of heart failure

1) Efof 15% 1)
End-stagehltf
2) sleeping
in chair t0%m%rtablY a) left-sided exacerbation
edeminlowettegstwekfhtgain right-sided AF
throw with worsening
4) SOB for /Ast 3 days 4) pulmonary edema is presents
activity
1) Carlos hasn't been following 1) The increase in
liquids salty foods
+

his diet restrictions will increase his fluid t worsen symptoms

of pulmonary edlhnatttf

MI with CAB thrombus prevention

Heart failure NHRtBP
hyperlipidemia cholesterol invessels
heart failure 9 TSV
chronic renal insult fluid retention
.

atrial fibrillation Kt regulation

MI with CAB Thrombus formation
prevention
 pulse : 82 afib exacerbation → increased cardiac
output
.

RR : 26
pulmonary edema indicates he's in distress

Bp : 162154 Pt is anxious +
increasing after load → heart is
to maintain cardiac output
Oz saturation : 90% overworking
Inadequate perfusion
diaphoretic due to tachycardia 14 )
HR
coarse crackles skin is
coarse crackles indicate fluid in
3T edema
lungs
pitting →
now R
-

sided heart failure

ventricular rate B 100 bpm +

rhythm is irregular → atrial fibrillation

Pt is now in
heart is tachycardia with
irreg heart rate This indicates the
-

struggling to produce
output .PT is at risk of

throwing blood dots .

 heart rate indicates atrial fib
The
irregular
.

pulse : 82
This shows heart is
also in tachycardia
.

" Pt is
RR "
to to maintain cardiac output
working overtime
.

162154
BP indicates inadequate perfusion
:

oz
saturation : 901 .
901 .
sat

coarse crackles despite heart working double time .

since
to
The primary problem is left-sided heart failure It has .

progressed
crackles , SOB , peripheral edema ,
heart failure Findings are coarse
right-sided BUN + creatinine indicate poor
.

The elevated
and the 151 ejection fraction . .

renal perfusion
.

maintain
the heart has become a tired pump tis unable to
the cardiac output necessary to perfuse the
those of the vital organs
adequately
tissues of thebody , especially
.

not enough after Ood, fluid is

Because the
heart is
pumping
building t up to the lungs
backing pulmonary edema causing
① Adequate perfusion ⑧ After load reduction
② Preload reduction

of bed position ☐ position facilitates respiratory psorproved

1)Elevate head
+

function by gravity oxygenation

client
upright help
indicated 2) Pharm agents generally, reduce control Of
symptomsIretief
.

2) Administer
meds as

cbroncho dilators,
prevent t control symptoms
of exacerbating
by provider anti frequency & severity be
antitussives / mucoiytics, improve tolerance 3) Oz to
-

+
) will help than
bio tics
additional supplemental 3) Additional Oz greater
provide oxygenation 921
improve
.
.

oxygen

irritability restlessness cardiac system VS

-

mental status Loc, confusion ,

crackles, SOB
-
,

abnormal skin color, diaphoresis resp system

Integument
.
- .

CBC coz levels

-

of CHF
Pt can anticipate renal failure as a result
.

Most likely complication is a heart attack or stroke .

Output urine assessment urinalysis ) Assess abdomen : distention , charges

in
frequency
Input / sounds
:

BUN , creatinine sounds : rate / depth , abn

lung
.

CBC : GFR , location

Assess skin : dehydration , pale skin , edema , elasticity Assess pain level &

monitor vs q 4h esp Bpo HR changes from baseline

→

weight daily
.

monitor It's &

-

auscultate breath sounds -

restrictions
-

elevate HOB 30-450 flu it t salt

-

- educate about
-
monitor pt for Loc charges
or confusion
 -

Increased Oz will help 9

Perfusion
tissue
-02591-192-1 .

preload reduction by
-

fluid overload
reducing -
nomore coarse
crackles in
lower lungs
-

systolic Bpto reduce

afterward
-

decrease edema
monitor renal function
indicating
-

-
maintain urine
renal perfusion
output of -30mL/hr
-

monitor renal function -

levels within
expected
range
① OZSLPP ⑦ increase tissue perfusion
② Nltnglycdtipzostopohestpainoopenvessels
③ lasixpusb ⑤ Reducefluid overload
④ ITO 'S ④ monitor renal perfusion

potent loop
diuretic told
-

monitoravsceltale
sounds
excretion of Nat lung
+ Hzoby kidneys -

monitorskehtrrgort
MUCUI membranes
+ help body

Average excreiewaietto -

monitor Bpsrpulse
veducefwidin
betoretdctingadmin .

lungs

luidlnasbaokedusinhkngsas
C-
ineffective plhptunableto
heart is
circulate blood
throughout body effectively .
 WNC
WNC
WNL
WNL
BLOW

band cells are immature Band forms appear to be

low band which fight
neutrophils
✓ MS
Coutof disease
.tn#wvaiuecanstable.WBCVaklesore
trending upward
which
1% sniff
3-51 ).
indicate infection ,
support possible presence
presence of MI Of infection
possible
occurring .

