This chapter is from the book
This chapter is from the book
This chapter is from the book
Congestive Heart Failure
When fluid accumulation occurs and the heart is no longer able to pump in an efficient manner, blood can back up. Most heart failure occurs when the left ventricle fails. When this occurs, the fluid backs up into the lungs, causing pulmonary edema. The signs of pulmonary edema are frothy, pink-tinged sputum; shortness of breath; and orthopnea. When right-sided congestive heart failure occurs, the blood backs up into the periphery. Pitting can be evaluated by pressing on the extremities and noting the degree of pitting, how far up the extremity the pitting occurs, and how long it takes to return to the surface. Treatment for congestive heart failure includes use of diuretics, inotropic drugs such as milrinone (Primacor), and cardiotonics such as nesiritide (Natrecor). Morphine might also be ordered.
Diagnostic Tests for Review
The following diagnostic tests should be reviewed prior to taking the NCLEX exam:
CBC—A complete blood count tells the nurse the level of oxygenation of the blood, particularly the hemoglobin and hematocrit.
Chest x-ray—Chest x-rays and other x-rays tell the nurse whether the heart is enlarged or aneurysms are present.
Arteriogram—Arteriography reveals the presence of blockages and abnormalities in the vascular system.
Cardiac catheterization—A cardiac catheterization reveals blockages, turbulent flow, and arteriosclerotic heart disease.
ECG interpretation—Indicates abnormalities in the rate and rhythm of the conductions system of the heart.
Central venous pressure monitoring—CVP indicates fluid volume status.
B-type natriuretic peptide (BNP)—Used to diagnose heart failure in clients with acute dyspnea. It is used to differentiate dyspnea found in those with lung disorders from those with congestive heart failure.
Stress test—A stress test can be done using a treadmill. The client is asked to walk at a rapid rate to increase the work load on the heart. The client’s blood pressure and heart rhythm is then observed for abnormal changes. A non-treadmill stress test is used when the client is unable to walk on the treadmill machine. This test is used to determine ischemia. A radionuclide such as Thallium or Cardiolite is injected at the peak of exercise. A creatinine should be checked to determine renal function. The client should be questioned regarding allergies to iodine or shellfish.
