Question

1.list 4  Manifestations of Right and Left sided Failure and 4 Symptoms of both right and left sided failure.

2.Loop Diuretics are given as a drug of choice,

i Name the two Diuretics that affect the loop of Henle.

ii What is the dosage and route this would be administered?

iiiName a contraindication for this medication.

3. List what assessment parameters must be assessed for CHF

4. Differentiate: Right, Left, Chronic Failure and Acute decompensated heart failure (ADHF).

   5. What are immediate nursing actions taken upon Assessment of a patient in ADHF

part 2

1. Please Identify 3 Nursing Diagnosis related to CHF

2. Write one patient Goal for one of the Nursing Diagnosis, you Identified.

3. Write 2 priority Nursing Interventions Related to the Nursing Diagnosis and Patient Goal

4. List 4 areas patient and family teaching related to the CHF

Answer 1

1.List 4  Manifestations of Right and Left sided Failure and 4 Symptoms of both right and left sided failure.

A) Manifestations of right sided heart failure

1. Distended jugular veins

2. Increased peripheral venous pressure

3. Dependent edema

4. Ascites.

B) Manifestations of left sided heart failure

1.Pulmobary congestion

2. Paroxysmal nocturnal dyspnea

3. Tachycardia

4. Orthopnea

A) Symptoms right sided heart failure

1. Anorexia

2. Nausea, vomiting

3. Fatigue

4. Nocturia

B) Symptoms left sided heart failure

1. Cough

2. Anxiety

3. Fatigue

4. Restlessness and confusion

2.Loop Diuretics are given as a drug of choice,

Loop diuretics remain the mainstay therapy for fluid removal in patients with HF. They exert their action by inhibiting the sodium-potassium-chloride cotransport system located within the thick ascending limb of the loop of Henle. Prevents reabsorption of sodium and chloride in the kidneys, increase excretion of water, sodium, chloride, magnesium, potassium

i Name the two Diuretics that affect the loop of Henle.

1.furosemide (Lasix )

2. bumetanide (Bumex)

ii What is the dosage and route this would be administered?

1.furosemide (Lasix )

injectable solution

• 10mg/mL

oral solution

• 10mg/mL
• 8mg/mL

tablet

• 20mg
• 40mg
• 80mg

Edema

20-80 mg PO once daily; may be increased by 20-40 mg q6-8hr; not to exceed 600 mg/day

Alternative: 20-40 mg IV/IM once; may be increased by 20 mg q2hr; individual dose not to exceed 200 mg/dose

Refractory CHF may necessitate larger doses

2. bumetanide (Bumex)

injectable solution

• 0.25mg/mL

tablet

• 0.5mg
• 1mg
• 2mg

Edema

PO: 0.5-2 mg once; may be repeated in 4-5 hours for up to 2 doses; not to exceed 10 mg/day

IM: 0.5-1 mg once; may be repeated in 2-3 hours for up to 2 doses; not to exceed 10 mg/day

IV: 1 mg initially, then 0.5-2 mg/hr

iiiName a contraindication for this medication.

1)Furosemide (Lasix )

Furosemide is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide.

2) bumetanide (Bumex)

Documented hypersensitivity to bumetanide or sulfonamides

Severe uncorrected electrolyte depletion, anuria, hepatic coma

3. List what assessment parameters must be assessed for CHF.

1. Vital Signs
   Baseline vital signs are important here as well as for our other assessments, including an apical pulse; history is also important.
2. Cardiovascular
   Assess heart rhythm, and strength of the heartbeat. Assess pulses, skin color, tugor and blanching.
3. Respiratory
   Assess lung sounds for congestion, rales
4. General Medical
   Neuro assessment, lethargy, restlessness, skin color, extremities for reduced circulation.
5. Look for weight increase.
6. Ask about orthopnea, paroxysmal nocturnal dyspnea. ...
7. Examine pitting edema. ...
8. Observe jugular venous pressure, jugular venous distension. ...
9. Consider chest X-ray, lung exam results.
10. Look for ascites.