LOW
HIGH
WNL
WNL
WNL
WNL
WNL

High
High
WNL

indicates Nat worsening I increase )

potassium
kt High
LOW
cardiac dysrhymias present a- worsening I decrease]
Nat (decreases
Nat support electrolyte BUN worsening
BUN High imbalance creatinine worsens
dear ).

creatinine Hgh BuNo creatinine

that poor
snow
renal perfusion
stress on
is putting
kidneys

WNL
WNL
LOW

High
zowck MB- -
indicates muscle
wasting staying
-

saneaspt is
+
atrophy not
improving innealth
High BNP
-
indicates heart failure -

increasing as Hfis
( spec left-sided) exacerbated
worsening &
-

:
range This
high value -

ptforsrgnsof
assess Skin
0.74-1-35 indicates kidney breakdown
itching
or

failure is
beginning -

As Buntcreat rise -

, patient may
perfusion
nansedtvomitrng fatigued
as renal have
High
,

-
ispoordveto muscle weakness so
poor cardiac output keep ptnpotpedbolnd
 in pt remains in fluid overload + cardiac
NO change -

+ output has not improved

resp
crackles
lasix are not excreting enough
.

effort → still difficult fluid to NPUIM edema .

urine output 30mL -

since kidneys Hoop of Hertel are not
in last 4 hrs
responsive to has ix.this can indicate
despite last ✗ with worsening
kidney failure renal perfusion
decreases in vs
status has stabilized with
no
significant mechanisms
or function This is expected as pts compensatory
actively
.

in
we need to focus now more on kidney function since
cardiac status has stabilized + signs of kidney failure have
increased .

DX is excess fluid vow merit renal failure we need

Nursing
.

+ assess edema+ resp

to now monitor urine specific
gravity
.

status

Pt is Carlos Ballerini in Ms 1- He has come into hospital

with exacerbation of left-sided heart failure .

pt has hx of left-sided Hf and has recently been drinking

a lot of fluids & snacks which have worsenedsymptoms
eating salty
in resp assessment &
pt is restless with coarse crackles
.

fluid in lungs in radiology report Unheoitput is Boman

.

past 4 hrs despite IV fluids t.lv

furosemide .

failure + needs accnsu It to

I believe Pt is in kidney
alter treatment a possible dialysis
 High
High
Kt is
High furosemide is Kt
so wasting
we'd expect this Both vanes are
creatinine is value to be low . Indicates worsening which
renal failure indicate pts
High High indicates
cheat Also
.

renal status is
renal failure as cells are
wasting from perfusion
poor worsening

Pt is Carlos Boccerini
who come in from
with exacerbation of home
from MSI to ICU
Hf symptoms
He has since .

moved
yesterday
as his status is
progressed to renal failure .
worsening t
He has lnx of left -

sided Hf which has now

to
right-sided .

progressed

pt is restless with
worsening crackles in
Lagi ✗ * Ivf , his urine output remains
levels of Kt at 5.9 t creatinine 30mL
lungs
in
Despite
.

at
4 his &
3 , .
.

pt needs strict 7-00 's with

continued resp assessments
Keep Pt bed bound & NPO
.

LOG
.

monitor & stunt .

 24hr period tailgate
Pt should scatter beverages throughout w/out
avoid periods
btw hot , cold
+ frozen choices to help
of choices & reduce sense of deprivation
fluids , boredom foods
+ processed
& thirst .PT needs to avoid salty
eat kidney sale diet
.

+ a

of food
Have pt repeat back a possible day
of diet limitations
choices to show understanding .

preview pt labs routinely to monitor adherence

to medication regimen
.

The pt is
likely
scored + confused He .

maybehis
nurses are worried
about
contused why
as to
its his heart thats in trouble .

kidneys when
There may be a barrier
language
to
adding
the confusion .

Sit with the patientthis wife to answer all

have When each blood draw
questions they may
.

is happening explain ,
what we are for
lookingdistress
pt is in resp ,
What means Since
.

& that .

offer comfort measures in room like preferred

book distraction
magazine
or
music
.

&