CARDIAC

Heart Sounds:
S1- tricuspid and mitral valve close
S2- pulmonary and aortic valve close
S3- ventricular filling complete
S4-elevated atrial pressure (atrial kick)

Right Sided Heart Failure

Right Upper Quadrant Pain
Right Ventricular Heave
Tricuspid Murmur
Weight gain
Nausea
Elevated Right Atrial Pressure
Elevated Central Venous Pressure
Peripheral Edema
Ascites
Anorexia
Hepatomegaly

Left Sided Heart Failure

Left Ventricular Heave
Confusion
Paroxysmal Nocturnal Dyspnea
DOE
Fatigue
S3 Gallop
Crackles
Tachycardia
Cough
Mitral Murmur
Diaphoresis
Orthopnea

CONGESTIVE HEART FAILURE

Class I describes a patient who is not limited with normal physical activity by symptoms.
Class II occurs when ordinary physical activity results in fatigue, dyspnea, or other symptoms.
Class III is characterized by a marked limitation in normal physical activity.
Class IV is defined by symptoms at rest or with any physical activity.

Causes: CAD, Valvular heart disease, Cardiomyopathies, Endocarditis, Extracardiac infection, Pulmonary
embolus
Symptoms: Skin cold or cyanotic, Wheezing, Mitral valvular deficits, Lower extremity edema, Pulsus
alternans, Hypertension, Tachypnea
0.9% NaCl (normal saline) isotonic
0.25% NaCl hypotonic
0.45% NaCl hypotonic
2.5% dextrose hypotonic
Lactated Ringer's solution isotonic
D5W (acts as a hypotonic solution in body) isotonic
D5 NaCl hypertonic
D5 in Lactated Ringer's hypertonic
D5 0.45% NaCl hypertonic

ISOTONIC SOLUTIONS:
1. NORMAL SALINE (0.9% NS)fever, etc.

Intravascular dehydration(running, labor,

2. LACTATED RINGERS (LR)-

3. D5W (SOME SOURCES CLASSIFY AS HYPOTONICrisk for Increase Intracranial Pressure

AVOID D5W in clients at

Hypotonic Solutions
1. 0.5% Normal Saline (HNS or 0.45% NS)-Prolonged dehydration

Treat intracellular dehydration:

2. 0.33% Normall Saline ( 1/3 NS)- -Prolonged TPN

3. 2.5% Dextrose in 0.45% Saline

Hypertonic Solutions
1. 5% DEXTROSE IN LACTATED RINGERS (D5LR)Treat intravascular
dehydration with cellular or interstitial over hydration.

2. 5% DEXTROSE IN 0.45% SALINE (D5 NS)- Treat post-operative

dehydration from blood loss
*Treat ascites
3. 5% DEXTROSE IN 0.9% SALINE (D5NS)Treat 3rd Spacing
**AVOID in client with kidney or heart failure