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Heart Failure (ch 121)

Congestive heart failure (CHF) risks

- HTN - MI, CAD            - DM - Metabolic syndrome
- Drug Abuse - PVD - Valvular heart disease.       - Cardiomyopathies

CHF typical presentation

- Fatigue              - decrease in exercise tolerance         - SOB        - Cough, rales
- JVD/edema          - Palpitations               - Anorexia, early satiety
- Wt gain                 >2 lb in 1 day           >5 lb in 1 wk
- AMS (elderly)           - S3

NYHA Classification of CHF

* Class I*********Cardiac disease without resulting limitation of physical activity

* Class II*******Slight limitation of physical activity - comfortable at rest, but ordinary physical activity results in              fatigue, palpitation, dyspnea, or anginal pain

* Class III******Marked limitations in physical activity - comfortable at rest, but less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain

* Class IV******Inability to carry on any physical activity without discomfort - or symptoms at rest

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PE (pulmonary embolism)  

What diagnostic test is used most frequently for dx test and requires IV contrast media?

Spiral (helical) CT scan

what diagnostic test is used if pt can't have contrast?

V/Q scan

*****what diagnostic test is the most sensitive but invasive?

pulmonary angiography

______ is key for PE?

prevention

collaborative care for PE:
-____________ compression devices******-sequential
-early _______******-ambulation
-prophylactic ________*******-anticoagulation

Goals of treatment for PE:
-prevent further ______***-thrombi
-prevent further embolization to _______ system****-pulmonary
-provide __________ support******-cardiopulmonary

examples of supportive care for PE?

-oxygen-->mechanical ventilation             -fluids         -diuretics          -analgesics

Examples of Anticoagulation therapy used for PE?

-Low-molecular-weight heparin (LHWH)
-Unfractionated IV heparin
-Warfarin (Coumadin)

examples of fibrinolytic agents used for PE?

-Tissue plasminogen activator (tPA)
-Alteplase (Activase)

what surgical therapy should be used for a massive PE?*************Pulmonary embolectomy

what surgical therapy prevents migration of clots in pulmonary system?****Inferior vena cava (IVC) filter

Nursing management for PE:
-__________ position****semi fowlers
-_____access****IV
-Oxygen therapy
-Frequent assessments
-Monitor _______ results.****lab
-Emotional support and reassurance

what should a nurse teach to a pt with PE?

-Regarding long-term anticoagulant therapy.       -Measures to prevent DVT         -Importance of follow-up exams

Evaluation:
-Adequate tissue _______ and respiratory function*****perfusion
-Adequate _______ output****cardiac
-Increased level of ______******comfort
-No recurrence of PE

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