ChronicHeartFailureExacerbation

PNCILearner

PreparationQuestions

Listtheriskfactorsforchronicleftsidedheartfailurerelatedto
coronaryarterydisease.
smoking,alcohol,ordruguse
obesity
hypertension
heartdisease
diabetes
coronaryarterydisease
familyhistory

Explainthecauseofthecompensationsforchronicheartfailure.
Thecompensationsofchronicheartfailurearecausedby
decreasedcardiacoutputduetoimpairedfunctionoftheheart
ventricles,andthegoalofthecompensationsistomaintain
cardiacoutput.
Thecompensationsthatoccurare:
increasedheartrateandforceofcontractioninorderto
increasecardiacoutput
activationoftheRAASsystem,whichcauses
vasoconstrictionandfluidretentionwhichresultsin
increasedBP
hypertrophyinordertoincreaseforceofcontractions
dilationofheartventriclestoincreasecardiacoutput

Describethemanifestationsandeffectsofrightsidedandleftsided
heartfailure.

 Rightsided:effectisbloodbackupintothebody
Manifestationsinclude:
o edema
o ascites
o weightgain
o distendedjugularveins
o enlargedliverandspleen
o GIdistress
Leftsided:effectisbloodbackupintolungs
o pulmonaryedema
o possiblebloodysputum
o dyspnea
o orthopnea
o adventitiouslungsounds
crackles,wheezing,
o difficultybreathing
o confusion

Listthegoalsintheinterdisciplinarycareofapatientwithchronic
heartfailure.
selfmanagementofdiseasebythept.throughpt
educationofdiseaseandsymptoms
increaseactivitylevel
obtainimprovedcardiacoutputandsymptoms
improvedgasexchange
increasedqualityoflife

Listthetwohormonesreleasedbytheheartmuscleinresponseto
changesinbloodvolume.
ANP(atrialnatriureticpeptide)
BNP(brainnatriureticpeptide)
Theeffectsofthesehormonesarenatriuresis,diuresis,and
reducedbloodpressure

Explainthenursingimplicationsfortheclientreceiving

echocardiographywithDopplerflowstudies.
Explainproceduretopatientandverifyunderstandingofthe
procedurefromthepatient
Placepatientinsupinepositionandturnonleftside

Definerefractoryheartfailure.
Refractoryheartfailureisdefinedasmanifestingheartfailure
whileatrestdespiteaggressivetreatment.

Listthenursingimplicationsandeducationneedsforeachofthe
followingcategoriesofmedicationrelatedtoheartfailure:Angiotensin
convertingenzyme(ACE)inhibitorsandangiotensinreceptorblockers
(ARB)
Implications:monitorBP,HR,BUNandcreatininelevels
o notifyptthatitcancauseadecreaseintaste
Education:educateptaboutadverseeffects(rash,swelling)
o educateptonhypotension
o donotstopthismedicationsuddenly
Betaadrenergicreceptorblockers
Implications:monitorBP,HR,andapicalpulse
o donotadministermedifapicalpulseislessthan60
Education:
Diuretic
Implications:monitorintakeandoutput,weightdaily,monitor
electrolytelevels
Education:
Positiveinotropeagent
Implications:takeradialpulsebeforeadministration,donot
administeriflessthan60,assessrateandrhythm,ofpulse,
monitorDiglevelandpotassiumlevels
Education:
Sympathomimeticagent
Implications:
Education:
Phosphodiesteraseinhibitors

 Implications:
Education:

Listtheinterdisciplinaryinterventionsforeachofthefollowingnursing
diagnosesrelatedtochronicheartfailure.
Decreasedcardiacoutput:
reviewdiagnosticstudiesandlabs
o ECG,echocardiogram,cardiacoutput/ventricular
ejectionstudies,heartscan,chestradiograph
o Labs:CBC,electrolytes,ABGs,PT,PTT
monitorheartforanycardiacdysrhythmias
assessforsignsofcardiacfailure
o assessvitalsigns,caprefill,pulses,colorand
temperatureofextremities,andchangeinmentalstatus
assessforedema
educateptonsignsandsymptomstoreportimmediatelyto
provider
educateptontheirmedications,adverseeffects,andestablish
drugregimen
Excessivefluidvolume
monitorvitalsigns,ptweight,inputandoutput,andsignsof
edema
o assessforjugularveindistensionandlungsounds
monitorforsignsofrenalandkidneyinsufficiency
o Labs:electrolytes
dietaryandfluidrestrictions
promoteambulationandfrequentpositionchanging
educateptontheirmedications,adverseeffects,andestablish
drugregimen
Activityintolerance
assessvitalsignsduringphysicalactivity
o BP,HR,respirationsbefore,duringandafter
assessmedicationregimenforpossiblecontributingside
effectsorinteractions

 assistwithactivitiesandnotefatiguelevel
implementgradedexerciseorrehabilitationundermedical
supervision
encourageuseofrelaxationtechniques(visualization,
meditation,guidedimagery)
encourageparticipationinactivities
Ineffectivehealthmaintenance
identifyriskfactorsinptlife
assessptabilityanddesiretolearn
o includeanybarrierssuchasdevelopmentalstatusor
communicationbarriers
evaluateforsubstanceabuse
provideactivelisteningforptconcerns
encouragesocializationtodevelopsupportsystem
makereferralasneededtocommunitysupportservices
Deficientcommunityhealth
assessptknowledgeofdiseaseanddiseaseprocessand
identifyareasforeducation
educateptonsignsandsymptomsandwhentocontact
provider
educateptonselfmanagementtominimizeemergency
episodes

Listthesignsandexplaintheinterdisciplinaryinterventionsforeachof
thefollowingnursingdiagnosesrelatedtopulmonaryedema.
1 Impairedgasexchange
1 signs:
dyspnea
cyanosis
abnormalbreathing
tachycardia
diaphoresis
hypoxia,hypoxemia
lethargy
2 interventions:

monitorlungsforpresenceofadventitiouslungsounds
monitorvitalsigns
positionptinsemiFowlerstohelpalleviatedyspnea
administerO2asordered
3
2 Decreasedcardiacoutput
3 signs:
alteredheartrateandrhythm
jugularveindistention
edema
dyspnea
prolongedcaprefill
decreasedpulses
fatigue
restlessness
4 interventions:
reviewEKG,echocardiogram,chestradiograph,heart
scan/catherization
reviewCBC,ABGs,electrolytes,cardiacenzymes,liverfunction,
kidneyfunction,thyroid,andPTandPTT
assessheartsoundsandlungsounds
monitorBP,HR,respirations,temperatureandinputandoutputs
applycompressiondevices
elevatelegswhenresting
teachhomemonitoringforselfmanagement
1
2 Anxiety
3 signs:
ptverbalizedconcernsandfearaboutlifeevents,uncertainty,
worry,feelingsofinadequacy,
insomnia
restlessness
shakiness,drymouth,heartpounding
respiratorydifficulty(shortnessofbreath,difficultybreathing)
nausea,abdominalpain,diarrhea

interventions:
obtainfamilyhistory,medicalhistory,andsocialhistory
includeassessmentofcurrentstressors
assesslevelofanxiety:mild,severe,panic)
basedonobjectiveandsubjectivedata
reviewdiagnostictests:
drugscreening,CBC,chemistrypanel
assessandeducateuseofcopingskills
providesafeenvironmenttopreventselfinjury