HEART FAILURE (HF): CLINICAL SYNDROME INVOLVING IMPAIRED CARDIAC PUMPING/ FILLING (HAYES, 2015)

ETIOLOGY (MCMURRAY ET AL., 2012)
1. MOST COMMON
  1. HYPERTENSION
  2. CORONARY ARTERY DISEASE
  3. DIABETES MELLITUS
2. LESS COMMON
  1. RHEUMATIC HEART DISEASE
  2. ANEMIA
  3. CARDIOMYOPATHY
  4. VALVULAR DISORDERS
  5. CONGENITAL HEART DISEASE
3. PRECIPITATING
  1. MYOCARDITIS
  2. PULMONARY EMBOLISM
  3. PULMONARY DISEASE
  4. PAGET'S DISEASE
  5. HYPERVOLEMIA
  6. INFECTION
  7. HYPOTHORYDISM
COMPLICATIONS (MCMURRAY ET AL., 2012; HAYES, 2015)
1. PLEURAL EFFUSION
2. DYSRHYTHMIAS
3. LEFT VENTRICULAR THROMBUS
4. HEPATOMEGALY
5. RENAL FAILURE
TYPES
1. LEFT SIDED HF (LEWIS ET AL.,2010)
  1. SIGNS
    1. CRACKLES
    2. TACHYCARDIA
    3. LEFT-VENTRICULAR HYPERTROPHY
    4. CHEYNE-STOKES RESPIRATIONS
  2. SYMPTOMS
    1. FATIGUE
    2. DYSPNEA
    3. ORTHOPNEA
    4. DRY, HACKING COUGH
    5. PULMONARY EDEMA
    6. NOCTURIA
    7. PAROXYSMAL NOCTURNAL DYSPNEA (PND)
    8. ANXIETY
    9. RESTLESSNESS
2. RIGHT SIDED HF (LEWIS ET AL.,2010)
  1. SIGNS
    1. RV HYPERTROPHY
    2. MURMURS
    3. WEIGHT GAIN
    4. TACHYCARDIA
    5. PERIPHERAL EDEMA/GENERALIZED EDEMA
    6. HEPATOMEGALY
    7. SPLENOMEGALY
    8. ASCITES
    9. RIGHT-SIDED PLEURAL EFFUSION
  2. SYMPTOMS
    1. RIGHT UPPER QUADRANT PAIN
    2. DEPENDENT EDEMA
    3. FATIGUE
    4. ANOREXIA/GI BLOATING
    5. NAUSEA
PREVALENCE (HEART & STROKE FOUNDATION, 2016a)
1. 600,000 CANADIANS LIVING WITH HF
2. 50,000 DIAGNOSED EACH YEAR
3. INCREASED HOSPITALIZATION
  1. $ 2.8 BILLION/YEAR
PATHOPHYSIOLOGY (LEWIS ET AL, 2010)
1. SYSTOLIC (MOST COMMON)
  1. DECREASED IN LEFT VENTRICULAR EJECTION
  2. CAUSES
    1. IMPAIRED CONTRACTILE FUNCTION (I.E. MI)
    2. INCREASED AFTERLOAD (I.E. HYPERTENSION
    3. CARDIOMYOPATHY
    4. MECHANICAL ABNORMALITIES (I.E. VALVULAR HEART DISEASE
2. DIASTOLIC
  1. IMPAIRED ABILITY OF VENTRICLES TO FILL
  2. CAUSES
    1. LEFT VENTRICULAR HYPERTROPHY
    2. AORTIC STENOSIS
    3. HYPERTROPHIC CARDIOMYOPATHY
  3. PREDIMONINANTLY WOMEN
    1. DUE TO HYPERTENSION AND MYOCARDIAL FIBROSIS
  4. SEEN IN OLDER ADULTS
3. MIXED SYSTOLIC AND DIASTOLIC
4. COMPENSATORY MECHANISM
  1. DILATION OF HEART CHAMBERS
  2. HYPERTROPHY
  3. SNS ACTIVATION
  4. NEUROHORMONAL RESPONSE
  5. VENTRICULAR REMODELLING
TREATMENT (MCMURRAY ET AL., 2012; HAYES, 2015)
1. DRUG THERAPY
  1. ACE INHIBITORS
  2. ANGIOTENSIN RECEPTOR BLOCKERS (ARB)
  3. ALDOSTERONE RECEPTOR ANTAGONISTS
  4. BETA BLOCKERS
  5. ANGIOTENSIN II RECEPTOR BLOCKER
  6. DIURETICS
    1. THIAZIDE (FIRST CHOICE)
