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HF~FEB 09 - HEART FAILURE Karen L OBrien MSN RN Spring 2011...

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HEART FAILURE Karen L. O’Brien, MSN, RN Spring 2011
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Nursing Diagnosis Ineffective tissue perfusion Activity intolerance Fluid volume excess Impaired gas exchange Anxiety Deficient knowledge
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Heart Failure: The Numbers Affects nearly 5 million Americans Estimated 400,000-700,000 diagnosed annually since 1979 Less than 50% alive after 5 years, less than 25% after 10 years Heart Failure (HF) is the most common admitting dx for hospital admissions over age 65
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Heart Failure: Risk Factors CAD (ischemic) HTN DM Obesity Smoking Hyperlipidemia Obstructive sleep apnea
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Heart Failure Perfusion : supplying an organ or tissue with nutrients and oxygen via the blood through the arteries HEART FAILURE is a syndrome that results from pump failure , heart unable to pump adequate amounts of blood to meet the body’s metabolic needs
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Heart Failure: Systolic vs Diastolic Systolic : ventricles not contracting with enough force (pump) blood out to the rest of the body during systole (emptying) Ejection Fraction <40% LV : thinned, dilated S&S: Decreased exercise tolerance, dyspnea, congestion, and/or pulmonary edema
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Heart Failure: Systolic vs Diastolic Diastolic: ventricles not able to relax or fill properly (wall stiffness), less enters heart, contracts normally Ejection Fraction > 50% LV: hypertrophy S&S: Decreased exercise tolerance, dyspnea, congestion, and/or pulmonary edema
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Question Systolic Heart failure is characterized by: a. Impaired ability of the ventricle to relax b. Impaired ability of the ventricle to contract c. EF <40% d. Manifested by SOB, fatigue, pulmonary congestion
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Review Blood Flow
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Principles of Blood Flow: CARDIAC OUTPUT CO = SV x HR CO (cardiac output) is the amount of blood ejected by the left ventricle into the aorta in one minute, approx 5.25 L/min SV (stroke volume) amount of blood ejected during each ventricular contraction, 70-75 ml HR (heart rate) number of times the heart beats per min
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Ejection Fraction Percentage of blood that's pumped out of a filled ventricle with each heartbeat Normal 50-70% Diastolic Failure: EF > 50% Systolic Failure: EF < 40%
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EF = 60 % SV = 100 ml EF = 40 % SV = 100 ml EF = 20 % SV = 100 ml The stroke volume does not change, only the ability of the ventricle to contract strong enough to pump the blood out of the heart to the rest of the body.
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Principles of Blood Flow: Stroke Volume PRELOAD Volume of blood that fills the heart with each beat Larger the PRELOAD, the greater the stroke volume
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Principles of Blood Flow AFTERLOAD The resistance the heart has to pump against to eject blood from the heart Also know as systemic vascular resistance (SVR)
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Principles of Blood Flow CONTRACTILITY The ability of the heart muscle to contract and eject blood from the heart Inotropic: positive or negative
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Pathophysiology of HF Increased Preload Too much volume Impaired contractility of the muscle causing inability of the heart muscle to eject the blood.
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