Alterations in Oxygenation 14

7/31/2019 Alterations in Oxygenation 14

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Alterations in

OxygenationManagement of Patients with

Complications from Heart Disease


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Heart Failure

The inability of the heart to pump sufficientblood to meet the needs of the tissues foroxygen and nutrients

Asyndrome characterized by fluid overload or

inadequate tissue perfusion The term HF indicates myocardial disease, in

which there is a problem with the contraction ofthe heart (systolic failure) or filling of the heart

(diastolic failure). Some cases are reversible. Most HF is a progressive, lifelong disorder

managed with lifestyle changes and medications.


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Clinical Manifestations

Right-sided failure RV cannot eject sufficient amounts of blood, and

blood backs up in the venous system. This resuts inperpheral edema, hepatomegaly, ascites, anorexia,

nausea, weakness, and weight gain. Left-sided failure

LV cannot pump blood effectively to the systemiccirculation. Pulmonary venous pressures increase,

resulting in pulmonary congestion with dyspnea,cough, crackles, and impaired oxygen exchange.

Chronic HF is frequently biventricular.


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Medications

Angiotensin-converting enzyme inhibitors

Angiotensin II receptor blockers

Beta-blockers (Inderal) Diuretics

Digitalis

Other medications


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Nursing Process: The Care of the

Patient with HF: Assessment

Health history

Sleep and activity

Knowledge and coping

Physical exam Mental status

Lung sounds: crackles and wheezes

Heart sounds Fluid status/signs of fluid overload

Daily weight and I&O

Assess responses to medications


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Patient with HF: Diagnosis

Activity intolerance and fatigue

Excess fluid volume

Anxiety Powerlessness

Noncompliance


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Patient with HF: Planning

Goals may include promoting activity andreducing fatigue, relieving fluid overloadsymptoms, decreasing anxiety or

increasing the patients ability to manageanxiety, encouraging the patient to makedecisions and influence outcomes,

teaching the patient about the self-careprogram.


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Activity Intolerance

Bed rest for acute exacerbations

Encourage regular physical activity; 30-45 minutes daily

Exercise training

Pacing of activities

Wait 2 hours after eating before doing physical activity.

Avoid activities in extremely hot, cold, or humid weather.

Modify activities to conserve energy.

Positioning; elevation of HOB to facilitate breathing andrest, support of arms


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Fluid Volume Excess

Assessment for symptoms of fluidoverload

Daily weight

I&O

Diuretic therapy; timing of meds

Fluid intake; fluid restriction Maintenance of sodium restriction


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Patient Teaching

Medications Diet: low-sodium diet and fluid restriction Monitoring for signs of excess fluid, hypotension,

and symptoms of disease exacerbation,including daily weight

Exercise and activity program Stress management Prevention of infection Know how and when to contact health care

provider Include family in teaching


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Pulmonary Edema

Acute event in which the LV cannot handle anoverload of blood volume. Pressure increases inthe pulmonary vasculature, causing fluid tomove out of the pulmonary capillaries and into

the interstitial space of the lungs and alveoli. Results in hypoxemia Clinical manifestations: restlessness, anxiety,

dyspnea, cool and clammy skin, cyanosis, weak

and rapid pulse, cough, lung congestion (moist,noisy respirations), increased sputum production(sputum may be frothy and blood-tinged),decreased level of consciousness


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Management of Pulmonary Edema

Prevention

Early recognition: monitor lung sounds and forsigns of decreased activity tolerance and

increased fluid retention Place patient upright and dangle legs.

Minimize exertion and stress.

Oxygen Medications

Diuretic (furosemide)


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Alterations in Oxygenation 14