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General Objectives: After 20 minutes of lecture-discussion, the BSN 3AA will be able to acquire basic knowledge, competent skills

and positive attitude on the concept of the discussion called FLUIDS. SPECIFIC OBJECTIVES CONTENT METHODOLOGY TIME ALLOTMENT RESOURCES EVALUATION

INTRODUCTION LectureDiscussion
Pump failure also known as cardiogenic shock, is a condition of diminished cardiac output that severely impairs the delivery of oxygen and vital nutrients to the body's organs and tissues. It reflects severe failure of the left ventricle, the heart's main chamber, and occurs as a serious complication in nearly 15% of all people hospitalized with a heart attack Pump failure typically strikes people in whom a heart attack has damaged more than 40% of the heart. The death rate may exceed 85%. Most people with pump failure die within 24 hours of onset. The prognosis for those who survive is poor.

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- After 2-3 hours of LectureDiscussion, the BSN 3-AA was able to acquire basic Knowledge, competent skills and positive attitude on the concept of Cholelithiasis. y y Open Forum Post Test

Specifically, they will be CONGESTIVE HEART FAILURE- A fluid overload able to: condition associated with heart failure. CARDIAC OUTPUT- The amount of blood pumped out of 1. Define the related the heart in 1 minute. terms Diastolic Heart Failure- The inability of the heart to comprehensively pump sufficiently because of an alteration in the ability of the heart to fill. Systolic Heart Failure- The inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract. AFTERLOAD- The resistance to ejection of blood from a ventricle. PRELOAD- The amount of myocardial stretch just before systole aused by the volume of blodd presented to the ventricle. EJECTION FRACTION-Percentage of blood volume in the ventricles at the end of diastole that is ejected during a systole HEART FAILURE-The inability of the heartto pump sufficient blood to meet the needs of the tissues for oxygen and nutrients. that involves PERICARDIOCENTESIS-Procedures aspiration of fluids from the pericardial sacs. 2. State the etiology Causes of PUMP FAILURE of PUMP FAILURE Specific causes of cardiogenic shock include the following: Left ventricular failure Systolic dysfunction (decreased contractility) y Ischemia/MI

LectureDiscussion

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Global hypoxemia Valvular disease (see Valvular or structural abnormality) Myocardial depressant drugs (eg, beta-blockers, calcium channel blockers, antiarrhythmics) Myocardial contusion Respiratory acidosis Metabolic derangements (eg, acidosis, hypophosphatemia, hypocalcemia)

Diastolic dysfunction/increased myocardial diastolic stiffness y Ischemia y Ventricular hypertrophy y Restrictive cardiomyopathy y Consequence of prolonged hypovolemic or septic shock y Ventricular interdependence y External compression by pericardial tamponade Greatly increased afterload y Aortic stenosis y Hypertrophic cardiomyopathy y Dynamic aortic outflow tract obstruction y Coarctation of the aorta y Malignant hypertension Valvular or structural abnormality y Mitral stenosis y Endocarditis

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Mitral aortic regurgitation Obstruction due to atrial myxoma or thrombus Papillary muscle dysfunction or rupture Ruptured septum or free wall arrhythmias

Decreased contractility y RV infarction y Ischemia y Hypoxia y Acidosis 3. Discuss the Anatomy and Physiology. ANATOMY AND PHYSIOLOGY

Function of Aorta The blood vessel (or vessels) carrying blood from the heart to all the organs and other structures of the body. At the opening from the left ventricle into the aorta is a three-part valve that prevents backflow of blood from the aorta into the heart. The aorta emerges from the heart as the ascending aorta, turns to the left and arches over the heart (the aortic arch), and passes downward as the descending aorta. The left and right coronary arteries branch from the ascending aorta to supply the heart muscle. The three main arteries branch from the aortic arch and give rise to further branches that supply oxygenated blood to the head, neck, upper limbs, and upper part of the body. The descending aorta runs down through the posterior centre of the trunk past the heart, lungs, and esophagus, through an opening in the diaphragm, and into the abdominal cavity. In the chest the aorta, as it descends, gives off branches to (1) the pericardium, the sac that encloses the heart, (2) the connective tissues of the lungs, (3) the bronchi, which carry air from the windpipe into the lungs, (4) the esophagus, (5) part of the diaphragm, and (6) the chest wall. Function of Vena Cava

