Heart Failure.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * Heart Failure Assessments, Interventions and Outcomes Psychosocial Assessment Query patient about recent stressors Ask patient to rate current stress level Ask patient to describe any significant recent life change Hope is a major determinant of well being. Lab Assessment Serum electrolytes BUN, Creatinine, Creatinine Clearance Urinalysis HH ABG’s BNP Radiographic Assessment Chest X-ray Other Diagnostic Tests ECG Ventricular hypertrophy, dysrhythmias, myocardial ishemia, injury, infarction Echo Cardiac valvular changes, pericardial effusion, chamber enlargement, ventricular hypertrophy Radionuclide studies Can indicate presence and cause of heart failure MUGA scan Provide information about Left ventricular ejection fraction and velocityPulmonary Artery Catheter Other Diagnostic Tests (cont.) Pulmonary Artery Catheter Right Atrial Pressure increased in Right Ventricular Failure Normal or increased in Left Ventricular Failure Pulmonary Artery Pressure and Pulmonary Artery Wedge Pressure (PAWP) elevated in Left sided failure Nursing Diagnoses Impaired Gas Exchange related to inadequate cardiac pump function Decreased Cardiac Output related to a reduction in stroke volume as a result of mechanical malfunctions Activity Intolerance related to an imbalance between oxygen supply and demand, fatigue, or an electrolyte imbalance Primary Collaborative Problem Potential for Pulmonary Edema Additional Nursing Diagnoses Ineffective Therapeutic Regimen Management Ineffective Coping Acute Confusion Impaired Physical Mobility Potential for Pneumonia Potential for Dysrhythmias Potential for Renal Dysfunction secondary to decreased renal perfusion Impaired Gas Exchange Expected Outcome: Client with heart failure is expected to have: Normal rate, rhythm and depth of respirations Oxygen saturation within normal limits No dyspnea at rest Impaired Gas Exchange Interventions: Should be aimed at promoting optimal spontaneous breathin