Enlarged liver ascites Left sided failure more common Cardiogenic Pulmonary

Enlarged liver ascites left sided failure more common

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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
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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
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