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Chapter 30 Coordinating Care for Patients With Cardiac Disorders
Evaluating Care Outcomes Heart failure patients are at risk for frequent exacerba- tions due to even small changes in fluid status, salt intake, or being exposed to common ailments such as a cold. Reducing stressors that can lead to exacerbations is key. Successful management requires collaboration with the patient and family and the interprofessional team (phy- sician, pharmacist, respiratory care therapist, dietitian, diagnostic technicians, social workers, and palliative care) to develop and implement a treatment plan. That plan should include frequent assessment, comprehensive patient education, and self-management. A well-managed patient has reduced dyspnea and fatigue, is able to actively participate in activities of daily living, and has reduced hospitalizations. Connection Check 30.5 What assessment would the nurse identify as a hallmark finding of left-sided heart failure? A. Ascites B. Bradycardia C. Crackles D. Edema
z Depression screening High rates of depression and anxiety are noted in the HF population. These can affect self-management. z Social support Social isolation has been shown to be an independent predic- tor of mortality among HF patients. ■ Actions z Oxygen therapy To maintain adequate oxygenation z Elevate the head of the bed to decrease dyspnea. Maximize oxygenation and promote comfort. z Medication administration as ordered: • Administer diuretics. Diuretics decrease volume, thus preload. • Administer ACE inhibitors, ARBs, ARNIs, and vasodilators. Angiotensin-converting enzyme inhibitors, ARBs, ARNIs, and vasodilators decrease afterload, which helps to decrease the workload on the heart and decrease myocardial oxygen consumption. • Administer beta blockers. Beta blockers decrease the sympathetic response (heart rate), thus reducing myocardial oxygen consumption. • Administer inotropic agents. Enhance contractility. • Administer sodium glucose cotransporter 2 inhibitors (STGLC2i). Promote fluid excretion. z Fluid and sodium restriction To prevent fluid overload ■ Teaching z Medication management Understanding and adhering to the medication treatment plan are essential for effective medication treatment. z Maintain activity as tolerated. Alternate rest and activity periods. To reduce muscle wasting and functional losses; to decrease workload on the heart z Low-salt diet To prevent fluid retention and exacerbation of HF z Daily weight at home at the same time each day, preferably in the morning after voiding Evaluate fluid retention and need to call provider. z Cardiac rehabilitation Cardiac rehabilitation reduces mortality, improves functional status, reduces hospitalization, and improves quality of life. z Signs and symptoms of worsening HF checklist (edema, SOB, fatigue, and orthopnea) Knowing the symptoms can expedite treatment and reduce hospitalizations. z Immunization needs Patients with HF are vulnerable to communicable diseases such as influenza, COVID, and pneumonia.
Making Connections
CASE STUDY: WRAP-UP Mr. Thompson’s ECG reveals atrial fibrillation with a heart rate of 130 to 140 bpm. His blood pressure continues to be high at 185/102 mm Hg. His respirations are still slightly labored and fast at 40 per minute. He continues on oxygen at 4 L/min via nasal cannula, with an oxygen saturation of 95%. The results of Mr. Thompson’s diagnostic tests reveal the following: • A chest x-ray indicates LV hypertrophy. • A transthoracic echocardiogram indicates an EF of 30%. • Cardiac biomarkers are negative for ischemia, with troponin I less than 0.1 ng/mL. • Renal function tests reveal borderline failure, with a creatinine of 1.5 mg/dL and a BUN of 30 mg/dL. • His BNP value is elevated to 500 pg/mL. • Serum electrolytes reveal elevated potassium at 6.0 mEq/L. It is determined that Mr. Thompson is in HF, and he begins treat- ment. A diuretic is administered; an ACE inhibitor and a beta blocker are ordered. His SOB and color begin to improve. His transient chest pain resolves with treatment. Case Study Questions 1. The nurse has received the following orders for Mr. Thomp- son. Which order should the nurse implement first? A. Furosemide (Lasix) 40 mg IV B. Insert a Foley catheter C. Low-sodium, low-fat diet D. Apply sequential compression device
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