PERFUSION Concept Map: CHF by Connie Barbour

Congestive Heart Failure

connbarb — 2021-09-28 15:08:35 UTC

CONCEPT(s):

Pathophysiology

connbarb — 2021-09-28 15:08:59 UTC

Right Sided: The inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure. It can result from left heart failure when an increase in left ventricular filling pressure is reflected back into the pulmonary circulation. As pressure in the pulmonary circulation rises, the resistance to right ventricular emptying increases.

Left Sided: Categorized as heart failure with reduced EF (systolic heart failure) or heart failure with preserved EF (diastolic heart failure). It is possible for these two types of heart failure to occur simultaneously in one individual

Haley Bryant, Kaylyn Fairchild, Samantha Dixon

signs and symptoms (CUES = Assessment)

connbarb — 2021-09-28 15:09:13 UTC

Expected (Relevant):
Symptoms: difficulty breathing, fatigue and weakness, swelling in the legs, ankles, and feet, indigestion or nausea
Signs: Third heart sound, tachycardia

Worsening:
Symptoms: chest pain that lasts more than 15 minutes (that is not relieved with rest or nitroglycerin), severe or persistent shortness of breath, fainting or passing out
Signs: persistent cough with chest congestion, excessive weight gain (3 or more lbs in one week)
Reduced heart function (reduced ejection fraction)

Skylar Phillips, Abbigale Souther, Shakia Perry

Laboratory values to monitor (CUES = Assessments)

connbarb — 2021-09-28 15:09:44 UTC

ABG's, BMP(sodium, potassium, magnesium, glucose), troponin, BNP, BUN, Creatine, and monitor digoxin levels for toxicity if the patient is on digoxin.

Kinsley Beasley and Mary Katherine Laverty

Priority Medications

connbarb — 2021-09-28 15:10:48 UTC

Category: ACE inhibitors

Action: block conversion of angiotensin I to angiotensin II

S/E to monitor: dizziness, fatigue, headache, insomnia, hypotension, angina, tachycardia
(Hannah Hack)

Category: Cardiac Glycoside (Digoxin)

Action: Increases the force of myocardial contraction INOTROPIC EFFECT), prolongs refractory period of the AV node (DROMOTROPIC EFFECT)), decreases conduction through the SA (CHRONOTROPIC EFFECT) (so causes slower deeper/stronger contractions of the heart)
(Samantha Drake)

Monitor potassium levels CLOSELY when a patient is on both digoxin and furosemide. HYPOkalemia causes digoxin toxicity (level greater than 2).

Encourage patients to eat foods HIGH in potassium

Nursing consideration for medications (ACTIONS to implement)

connbarb — 2021-09-28 15:22:54 UTC

taking medication as directed, report immediately to HCP if chest pain, palpitations, or angioedema occurs.
(Hannah Hack)

More Lab Values

2021-09-30 18:36:58 UTC

Chest X-Ray & BNP and Monitor I/Os, daily weights, monitor electrolytes
Stacia, Caleb, Lillian, Sarah, Christina,

Range of Lab Values

sstaggs11 — 2021-10-01 00:22:37 UTC

ABG's: [Normal Range]
- pH: 7.25-7.45
- PaCO2: 35-45 mmHg
- PaO2: 80-100 mmHg
- HCO3: 22-26 mEq/L

BMP: [Normal Range]
- Sodium: 135-145 mEq/L
- Potassium: 3.5-5 mEq/L (#1 PRIORITY)
- Magnesium: 1.3-2.1 mEq/L
- BUN: 7-20 mg/dL
- Creatine: 0.6-1.2 mg/dL (#2 creatinine)

BNP:
-Normal: <100pg/mL
-Mild HF: 100-300
-Moderate HF: 300-700
-Severe HF: >700

Troponin: [Normal Range]
- 0-0.1 μg/L

Chest X-Ray: [Abnormal/Signs of CHF]
- Enlarged heart
- Pulmonary infiltrates

Stacia, Caleb, Lillian, Sarah, Christina

sstaggs11 — 2021-10-01 00:25:10 UTC

sstaggs11 — 2021-10-02 20:53:20 UTC

sstaggs11 — 2021-10-02 20:57:36 UTC

2021-10-05 21:29:54 UTC

The heart has to work harder to deliver blood throughout the body causing muscle to become thicker and larger. Eventually these muscles become weaker. (Alexis Mpezo & Victoria Miles)

Medications

2021-10-05 21:36:00 UTC

Category: Angiotensin II Receptor Blockers "ARBS"

End with '-SARTAN'

Losartan
Valsartan
Olmesartan

Action: Angiotensin II causes vasoconstriction resulting in High BP. ARBS affects the ending results of the Renin-Angiotensin-Aldosterone System; Blocks activation of Angiotensin II receptors found in vessels and promotes Vasodilation.

AE: HyperKalemia + Symptoms, (>5.0), Renal Failure, Angioedema

Patient Education: Avoid Foods High in Potassium [Bananas, Kale, etc.]

(Alexis Mpezo, Victoria Miles)

2021-10-05 21:50:09 UTC

Alexis Mpezo, Victoria Miles

2021-10-05 22:01:06 UTC

(Alexis Mpezo and Victoria Miles)

2021-10-05 22:02:31 UTC

Alexis Mpzeo & Victoria Miles

2021-10-07 18:01:08 UTC

Diet Modifications

2021-10-07 18:09:40 UTC

Diet modifications may include
-low sodium
-low fat
-low cholesterol
-fluid restriction (spread out fluids throughout the day)
Sydney Winters

Heart Failure Part 1

2021-10-08 01:25:57 UTC

Christina Becker

Heart Failure Part 2

2021-10-08 01:27:19 UTC

Christina Becker

Medication

2021-10-08 19:14:09 UTC

Category: Diuretics

Loop Diuretics: Furosemide

Action: Blocks the reabsorption of sodium in the kidneys, draining fluid from the body and off the heart.

SE/AE: Hypokalemia, orthostatic hypotension, constipation

Nursing Considerations: Do not administer medication if K+ is below 3.5, encourage the patient to eat more fruits and fiber, and foods high in potassium, avoid licorice (can decrease K+ levels), Administer this medication slowly
(Breanna Hatfield)