Enlarged liver--ascites
Left-sided failure
( more common)
Cardiogenic Pulmonary Edema:
–
Fatigue
–
Dyspnea
–
Orthopnea
–
Wheezing/Rales
–
Dry hacking cough or pink frothy expectorant
–
Drowning feeling
–
Skin: cool, clammy, pale, cyanotic
–
Elevated PAWP (pulmonary artery wedge pressure)
Many people will have adaptations of both left and right sided failure
•
Left sided can progress to cardiogenic shock due to inadequacy of left ventricular
pumping
•
Cardiogenic shock
adaptations:
mental status changes
hypotension
tachycardia
tachypnea
decreased urine output
decreased peripheral circulation
Assessment
Clinical Manifestations :
•
Daily weights (2.2lb/1kg = 1L)
•
Strict I & O
•
Lung sounds
•
Cardiac sounds
•
Dependent edema
•
Recent dietary changes
•
Recent medication changes
Testing:
•
EKG/ Holter monitor/EPS / Stress testing (see dysrhythmia content)
•
CXR
•
MUGA scan (view radioisotopes circulating in blood through heart) provides
ejection fraction
•
Echocardiogram/ TEE transesophageal echo (NPO)
•
ABG’s/ pulse ox
•
Electrolytes/ Dig levels/H &H
•
Cardiac enzymes (review NUR105 content)
•
BNP
•
Cardiac catherization: angiography (contrast agent):
can be venous
(right side of
heart) or more commonly arterial (left side of heart & coronary arteries)
Check for allergies to shellfish & iodine
Check for adequate hydration & urine output
Administer Mucomyst (acetylcysteine) PO prior to test to prevent
nephrotoxicity from contrast. Take with soft drink or fruit juice to
mask the odor of the solution best (smells like sulfur or
rotten eggs)
Teach to fast 8- 12 hours prior to test
Will experience “hot flash” when dye is injected; may experience
palpitations; need to report chest pains
Maintain bedrest for 4-6 hours post-procedure with head of bed <30
degrees; for 24 hours no heavy lifting/straining
Observe site for bleeding/hematoma
Check circulation distal to insertion site (color, warmth, pulses, capillary
refill, sensation)
Encourage fluid intake (unless contraindicated) as dye acts as diuretic
•
CVP (central venous pressure):
a direct measurement of the blood pressure in the
right atrium and vena cava. Catheter is threaded into any of several large veins.
The tip of the catheter rests in the lower third of the superior vena cava. The
second lumen may be used to administer fluids/meds. (norm 0-8 mm)
•
Swan-Ganz line:
When balloon on tip of catheter is briefly inflated, it measures
pressure coming from left side of heart into the pulmonary vasculature.
Also has CVP measuring ability. Used only for monitoring; NO
infusions.
•
BNP (b-type or brain natriuretic peptide) measures the amount of the BNP
hormone in the blood. BNP is made by the heart. In heart failure, the heart
releases more BNP and the blood level of BNP will get higher. The BNP level will
drop when treatment for heart failure is working.
Norm <100µg/mL
CHF >4,000 µg/mL
Commonalities of hemodynamic monitoring: CVP, arterial line, Swan-Ganz
•
Monitor for infection
•
Monitor for bleeding/hematoma
•
Prevent air embolism
•
Maintain occlusive sterile dressing
•
Relate findings to other assessment data
Nursing Problems
Decreased cardiac output
Impaired gas exchange
Fluid volume excess
Altered tissue perfusion
