1-27
1-27. HEART FAILURE
a. Heart failure is the clinical state in which there is inadequate cardiac output, resulting in poor perfusion of all organ systems.
b. In left sided heart failure, the pumping action of the left ventricle is compromised, but the right ventricle continues to function normally. There is an imbalance between the out-put of each ventricle. The right heart continues to pump blood into the lungs to be oxygenated. The failing left heart, however, is unable to return that same volume of blood to the systemic circulation. The result is an accumulation of blood in the pulmonary blood vessels. Increased pressure in the pulmonary vessels causes fluid to leak into the interstitial lung tissue, compromising gas exchange. This condition is called pulmonary edema.
c. Right sided heart failure usually follows left sided failure. The increased pressure in the pulmonary vessels causes "back pressure" to the right side of the heart. This interferes with venous return, and consequently, the organs of the body become congested. This condition, known as congestive heart failure (CHF), is manifested by neck vein distention and body edema.
d. Right sided failure may occur without left sided failure. This condition, called corpulmonale, may be caused by pulmonary hypertension secondary to lung disease or by the presence of pulmonary emboli.
e. Medical management of heart failure is twofold. The first concern of treatment is to stabilize the failure, relieving the edema and congestion. The second concern is to discover and treat the underlying cause of the failure.
f. Nursing care of the patient with heart failure involves two major areas: nursing intervention during the acute phase of illness and patient education to prepare the patient for discharge.
(1) During the acute phase, nursing considerations include the following:
(a) Monitoring fluid retention by weighing the patient daily.
(b) Monitoring intake and output.
(c) Frequent assessment of vital signs.
(d) Frequent monitoring of electrolytes.
(e) Promoting mental and physical rest to reduce the workload of the heart.
(f) Administration of prescribed medications to improve the heart's effectiveness as a pump.
(g) Administration of prescribed dietary restrictions (sodium and fluids).
(2) Patient education should include the following nursing considerations:
(a) Instruction on effective coping mechanisms that will reduce stress in daily living.
(b) Compliance in taking prescribed medications.
(c) Compliance in following the prescribed dietary and fluid restrictions.
(d) The importance of regular check-ups.
