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Heart Failure, Fluids, and Diet

Heart Failure, Fluids, and Diet. Carolyn Scroggins, MSN, RN, GNP. Role of Potassium. Disturbed K + metabolism r/t majority of clinical arrhythmias Na + & Ca ++ reverse K + -induced depression of conduction K + only electrolyte clinically significant anti-arrhythmic properties.

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Heart Failure, Fluids, and Diet

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  1. Heart Failure, Fluids, and Diet Carolyn Scroggins, MSN, RN, GNP

  2. Role of Potassium • Disturbed K+ metabolism r/t majority of clinicalarrhythmias • Na+ & Ca++ reverse K+ -induced depressionof conduction • K+ only electrolyte clinically significantanti-arrhythmic properties.

  3. Healthy Left Side Heart • Left heart receives blood as it returns from the lungs • Pumps blood into the aorta, main artery of the body. • Then-- blood delivered via arteries to all organs, muscles & tissues.

  4. Left Side Does the Hardest Work

  5. What happens in Lt. Heart Failure LHF? • Body holds extra fluid, blood backs up into the lungs: • because left heart pumps blood away from heart to body organs. • During LHF, kidneys do not get enough blood, & are fooled into reacting as if body does not have enough blood. • Therefore, they hold on to salt & water to keep it in the blood rather than passing it out into the urine.Resulting: excess fluid builds up in the body, putting an additional strain on heart. • This strain makes pumping function of the left side of heart worse, causing less blood to get to the kidneys =vicious cycle.

  6. Causes of Left-sided failure • Heart Attack • Chronic blockages of the heart arteries • High Blood Pressure • Leaking or narrow heart valves • Heart muscle infections • Acute MI & Cardiomyopathy

  7. Blocked Cardiac Arteries

  8. Leaky Valve

  9. Cardiomyopathy

  10. Myocardial Infarction

  11. What is this artery called?

  12. Lt. Sided Heart Failure Symptoms • dyspnea, orthopnea, crackles, wheezing, hypoxia, respiratory acidosis, cough (frothy sputum), cyanosis, palpitations, arrhythmias, elevated blood pressure • dyspnea on exertion appears to be earliest symptom • complaints of paroxysmal nocturnal dyspnea (awakening from sleep with shortness of breath), or new-onset dyspnea on exertion should undergo evaluation for heart failure

  13. Shortness of Breath

  14. Assessment for Fine Crackles

  15. Left Heart Failure

  16. Cyanosis R/T Lt. Sided Heart Failure

  17. Difficulty Breathing R/T Lt. Sided Heart Failure

  18. Medications for Lt. Sided Heart Failure • DIURETICS • ACE INHIBITORS • BETA BLOCKERS • DIGOXIN

  19. Why Meds are Used: • Diuretics relieve pulmonary & peripheral edema. May also treat hypertension since they dilate blood vessels. • Potential Side effects: dizziness, severe leg cramps, high blood sugar levels, high cholesterol levels (NURSES WATCH FOR THIS) • Examples: Furosemide(Lasix,) Bumetanide(Bumex), Hydrochlorthiazide(HCTZ)

  20. ACE Inhibitors Angiotensin Converting Enzyme (ACE) • Inhibitors block Angiotensin II formation, • causes constriction of blood vessels. • reduce strain on heart; relax smaller arteries & lower BP. • SE: dizziness. ACE inhibitors can prevent increases in heart size. • Potential Side effects: cough, dizziness, worsening of some types of kidney disease • Examples: Lisinopril (Prinivil), Enalapril (Vasotec), Captopril (Capoten)

  21. Vasodilators • Med group-- relax blood vessels & lower resistance against which the heart has to pump. • Like ACE inhibitors or ARBs (Angiotensin Receptor Blockers) they can cause low blood pressure & dizziness. • Potential Side effects: hypotension, dizziness, tachycardia, headache (NOTE: THIS IS WHY NURSES TAKE BLOOD PRESSURE BEFORE ADMINISTRATION) • Examples: Hydralazine, IsosorbideDinitrate, Nitroglycerin

  22. Beta Blockers • Some sympathetic tone on the heart • beta-blockers reduce sympathetic influences that stimulate heart rate • beta-blockers--decrease heart rate, contractility, conduction velocity, & relaxation rate.

