Medical-surgical Nursing Demystified

(^34) Medical-Surgical Nursing Demystified

• Chest x-ray.
  
  
  • Left-sided heart failure:
    
    
    • Pulmonary congestion because of accumulation of fluid in the lungs.
    
    
    • Enlarged left ventricle (LVH) because of the increased stress on the
      heart to pump blood.
    
    
    
    
  
  
  • Right-sided heart failure:
    
    
    • Pulmonary congestion because of accumulation of fluid in the lungs.
    
    
    • Accumulation of fluid in the pleural cavity (pleural effusion).
    
    
    • Enlarged heart (cardiomegaly) because of the increased stress on the
      heart to pump blood.
    
    
    
    
  
  
  
  

TREATMENT

Treatment is aimed at the underlying disease, i.e. ischemia, valve defects, arrhyth-

mias. Excreting volume with diuretics, supplemental oxygen, use of medications

to reduce workload of heart muscle, peripheral vascular resistance (afterload), and

venous return to the heart (preload) may all be used. Dietary indiscretions may be

a contributing factor, i.e. too much salt, too many calories.

• Administer diuretics for symptom control resulting in patient comfort by
  reducing blood volume.
  
  
  • Furosemide, bumetanide, metolazone, hydrochlorothiazide, spironolactone
    —be aware of electrolyte imbalance—these medications may alter the
    K+level.
  
  
  
  


• Administer ACE inhibitors to decrease afterload.
  
  
  • Captopril, enalapril, lisinopril.
  
  
  
  


• Administer beta blockers, which help to raise ejection fraction, and decrease
  ventricular size.


• Administer inotrope to strengthen myocardial contractility:
  
  
  • Digoxin.
  
  
  
  


• Administer vasodilator to reduce preload, relieve dyspnea:
  
  
  • nitroprusside, nitroglycerin ointment.
  
  
  
  


• Administer anticoagulants in patients with severe heart failure, as they have
  a propensity to develop thrombus and emboli; those with concurrent atrial
  fibrillation will also need anticoagulation.


• Reduce fluids as fluid overload is a causative factor in CHF.