of the heart term for the inadequacy of the heart to pump blood throughout the body; to pump blood throughout the body; causes insufficient perfusion of body causes insufficient perfusion of body tissue with vital nutrients and tissue with vital nutrients and oxygenoxygen

• Left-sided heart failureLeft-sided heart failure

• Right-sided heart failureRight-sided heart failure

• High-output failureHigh-output failure

Compensatory Compensatory MechanismsMechanisms

• Sympathetic nervous system Sympathetic nervous system stimulationstimulation

• Renin-angiotensin system Renin-angiotensin system activationactivation

• Other neurohumoral responsesOther neurohumoral responses

• Myocardial hypertrophyMyocardial hypertrophy

Left-Sided Heart FailureLeft-Sided Heart Failure

• Manifestations include:Manifestations include:– WeaknessWeakness– FatigueFatigue– DizzinessDizziness– ConfusionConfusion– Pulmonary congestionPulmonary congestion– Shortness of breathShortness of breath

(Continued)(Continued)

Left-Sided Heart Failure Left-Sided Heart Failure (Continued)(Continued)

– OliguriaOliguria– Organ failure, especially renal Organ failure, especially renal

failurefailure– Death Death

• Assess blood pressure, mental Assess blood pressure, mental status, breath soundsstatus, breath sounds

Right-Sided Heart Right-Sided Heart FailureFailure• Manifestations include:Manifestations include:

– Distended neck veins, increased Distended neck veins, increased abdominal girthabdominal girth

– Hepatomegaly (liver engorgement)Hepatomegaly (liver engorgement)– Hepatojugular refluxHepatojugular reflux– AscitesAscites– Dependent edemaDependent edema– Weight: the most reliable indicator Weight: the most reliable indicator

of fluid gain or lossof fluid gain or loss

Assessments Assessments

• Laboratory assessmentLaboratory assessment

• Radiographic assessmentRadiographic assessment

• ElectrocardiographyElectrocardiography

• EchocardiographyEchocardiography

• Pulmonary artery cathetersPulmonary artery catheters

Hemodynamic Hemodynamic RegulationRegulation• Interventions include:Interventions include:

– Reduce afterload.Reduce afterload.– Reduce preload.Reduce preload.– Improve cardiac muscle contractility.Improve cardiac muscle contractility.– Administer drugs as prescribed.Administer drugs as prescribed.– Monitor for therapeutic and adverse Monitor for therapeutic and adverse

effects.effects.– Teach client and family drug therapy.Teach client and family drug therapy.

Valvular Heart Disease Valvular Heart Disease

• Mitral stenosisMitral stenosis

• Mitral regurgitation Mitral regurgitation (insufficiency)(insufficiency)

• Mitral valve prolapse Mitral valve prolapse

• Aortic stenosisAortic stenosis

• Aortic regurgitation Aortic regurgitation (insufficiency)(insufficiency)

Assessment Assessment

• Client may become suddenly ill or Client may become suddenly ill or slowly develop symptoms over many slowly develop symptoms over many years.years.

• Question client about attacks of Question client about attacks of rheumatic fever, infective rheumatic fever, infective endocarditis, and possibility of IV endocarditis, and possibility of IV drug abuse.drug abuse.

• Obtain chest x-ray, echocardiogram, Obtain chest x-ray, echocardiogram, and exercise tolerance test.and exercise tolerance test.

Nonsurgical Nonsurgical Management Management • Drug therapy, including diuretics, Drug therapy, including diuretics,

beta blockers, digoxin, oxygen, beta blockers, digoxin, oxygen, and sometimes nitrates and sometimes nitrates

• Prophylactic antibiotic Prophylactic antibiotic

• Management of atrial fibrillation, Management of atrial fibrillation, cardioversioncardioversion

• AnticoagulantAnticoagulant

• Rest with limited activityRest with limited activity

Infective EndocarditisInfective Endocarditis

• Microbial infection involving the Microbial infection involving the endocardiumendocardium

• Occurs primarily with IV drug abuse, Occurs primarily with IV drug abuse, valvular replacements, systemic valvular replacements, systemic infections, or structural cardiac infections, or structural cardiac defectsdefects

• Possible ports of entry: mouth, skin Possible ports of entry: mouth, skin rash, lesion, abscess, infections, rash, lesion, abscess, infections, surgery, or invasive procedures surgery, or invasive procedures including IV line placementincluding IV line placement

Pericarditis Pericarditis

• Inflammation or alteration of the Inflammation or alteration of the pericardium, the membranous pericardium, the membranous sac that encloses the heartsac that encloses the heart

• Dressler’s syndromeDressler’s syndrome

• Postpericardiotomy syndromePostpericardiotomy syndrome

• Chronic constrictive pericarditisChronic constrictive pericarditis

Assessment Assessment

• Substernal precordial pain radiating Substernal precordial pain radiating to left side of the neck, shoulder, or to left side of the neck, shoulder, or backback

• Grating, oppressive pain, aggravated Grating, oppressive pain, aggravated by breathing, coughing, swallowingby breathing, coughing, swallowing

• Pain worsened by the supine Pain worsened by the supine position; relieved when the client sits position; relieved when the client sits up and leans forwardup and leans forward

• Pericardial friction rubPericardial friction rub

InterventionsInterventions

• Hospitalization for diagnostic Hospitalization for diagnostic evaluation, observation for evaluation, observation for complications, and symptom reliefcomplications, and symptom relief

• Nonsteroidal anti-inflammatory Nonsteroidal anti-inflammatory drugsdrugs

• Corticosteroid therapyCorticosteroid therapy

• Comfortable position, usually Comfortable position, usually sittingsitting

• Pericardial drainagePericardial drainage(Continued)(Continued)

Cardiomyopathy Cardiomyopathy

• Subacute or chronic disease of Subacute or chronic disease of cardiac musclecardiac muscle

• Dilated cardiomyopathy Dilated cardiomyopathy

• Hypertrophic cardiomyopathyHypertrophic cardiomyopathy

• Restrictive cardiomyopathyRestrictive cardiomyopathy

CardiomyopathyCardiomyopathy