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Enlarged liver--ascitesLeft-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 ventricularpumping•Cardiogenic shockadaptations: mental status changeshypotensiontachycardiatachypneadecreased urine outputdecreased peripheral circulationAssessmentClinical Manifestations :•Daily weights (2.2lb/1kg = 1L)•Strict I & O •Lung sounds•Cardiac sounds•Dependent edema•Recent dietary changes•Recent medication changesTesting:•EKG/ Holter monitor/EPS / Stress testing (see dysrhythmia content)•CXR•MUGA scan (view radioisotopes circulating in blood through heart) providesejection 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 ofheart) or more commonly arterial (left side of heart & coronary arteries)Check for allergies to shellfish & iodineCheck for adequate hydration & urine outputAdminister 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 orrotten eggs)Teach to fast 8- 12 hours prior to testWill experience “hot flash” when dye is injected; may experience palpitations; need to report chest painsMaintain bedrest for 4-6 hours post-procedure with head of bed <30 degrees; for 24 hours no heavy lifting/strainingObserve site for bleeding/hematomaCheck 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 theright 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. Thesecond 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 measurespressure coming from left side of heart into the pulmonary vasculature. Also has CVP measuring ability. Used only for monitoring; NOinfusions. •BNP (b-type or brain natriuretic peptide) measures the amount of the BNPhormone in the blood. BNP is made by the heart. In heart failure, the heartreleases more BNP and the blood level of BNP will get higher. The BNP level willdrop 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 dataNursing ProblemsDecreased cardiac outputImpaired gas exchangeFluid volume excessAltered tissue perfusion