Managing Heart Failure

Managing Heart Failure Carla Vossen, SPN Kristin Madigan RN, BSN NURS 1300: Research Project South Central College November 23, 2009 Heart failure is a chronic and progressive syndrome, resulting from the inability of the heart muscle to pump with enough force to meet the metabolic demands of the body. (Buckler,13) According to the Center for Disease Control; (CDC) there are approximately five million people in the United States that have heart failure. Approximately 550 thousand people are diagnosed with heart failure each year. African Americans have a higher death rate than Caucasian Americans; the estimated medical costs in 2006 were 29. 6 billion dollars. Heart failure has a very broad range of causes, some of the more common cardiovascular causes are: congenital heart conditions, valvular disease, coronary artery disease, myocarditis, cardiomyopathies, myocardial infarction, and hypertension. Noncardiovascular causes of heart disease include pulmonary embolism, thyrotoxicosis, and chronic obstructive pulmonary disease. (Williams,407 ) Lifestyle choice such as smoking, excessive alcohol intake and environment are contributing risk factors. (Buckler,13-15: Williams,408) The symptoms will vary depending on which side of the heart is failing, patients age, and the severity of the disease. However fatigue and weakness are the hallmark signs of heart failure. Williams,483) When pump failure occurs in a damaged left ventricle, referred to as left-sided heart failure (most commonly occurs here); signs and symptoms can include: Dyspnea on exertion, Cheyne-Stokes respirations, crackles, wheezing nocturia, restlessness, cough, pink frothy sputum, weakness, and paroxysmal nocturnal dyspnea, and cyanosis. Right ventricle failure or right-sided heart failure can either be primary failure or secondary to left-sided heart failure. Signs and symptoms can include: Peripheral edema, ascites , abdominal pain nd fullness, anorexia or sudden weight gain, tachycardia, jugular vein distention, nocturia, and nausea. (Williams,484) Controlling modifiable factors can prevent heart failure, such as smoking and diet. However these factors do not directly cause heart failure but is secondary to an underlying disease such as coronary artery disease that can lead to heart failure. In general heart failure patients have a poor prognosis unless the cause is correctable. If the heart failure is primarily due to a valvular disorder, repair or replacement could reverse the disorder. Heart transplant may be an option for some patients. Several diagnostic procedures may be done to aid in the diagnosis of heart failure. First a complete history and physical examination will be performed, followed by one or more of the following: chest x-ray to detect enlarged heart and pulmonary congestion; electrocardiogram (ECG) is used to assess hypertrophy, ischemia, and arrhythmias; echocardiograms assess blood flow and left ventricular function; cardiac catheterization may show ventricular dilation, coronary artery occlusion, and valvular disorders. Serum blood testes include: Brain natriuretic peptide (BNP) is very specific for detecting heart failure. Electrolytes, blood urea nitrogen, creatinine (to rule out kidney disease); complete blood count (CBC) is used to rule out anemia and infection; Arterial blood gasses (ABGs). (Myers, 484) These are just a few of the main diagnostic tools used to detect or eliminate heart failure and determine the cause. (Buckler,15-17) Treatment is patient specific and will focus on the underlying cause and severity of the heart failure. Pharmacologic interventions may include; ACE inhibitors to decrease cardiac hypertrophy and afterload, these are the first line of pharmacologic interventions. Diuretics are used to decrease fluid overload, beta blockers are used to improve cardiac output, and an anticoagulant may be needed. These medications along with cessation of smoking, close and accurate daily weight monitoring, low sodium diet to help eliminate fluid retention, a high potassium diet may be needed if a thiazide diuretic is prescribed, regular light activity with appropriate rest periods, within the parameters set by the physician, and oxygen therapy. Myers,487-89) Before discharge it is imperative that the patient and family understand the purpose, dosage, schedule, and route of administration of all the medications they are taking, as well as the side effects that need to be reported to their physician. Avoid any over-the-counter medications that may contain sodium, and if they are unsure of a medication, cons ult the physician or pharmacist. They need to understand the level and importance of daily activity and when to stop exercising and when to report to their physician; what procedure should be done when assessing their daily weight and the importance of notifying the physician of daily weight gain of two to three pounds of weekly gain of five pounds. They should also know the importance of the low sodium diet; or high potassium diet if their on a thiazide diuretic, and maintain their fluid restriction. (Buckler,19-20) Supportive resources should be provided to the patient and family. Any knowledge deficit in these areas can have dangerous consequences. Beers, 657-68 ) Patients will often experience shortness of breath, which will increase anxiety. They need to know that the anxiety can exacerbate the shortness of breath. Teaching the patient to sit in the Fowlers position, how to use oxygen as prescribed will help decrease the demand of oxygen. (Beers, 657) Patients should be aware of the different relaxation therapi es that they can practice to help alleviate stress and help slow their breathing; they need to know how and when to use any inhalers they may have prescribed, and the signs and symptoms of any side effects. I choose to research heart failure because of the amount of people that have the disease, its devastating effects on a person lifestyle, and the many underlying diseases that can lead to the disease. Heart failure may not be curable in most cases, however with a strict adherence to the medication, exercise, diet, fluid restriction; a patient has a chance to stop the progression of the underlying cause, therefore avoiding heart failure. References Beers, Mark. ed. , et al. Merck manual of Diagnosis and Therapy. New Jersey: Merck Research Laboratories, 16th ed. 2006. Buckler, L. (2009). Managing Heart Failure. Nursing Made Incredibly Easy. May/ June, 12-20. Center for Disease Control. (2009, Nov 20). Heart Failure Fact Sheet. Retrieved from: http://cdc. gov/dhdsp/library/fs_heart_failure. htm Myers, Tamara, ed. â€Å"Heart Failure. † Mosby’s Medical Dictionary. 8th ed. 2009. Mosby Elsevier. Williams, Linda, Paula Hopper. ed. Understanding Medical Surgical Nursing. Pennsylvania: F. A. Davis Company, 3rd ed. 2007, 480-496.