4. . Differentiate: Right, Left, Chronic Failure and Acute decompensated heart failure (ADHF).

1. Left-sided heart failure	Right-sided heart failure	Chronic heart failure	Acute Acute decompensated heart failure (AD
The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs). This causes shortness of breath, trouble breathing or coughing especially during physical activity. Left-sided heart failure is the most common type.	Here the right ventricle of the heart is too weak to pump enough blood to the lungs. This causes blood to build up in the veins (the blood vessels that carry blood from the organs and tissue back to the heart). The increased pressure inside the veins can push fluid out of the veins into surrounding tissue. This leads to a build-up of fluid in the legs, or less commonly in the genital area, organs or the abdomen (belly)	Chronic heart failure, otherwise known as congestive heart failure or heart failure, is an ongoing inability of the heart to pump enough blood through the body to ensure a sufficient supply of oxygen. Chronic heart failure The most common symptoms of chronic heart failure include shortness of breath, tiredness, swelling of the legs and ankles, chest pain and a cough. The condition’s name is potentially confusing; the term “heart failure” does not mean that the heart has stopped or is failing completely, but that it is weaker than is normal in a healthy person. In some cases, the condition can be mild, causing symptoms that may only be noticeable when exercising, in others, the condition may be more severe, causing symptoms that may be life-threatening, even while at rest.	Acute Acute decompensated heart failure (ADHF) is a sudden worsening of the signs and symptoms of heart failure. which typically includes difficulty breathing (dyspnea), leg or feet swelling, and fatigue. ADHF is a common and potentially serious cause of acute respiratory distress

5. What are immediate nursing actions taken upon Assessment of a patient in ADHF

1.Supplemental oxygen and assisted ventilation — Supplemental oxygen therapy and assisted ventilation should be provided as needed to treat hypoxemia (SpO2 <90 percent). Oxygen is not recommended as routine therapy in patients without hypoxemia, as it may cause vasoconstriction and reduction in cardiac output

2. Position the client in high fowlers posirion

and legs in a dependent position to reduce pulmonary congestion and to relieve edema

3.Loop diuretics

Patients with ADHF are usually volume overloaded. Even in the less common situation in which cardiogenic pulmonary edema develops without significant volume overload (eg, with hypertensive emergency, acute aortic or mitral valvular insufficiency), fluid removal with intravenous diuretics can relieve symptoms and improve oxygenation

4.Administer morphine sulphate: Assess for side effects like respiratory depression or hypotension

5. Administer digoxin : Increase ventricular contraction and stroke volume

6. Administer vasodilators( nitrates) to reduce after load increase capacity of the systemic venous bed,decrease venous return to the heart.

Part II

1. Three nursing diagnoses

• Decreased Cardiac Output related altered preloaded
• Impaired gas exchange related to ventilation perfusion imbalance
• Excess Fluid Volume related to compromised regulatory mechanisms

2. Write one patient Goal for one of the Nursing Diagnosis, you Identified.

Decreased cardiac output

Goal: Patient demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal parameters for patient; strong peripheral pulses; and an ability to tolerate activity without symptoms of dyspnea, syncope, or chest pain.

3. 3. Write 2 priority Nursing Interventions Related to the Nursing Diagnosis and Patient

1.Asess cardio vascular status of the client

(Closely monitor for symptoms of heart failure and decreased cardiac output, including diminished quality of peripheral pulses, cold and clammy skin and extremities, increased respiratory rate, presence of paroxysmal nocturnal dyspnea or orthopnea, increased heart rate, neck vein distention, decreased level of consciousness, and presence of edema.)

2.Record intake and output. If patient is acutely ill, measure hourly urine output and note decreases in output.For patients with increased preload, limit fluids and sodium as ordered.

4. List 4 areas patient and family teaching related to the CHF

Educate family and patient about the disease process, complications of disease process, information on medications, need for weighing daily, and when it is appropriate to call doctor.