Transcript 23. Interventions for Clients with Cardiac Problems

Interventions for
Clients with
Cardiac Problems
Heart Failure
• Also called pump failure, general
term for the inadequacy of the heart
to pump blood throughout the body;
causes insufficient perfusion of body
tissue with vital nutrients and
oxygen
• Left-sided heart failure
• Right-sided heart failure
• High-output failure
Etiology
• Heart failure is caused by systemic
hypertension in 75% of cases.
• About one third of clients
experiencing myocardial infarction
also develop heart failure.
• Structural heart changes, such as
valvular dysfunction, cause pressure
or volume overload on the heart.
Left-Sided Heart Failure
• Manifestations include:
– Weakness
– Fatigue
– Dizziness
– Confusion
– Pulmonary congestion
– Shortness of breath
(Continued)
Left-Sided Heart Failure
(Continued)
– Oliguria
– Organ failure, especially renal failure
– Death
• Assess blood pressure, mental status,
breath sounds
Right-Sided Heart Failure
• Manifestations include:
– Distended neck veins, increased
abdominal girth
– Hepatomegaly (liver engorgement)
– Hepatojugular reflux
– Ascites
– Dependent edema
– Weight: the most reliable indicator of
fluid gain or loss
Assessments
• Laboratory
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assessment
Radiographic
assessment
Electrocardiography
Echocardiography
Pulmonary artery
catheters
Drugs That Enhance
Contractility
• Digitalis
– Digitalis toxicity includes anorexia,
fatigue, changes in mental status.
– Monitor heart rate and electrolytes.
• Other inotropic drugs including
dobutamine, milrinone, and
levosimendan
• Beta-adrenergic blockers
Surgical Management
• Newer surgical therapies include the
following:
– Partial left ventriculectomy
– Endoventricular circular patch
– Acorn cardiac support device
– Myosplint
Potential for Pulmonary
Edema
• Interventions include:
– Assess for early signs, such as crackles
in the lung bases, dyspnea at rest,
disorientation, and confusion.
– Rapid-acting diuretics are prescribed,
such as Lasix or Bumex.
– Oxygen is always used.
– Strictly monitor fluid intake and output.
Valvular Heart Disease
• Mitral stenosis
• Mitral regurgitation (insufficiency)
• Mitral valve prolapse
• Aortic stenosis
• Aortic regurgitation (insufficiency)
Assessment
• Client may become suddenly ill or
slowly develop symptoms over many
years.
• Question client about attacks of
rheumatic fever, infective
endocarditis, and possibility of IV
drug abuse.
• Obtain chest x-ray, echocardiogram,
and exercise tolerance test.
Nonsurgical Management
• Drug therapy, including diuretics,
beta blockers, digoxin, oxygen, and
sometimes nitrates
• Prophylactic antibiotic
• Management of atrial fibrillation,
cardioversion
• Anticoagulant
• Rest with limited activity
Surgical Management
• Reparative procedures
• Balloon valvuloplasty
• Direct, or open, commissurotomy
• Mitral valve annuloplasty
• Replacement procedures
Infective Endocarditis
• Microbial infection involving the
endocardium
• Occurs primarily with IV drug abuse,
valvular replacements, systemic
infections, or structural cardiac
defects
• Possible ports of entry: mouth, skin
rash, lesion, abscess, infections,
surgery, or invasive procedures
including IV line placement
Manifestations
• Murmur
• Heart failure
• Arterial embolization
• Splenic infarction
• Neurologic changes
• Petechiae (pinpoint red spots)
• Splinter hemorrhages
Interventions
• Antimicrobials
• Rest, balanced with activity
• Supportive therapy for heart failure
• Anticoagulants
• Surgical management
Pericarditis
• Inflammation or alteration of the
pericardium, the membranous sac
that encloses the heart
• Dressler’s syndrome
• Postpericardiotomy syndrome
• Chronic constrictive pericarditis
Assessment
• Substernal precordial pain radiating
to left side of the neck, shoulder, or
back
• Grating, oppressive pain, aggravated
by breathing, coughing, swallowing
• Pain worsened by the supine
position; relieved when the client sits
up and leans forward
• Pericardial friction rub
Interventions
• Hospitalization for diagnostic evaluation,
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observation for complications, and
symptom relief
Nonsteroidal anti-inflammatory drugs
Corticosteroid therapy
Comfortable position, usually sitting
Pericardial drainage
Chronic pericarditis: radiation or
chemotherapy
Uremic pericarditis: dialysis
Pericardiectomy
Emergency Care of Cardiac
Tamponade
• Cardiac tamponade—an extreme
emergency
• Increased fluid volume
• Hemodynamic monitoring
• Pericardiocentesis
• Pericardial window
• Pericardiectomy
Interventions
• Nonsurgical management
• Surgical management
– Cardiomyoplasty
– Heart transplantation