In air-breathing vertebrates, including humans, either of two major trunks, the anterior and posterior venae cavae, that deliver oxygen-depleted blood to the right side of the heart. The anterior vena cava, also known as the precava, drains the head end of the body, while the posterior vena cava, or postcava, drains the tail, or rear, end. In humans these veins are respectively called the superior and inferior venae cavae. Whereas many mammals, including humans, have only one anterior vena cava, other animals have two. Function of Pericardium The heart is suspended in its own membranous sac, the pericardium. The strong outer portion of the sac, or fibrous pericardium, is firmly attached to the diaphragm below, the mediastinal pleura on the side, and the sternum in front. It gradually blends with the coverings of the superior vena cava and the pulmonary (lung) arteries and veins leading to and from the heart. (The space between the lungs, the mediastinum, is bordered by the mediastinal pleura, a continuation of the membrane lining the chest. The superior vena cava is the principal channel for venous blood from the chest, arms, neck, and head.) Function of Right Atrium In vertebrates and the higher invertebrates, heart chamber that receives blood into the heart and drives it into a ventricle, or chamber, for pumping blood away from

the heart. Fishes have one atrium; amphibians, reptiles, birds, and mammals, two. In humans the atria are the two upper chambers of the heart. Each is roughly cube-shaped except for an earshaped projection called an auricle. (The term auricle has also been applied, incorrectly, to the entire atrium.) The right atrium receives from the veins blood low in oxygen and high in carbon dioxide; this blood is transferred to the right lower chamber, or ventricle, and is pumped to the lungs. The left atrium receives from the lungs blood high in oxygen and low in carbon dioxide; this blood flows into the left ventricle and is pumped through the arteries to the tissues. The major openings in the walls of the right atrium are (1) the points of entrance for the superior and inferior venae cavae (the great veins that return blood from the bodily tissues), and for the coronary sinus, the dilated terminal part of the cardiac vein, bearing venous blood from the heart muscle itself; and (2) the opening into the right ventricle. The principal openings into the left atrium are the points of entry of the pulmonary veins, bringing oxygenated blood from the lungs, and the opening into the left ventricle. See also ventricle. Function of Coronary Artery One of two blood vessels that branch from the aorta close to its point of departure from the heart and carry oxygenrich blood to the heart muscle. Both arteries supply blood to the walls of both lower chambers (ventricles) and to the partition between the chambers. The right coronary artery

supplies blood to the right upper chamber (atrium), while the left supplies the left atrium. Blockage of any branch of the coronary arteries causes death of a portion of the heart tissue when it is deprived of oxygen-rich blood (see coronary heart disease). Function of Ventricle Muscular chamber that pumps blood out of the heart and into the circulatory system. Ventricles occur among some invertebrates. Among vertebrates, fishes and amphibians generally have a single ventricle, while reptiles, birds, and mammals have two. In humans, the ventricles are the two lower chambers of the heart. The walls of the chambers, and particularly the walls of the left ventricle, are far more heavily muscled than the walls of the atria, or upper chambers (see atrium), because it is in the ventricles that the major force is exerted in the process of pumping the blood to the bodily tissues and to the lungs. Each opening leading into or away from the ventricles is guarded by a valve. These openings are the following: those from the two upper chambers; the opening from the right ventricle into the pulmonary artery, which transports blood to the lungs; and the opening from the left ventricle into the aorta, the main trunk by which oxygen-rich blood starts its course to the tissues. The interior surfaces of the ventricles are ridged with bundles and bands of muscle, called trabeculae carneae. The papillary muscles project like nipples into the cavities of the ventricles. They are

attached by fine strands of tendon to the valves between the atria and ventricles and prevent the valves from opening when the ventricles contract. See also heart. I. Explain the Pathophysiology of Refer to Appendix A for Schematic diagram PUMP FAILURE Give the Clinical CLINICAL MANIFESTATIONS: manifestations related to PUMP y Confusion or lack of alertness FAILURE
y y y y y y y y Loss of consciousness Sweating Pale skin A weak pulse Rapid breathing Decreased or no urine output Cool hands and feet A sudden and ongoing rapid heartbeat

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III.