    2. LOOP DIURETICS I.E. FUROSEMIDE
    3. SPIRONOLACTONE (K+ SPARING)
  7. DIGITALIS
    1. DIGITALIZATION PROTOCOL
      1. THERAPEUTIC LEVEL (0.8-2.0 UG/L)
      2. MAINTENANCE DOSE (0.125-0.25 MG ONCE DAILY)
      3. DIVIDED INTO 3 SEPARATE DOSES OVER 24 HOUR PERIOD
    2. ACTIONS
      1. INOTROPIC (INCREASES FORCE OF HEART)
      2. DROMOTROPIC (PROLONGS REFRACTORY PERIOD)
      3. CHRONOTROPIC (DECREASES HR)
    3. NURSING IMPLICATIONS
      1. MONITOR APICAL PULSE 1 MIN
      2. ASSESS FOR ELECTROLYTE DEPLETION
      3. POTASSIUM LEVELS (3.5-5.0 MMOL/L)
      4. ASSESS FOR DIGOXIN TOXICITY
        ANTIDOTE: DIGIBIND
      5. DAILY WEIGHT + I&O
  8. VASODILATORS
2. CARDIAC REHABILITATION
  1. MEDICALLY SUPERVISED PROGRAM
  2. IMPROVE PHYSICAL, SOCIAL AND MENTAL FUNCTION
  3. STABILIZE, SLOW, REVERSE PROGRESSION OF HF
3. SURGERY & DEVICES
  1. CARDIAC TRANSPLANTATION
  2. BIVENTRICULAR PACING
  3. CARDIAC RESYNCHRONIZATION THERAPY
  4. IMPLANTABLE CARDIOVERTER DEFRIBILLATOR
  5. LEFT VENTRICULAR ASSIST DEVICE (LIMA ET AL., 2015)
NURSING AND COLLABORATIVE MANAGEMENT (LEWIS ET AL., 2010)
1. EVALUATION
  1. LESS ANXIETY
  2. REALISTIC PROGRAM OF ACTIVITY
  3. REDUCED OR ABSENT EDEMA
  4. ADHERES TO MEDICATION AND DIETARY REGIMEN
2. AMBULATORY AND HOME CARE (LEWIS ET AL, 2010
  1. EXPLAIN PHYSIOLOGICAL CHANGES THAT OCCURED
  2. ASSIST CLIENT IN ADAPTING TO PSYCHOLOGICAL AND PHYSIOLOGICAL CHANGES
  3. INTEGRATE CLIENT'S FAMILY AND SUPPORT SYSTEM IN CARE PLANS
3. HEALTH PROMOTION
  1. SMOKING CESSATION
  2. FLU AND PNEUMONIA VACCINATIONS
  3. PACEMAKERS/ANTIDYSRHYTHMIC AGENTS
  4. CONTTROL OF UNDERLYING HEART DISEASE (I.E. CONTROL OF HYPERTENSION OR VALVE REPLACEMENT
4. ACUTE INTERVENTION
  1. CLIENT-CENTRED TREATMENT PLANS
  2. SYMPTOM MANAGEMENT
    1. OXYGEN THERAPY
  3. SALT RESTRICTION
  4. ENERGY CONSERVATION
  5. SUPPORT SYSTEMS
  6. SURGICAL WOUND CARE
  7. CHEST TUBE (DRAINAGE)
5. NURSING DIAGNOSES
  1. ACTIVITY INTOLERANCE
  2. EXCESS FLUID VOLUME
  3. IMPAIRED GAS EXCHANGE
  4. ANXIETY
  5. DEFICIENT KNOWLEDGE
    1. PATIENTS WHO DO NOT SPEAK ENGLISH (BRENNAN, 2015)
      1. INTERPRETER/TRANSLATOR
6. PLANNING (COEN & CURRY, 2016)
  1. DECREASE IN SYMPTOMS I.E. SOB, FATIGUE
  2. DECREASE IN PERIPHERAL EDEMA
  3. INCREASE IN EXERCISE TOLERANCE
  4. ADHERENCE TO DRUG REGIMEN
  5. NO COMPLICATIONS R/T HF
7. NURSING ASSESSMENT
  1. SUBJECTIVE DATA
    1. PAST MEDICAL HISTORY
    2. MEDICATIONS
    3. SYMPTOMS
  2. OBJECTIVE DATA
    1. INTEGUMENTARY
      1. COOL, DIAPHORETIC SKIN
    2. RESPIRATORY
