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Wait 2 hours after eating for physical activity Avoid activities in extreme hot, cold, or humid weather Modify activities to conserve energyPositioning; elevation of the HOB to facilitate breathing and rest, support of arms Fluid Volume ExcessAssessment for symptoms of fluid overload Daily weightI&O Diuretic therapy- in AM!!!; timing of meds- check Potassium levels especially w/ loop diureticFluid intake; fluid restrictionMaintenance of sodium restrictionPatient TeachingMedicationsDiet: low-sodium diet and fluid restrictionMonitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, including daily weight (gain more than 2-3 lbs a day (call physician or take extra Lasix) and more than 5 lbs in a week)Exercise and activity programStress managementPrevention of infectionKnow how and when to contact health care provider
Include family in teaching Medications/Role of NurseReduce preload and afterloadImprove stroke volumeIncrease cardiac muscle contractility Non-Pharm TreatmentRole of the patientEducationCPAPAICD (implantable cardiac defibrillator) Biventricular pacing – pacing both ventricles helps to reproduces normal ventricular contraction; helps prevent remodelingVentricular assist device (VAD)- can’t do ADL’s would be good for them; usually on list fortransplant Acute HF or Pulmonary Edemaoacute event that results from LV failureomay already be diagnosed w/ chronic may be from MI toooS/SFrothy, blood-tinged sputumpt is literally drowning in their own secretions emergency WheezesCoughingCrackles and wheezesIncreased heart rateAgitation and confusionPale and possible cyanosisRR > 30; accessory muscle useO2 sat is significantly decreased oGoalsImprove LV function by decreasing volumeDecrease preloadDecrease afterloadImprove gas exchange and oxygenationDecrease anxietyoManagementFirst thing you want to do as a nurseif pt is SOB, tachypnic, etc sit them upright w/ legs dangling (fluid traps in legs and doesn’t go back to heart) start O2 Preventeasier to prevent than treatin early stages, it may be alleviated by placing pt upright with feet and legs dependent, eliminating overexertion, and minimizing emotional stress to reduce the LV loadEarly recognition: monitor lung sounds and for signs of decreased activity tolerance and increased fluid retentionPlace patient upright and dangle legsMinimize exertion and stress Oxygenface mask used initially may need ventilator monitored via pulse-ox and ABGsMedications
Morphine – vasodilator, reduces anxiety and helps relaxDiuretic: furosemide – causes vasodilation and pooling of blood in peripheral blood vessels, which reduces the amount of blood returned to the heartoFurosemideNo more than 10-20mg per minute IV (if given too fast, can cause ototoxicity)Check potassium level Vasodilators Nursing InterventionsAdministration of loop diuretics (Lasix, Bumex)Foley Catheter to measure UOPIVF’sIV NTG