  23. Beta Blockers • Drugs block the heart cell response to catecholamines (norepinephrine, epinephrine) – • Catecholamines- responsible for CNS "fight or flight" response. Beta-Blockers may reduce heart’s energy needs, & over a long time may reduce heart size & improve heart function. • Potential Side Effects: decreased ventricular function, slow heart rate, worsening of asthma symptoms. (NOTE: NURSES MUST TAKE APICAL PULSE) • Examples: Carvedilol (Coreg,), Metoprolol (Toprol XL)

  24. side effects of beta blockers • SE--beta-blockers r/t cardiac mechanisms & include: • bradycardia • reduced exercise capacity • heart failure • Hypotension • atrioventicular (AV) nodal conduction block. NOTE: (These side effects result from excessive blockade of normal sympathetic influences on the heart)

  25. Beta Blockers/CCB • When beta-blocker is given in conjunction with calcium-channel blockers (e.g., verapamil) = additive effects in producing electrical & mechanical depression. • beta-blockers--contraindicated in heart failure patients. • beta-blockers--contraindicated in pts. with bradycardia & partial AV block.

  26. Digitalis • Increases strength of heart's contractions, reducing resistance in blood vessels. • Decreases heart rate in heart failure patients & may decrease edema. • Potential Side effects: nausea & slow or fast heart beating • Examples: Digoxin (Lanoxin)

  27. Aldosterone Blockers • Aldosterone-- adrenal hormone responds to decrease in renal blood flow & other factors in heart failure. • May contribute to cardiac fibrosis. • Blockade of aldosterone effects may improve outcomes in advanced heart failure. • Potential Side effects: fatigue, headache, low blood pressure, nausea • Examples: Spironolactone( Aldactone )

  28. Healthy Right Side Heart • Right heart receives blood from veins. • Blood is returning from organs & low in oxygen. • Right side heart pumps blood to the lungs, where it picks up oxygen & delivers throughout the body. • Right heart begins to fail, blood & fluid back up into abdomen, legs & ankles. • Tenderness in upper right abdomen. • Loss of appetite, bloating, tired feeling.

  29. Cause of Right Sided Heart Failure • Left ventricle does not pump blood efficiently, • Leads to pressure buildup behind the left side of the heart • Eventually causes the right side of the heart to fail.

  30. Symptoms Rt. Heart Failure (cor pulmonale: rt.ventricle hypertrophy) • dependent peripheral edema • hepatomegaly • splenomegaly • jugular vein distention • ascites & kidney congested=decrease filtering • weight gain • arrhythmias, • nausea, vomiting, anorexia, • fatigue, dizziness, syncope, weakness

  31. Dependent Edema

  32. Dependent Edema

  33. Pitting EdemaEdema of ankles & feet-- common manifestation of right-sided heart failure. "Pitting" edema refers to the failure of the skin & soft tissue to immediately resume its normal contour upon release of pressure.

  34. Ascites R/T Rt. Sided Heart Failure

  35. Medications for Right-Sided Heart Failure • Diuretics: Furosemide or bumetanide help moderate to severe symptoms. • Hydrochlorothiazide, chlorthalidone, and chlorothiazideused for mild symptoms. • Spironolactone, prevents salt retention & helps with severe heart failure. • ACE inhibitors, Angiotensin Receptor Blockers Beta-blockers (such as metoprolol or carvedilol) can help prevent death • Digitalis NURSES NOTE: MEDICATIONS OFTEN INDICATE DEGREE OF HEART FAILURE

  36. Anti-Anginal Medications • Procardia (nifedipine)--Treats high blood pressure. migraine headaches, Raynaud's syndrome, cardiomyopathy, & congestive heart failure. • calcium channel-blocker—relaxes blood vessels of the heart

  37. Calcium Channel Blockers • Calcium channel blockers-- class of drugs that block entry of calcium into the muscle cells of heart & arteries. • The entry of calcium into these cells that causes heart to contract & arteries to narrow. By blocking the entry of calcium, CCBs decrease contraction of heart & dilate (widen) the arteries.

  38. CALCIUM CHANNEL BOCKERS (CCB) • By dilating arteries, CCBs reduce pressure in the arteries, making it easier for heart to pump blood, resulting in heart needing less oxygen. • By reducing heart's need for oxygen, CCBs relieve or prevent angina.

  39. For what conditions are CCBs used? • high blood pressure • angina • abnormal heart rhythms (e.g., atrial fibrillation). • used after a heart attack, among pts who cannot tolerate beta-blocking drugs (high-risk for hypotension or bradycardia) , have atrial fibrillation, or require treatment for angina.

  40. HEALTH HEART DIETS • CALORIE CONTROLLED • LOW-CHOLESTEROL • FAT-RESTRICTED • SODIUM-RESTRICTED • Note pg. 311 DHO Book FOR DIETS • FLUID RESTRICTIONS ACCORDING TO DAILY WEIGHT

  41. Enlarged Liver

  42. Enlarged Spleen

  43. Enlarged Spleen

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