      1. TACHYPNEA
      2. BLOOD TINGED SPUTUM
      3. CRACKLES
    3. CARDIOVASCULAR
      1. TACHYCARDIA
      2. MURMURS
      3. JUGULAR VEIN DISTENTION
    4. GASTRONINTESTINAL
      1. ABDOMINAL DISTENTION
      2. ASCITES
    5. NEUROLOGICAL
      1. RESTLESSNESS
      2. CONFUSION
8. END-OF-LIFE/PALLIATIVE CARE (MCKELVIE ET AL., 2011)
  1. RELIEVE PAIN/SYMPTOMS
    1. MEDICATIONS
    2. COMPLEMENTARY THERAPIES
      1. MASSAGE THERAPY
      2. ACUPUNCTURE
      3. PHYSIOTHERAPY
  2. MANAGING DISABILITY
    1. MEAL PREPARATION
    2. CLEANING
    3. TRANSPORTATION
    4. ASSISTIVE DEVICES
  3. ADDRESSING PSYCHOLOGICAL, SOCIAL AND SPIRITUAL ISSUES
    1. DEPRESSION
    2. ANXIETY
    3. SOCIAL SUPPORT
    4. SPIRITUAL SUPPORT
    5. CLINICAL COUNSELLING
  4. CAREGIVER SUPPORT
    1. BEREAVEMENT SUPPORT
  5. LEGAL/ETHICAL ISSUES (HEART &STOKE FOUNDATION, 2016)
    1. ADVANCED DIRECTIVES
      1. DO NOT RESUSCITATE (DNR)
    2. POWER OF ATTORNEY
    3. CULTURAL DIFFERENCES
      1. CHAPLAINCY AND SPIRITUAL CARE
      2. PERSONAL & FAMILY VALUES
9. PATIENT/CAREGIVER TEACHING (MCMURRAY ET AL., 2012)
  1. TAILORED TO INDIVIDUAL CLIENT
  2. HEALTH PROMOTION
  3. EXERCISE/REST
    1. KEEP ACTIVE
    2. SLEEP WELL
  4. DRUG THERAPY
    1. BE AWARE OF ADVERSE EFFECTS
  5. DIETARY THERAPY (WOODS, 2016)
    1. SALT RESTRICTION: LESS THAN 2000 MG PER DAY
    2. DAILY WEIGHTS: GAIN/LOSS ≥ 2 KG WITHIN 2 DAYS
    3. FLUID RESTRICTION: ≤ THAN 1.5-2 L/DAY
    4. REDUCE ALCOHOL INTAKE
    5. REDUCE CAFFEINE INTAKE
  6. END-OF-LIFE PLANNING
  7. ONGOING MONITORING
    1. BE AWARE OF S&S
    2. RECOGNIZE COGNITIVE IMPAIRMENT
    3. RECOGNIZE S&S OF DEPRESSION
  8. OTHER
    1. AVOID EXTREME COLD/HEAT
    2. KEEP REGULAR APPOINTMENTS
    3. SMOKE CESSATION
    4. RESTRICT ALCOHOL CONSUMPTION
DIAGNOSTIC STUDIES (LEWIS ET AL, 2010; HAYES, 2015)
1. ECHOCARDIOGRAM
2. STRESS TESTING
3. CARDIAC CATHETERIZATION
4. EJECTION FRACTION
5. HEMODYNAMIC ASSESSMENT
6. CHEST RADIOGRAM
7. HISTORY AND PHYSICAL EXAMINATION
8. LABORATORY DATA
  1. URINE TEST
  2. BLOOD AND BRAIN NATRIURETIC PEPTIDE TEST
    1. CALCIUM LEVELS
    2. CHOLESTEROL LEVELS
    3. GLUCOSE TEST
    4. LEVEL OF CLOTTING COMPONENT (I.E. FIBRINOGEN)
9. CORONARY ANGIOGRAM
10. SLEEP STUDY
11. DOPPLER ULTRASOUND
12. MONITORING
  1. HOLTER
  2. EVENT
  3. MOBILE TELEMETRY

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HEART FAILURE (HF): CLINICAL SYNDROME INVOLVING IMPAIRED CARDIAC PUMPING/ FILLING (HAYES, 2015)

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