IV.

Cite the Medical Management PUMP Refer to Appendix B FAILURE Provide the Nursing Management for Refer to Appendix C PUMP FAILURE

APPENDIX A

APPENDIX B

MEDICAL MANAGEMENT ASSESSMENT AND DIAGNOSTIC PROCEDURES: >Nebulization RATIONALE >A nebulizer makes inhaling medication easier for people who are having difficulty in breathing, which requires careful timing and control of ones breathing.

>Oxygen Therapy

>Oxygen levels in the blood decreased and the patient may need supplemental oxygen.Oxygen therapy is a key treatment in respiratory care.the purpose is to increase oxygen saturation in tissues >may show evidence of Myocardial infarction or ischemia. > may provide excellent analysis of the heart and reveal the nature of the pulmonary edema.

>Electrocardiograpy >Computed tomography scanning

>Echocardiography

>may be used to determine systolic and diastolic LV performance, the cardiac output, also may be used to identify clinically important valvular disease.

PATHOPHYSIOLOGY

Heart Damaged Ventricular Overload Decreased Ventricular Contraction

Ventricular Tachycardia Dilatation Myocardial Hypertrophy

Fluid Overload Edema

Decreased Cardiac Output

Increased Water Reabsorption

Decreased Renal Perfusion

Increased ADH

Increased Sodium Retention

Increased Osmotic Pressure

NURSING MANAGEMENT >Monitor for signs of respiratory distress

RATIONALE >Monitoring the patients respiratory status is the baseline to implement the needs of a patient to have an adequate oxygen. >to monitor the patients condition of symptoms of heart failure progress.

>Monitor for signs of altered cardiac output

> Monitor intake and output.

> measuring hourly urine output and noting decreases in output. Decreased cardiac output results in decreased perfusion of the kidneys, with a resulting decrease in urine output. > comfort Elevating the head of the bed may decrease the work of breathing, and also decrease venous return and preload >To evaluate how well the client is tolerating current medications before administering cardiac medications. > Getting out of bed to use a commode or urinal does not stress the heart any more than staying in bed to toilet and minimizes complications of immobility and is often preferred by the client. > An accurate daily weight is a good indicator of fluid balance

>Place client in semi-Fowler's position or position of comfort

> Check blood pressure, pulse, and condition before administering cardiac medications

>Have clients use a commode or urinal for toileting and avoid use of a bedpan.

> Weigh client at same time daily >Closely monitor fluid intake including IV lines. > Maintain fluid restriction if ordered. In clients with decreased cardiac output, poorly functioning ventricles may not tolerate increased fluid volumes.

BIBLIOGRAPHY: BOOK SOURCES: Black,J. Medical Surgical Nursing. 8th edition.ElsevierSaunders Publishing Inc Marieb, Elaine.Essential of Anatomy and Physiology.6th edition America Addison-wesley Publishing Company Inc. Mosby,E.Mosbys Pocket Dictionary.6th Edition.Elsevier Publishing Company Inc. Smeltzer,S.(2010).BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 12th Edition.Philadelphia:Lippincott Williams and Wilkins.

ELECTRONIC SOURCES: http://nurse-thought.blogspot.com/2010/04/nursing-interventions-for-congestive.html http://nursing-concept.blogspot.com/2010/02/nursing-care-plans-for-decreased.html http://www.medindia.net/education/familymedicine/congestiveheartfailure-Pathophysiology.htm#ixzz1Tlo0PZrW http://www.scribd.com/doc/13218347/congestiveheartfailure -brief-discussion

APPENDIX C

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