CAD/CHF Train of Thought

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I like to simplify. I figure that the human body systems must be simply and efficiently designed enough for us to be roaming the earth for so many moons. So, instead of getting tangled in details, I like to ferret out the key processes that are the overlords of each condition.

So, please assess my train of thought here, as far as CAD and CHF are concerned:

CAD: prevent, treat, and correct ischemia. Nursing care should be focused on promoting blood flow to all areas of the heart in the battle against ischemia.

CHF: improve and maintain cardiac output. Nursing care should be focused on balancing preload and afterload to provide consistant and adequate cardiac output.

Now, I can put on my critical thinker cap and figure out how to achieve these, by the appropriate devices for each patient. Does this look like a reasonable approach?

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you're leaving out some very important stuff, applicable to critical nursing observation and intervention: myocardial oxygen supply and demand.improving coronary artery blood flow to all areas of the heart is nice but more in the medical (vasodilators, e.g) or surgical (revacularization, e.g.) plan of care than nursing's. likewise, while nursing will generally regulate vasoactive drips to optimize preload and afterload, this is done by parameters set in the medical plan of care and is not strictly a nursing intervention. i strongly suggest you keep thinking about the physiology-- you do need to keep that all in mind-- but revisit your defining characteristics for the nursing diagnoses related to cardiac dysfunction to see what nursing does independently. this being nursing and all.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

We may have been roaming the earth for many moons ..... but the human body is a wonder and a very complex machine. Think back to what exactly applies to nursing in the pathophysiology of the disease itself. Like GrnTea said.......revisit those defining characteristics for the nursing diagnoses related to cardiac dysfunction to see what nursing does independently.

What exactly is your task?

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What exactly is your task?

My task is conceptualizing the major malfunction of these disorders in a way that eases explanation, to myself, to other students that are struggling, and eventually to patients.

The defining characteristics for Decreased Cardiac Output ARE altered preload, afterload, and contractility. To facilitate explaining this or selecting nursing care for a patient with HF require knowledge of these functions of the heart Without understanding the physiological backstory and rationale, just performing the usual nursing interventions are meaningless, IMO.

Hearts exist and do function similarly in many of the Earth's creatures. There must be a reason for that.

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katepasa, a few suggestions:

1) use smaller words. it makes your message and teaching easier to receive.

2) check out the anatomy coloringbook and the physiology coloring book. these are real references that will help you find clearer understanding and illustrations you can share with patients and peers. as i re-read your second post, i think this will be the best source of the answers you seek. available online and at your friendly online bookseller of choice.

3) i am looking at the nanda-i 2012-2014 edition, the most recent and the one you should be using, page 235-6. i see many, many more defining characteristics for decreased cardiac output than you mention (you have mentioned only three headings, not characteristics). (the three you give aren't even the physiological definitions of decreased cardiac output, although they are some -- some-- causes of it.) in the nanda-i defining characteristics i see many, many that are part of nursing assessment and can be the subject of independent nursing interventions (for good physiological reasons). now your task is to look for the other diagnoses that include "decreased cardiac output" as one of their defining characteristics. you'll be getting closer to nursing when you do that.

4) don't overthink this. start smaller and work up.

5) the reason earth's creatures developed circulatory systems is because once they got beyond one cell size in thickness they needed to develop a way to carry away waste and bring in nutrients and oxygen, because simple diffusion to/from the environment wouldn't be effective anymore. the bigger they got, the bigger and more complex the circulatory system required.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I must be not be in my understand mode. Are you teaching/tutoring students? Trying to figure it out yourself? What type of information are you looking for?

There are 2 different types of CHF, left sided and right sided, and both have different symptoms.

In right sided CHF, the right side of the heart is not pumping blood into the pulmonary arteries and into the lungs. Because of this blood builds up behind the heart-- patient develops pitting edema.

When the patient has Left sided CHF, the left ventricle is not pumping blood out of the lungs/pulmonary vein sufficiently. So, the lungs get over saturated with blood - the pressure from the right side causes a shift of fluid from the intravascular space into the lungs causing the main symptom of L CHF- crackles in the lungs. Other s/s d/t fluid in the lungs: increased respiratory rate, impaired gas exchange because of all the fluid--> SOB. Pt's are usually on O2, head in high fowlers, and lasix given to help pull back fluid from lungs into the intravascular space.

That is as simple as I think you can make it. Hope it somehow helps.

Heart failure is the inability of the heart to supply adequate blood flow and therefore oxygen delivery to peripheral tissues and organs. Under perfusion of organs leads to reduced exercise capacity, fatigue, and shortness of breath. It can also lead to organ dysfunction (e.g., renal failure) in some patients.

Heart failure is a clinical syndrome caused by disease or other abnormal conditions in the body. Heart failure can be caused by factors originating from within the heart (i.e., intrinsic disease or pathology) or from external factors that place excessive demands upon the heart. Intrinsic disease includes conditions such as dilated cardiomyopathy and hypertrophic cardiomyopathy

Acute heart failure develops rapidly and can be immediately life threatening because the heart does not have time to undergo compensatory adaptations. Acute failure (hours/days) may result from cardiopulmonary by-pass surgery, acute infection (sepsis), acute myocardial infarction, valve dysfunction, severe arrhythmias, etc. Acute heart failure can often be managed successfully by pharmacological or surgical interventions.

Chronic heart failure is a long-term condition (months/years) that is associated with the heart undergoing adaptive responses (e.g., dilation, hypertrophy) to a precipitating cause. These adaptive responses, however, can be deleterious in the long-term and lead to a worsening condition.

The number one cause of heart failure is coronary artery disease (CAD). CAD reduces coronary blood flow and oxygen delivery to the myocardium. This leads to myocardial hypoxia and impaired function. Another common cause of heart failure is myocardial infarction, which is the final and often fatal culmination of CAD. Infarcted tissue does not contribute to the generation of mechanical activity so overall cardiac performance is diminished.

CV Physiology: Heart Failure - Introduction

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Thanks to both of you. I'm sorry that I wasn't clearer in my original post (or my second one for that matter). I'm having trouble communicating, probably as a result of so much studying.

A couple of instructors direct people to me when they are struggling. One instructor is particularly well-regarded by the students, so I'm much obliged to help. Next year, I am considering volunteering to help tutor the underclass students. I love all things nursing, so I'm eager to pass it on. However, I do not want as you mentioned above to pound people over the head with big words or concepts that make the breaker in their brains flip off.

My original idea with the ischemia and CO was unless students understands the mechanisms behind these...the whole concepts behind CAD/angina/ACS/MI and heart failure would be lost on them. In other words, it's vital that they understand normal and the consequences of deviations from normal, and how to restore some degree of normalcy. But, I am willing to abandon that plan.

I'd love to know your tactics for helping new nursing students grasp the concepts, so that I can better help my peers, the underclass students...and maybe even myself.

Grn Tea, I think I'll take your advice on the coloring books, especially the pathophysiology one. I've got Netter's Atlas of Human Anatomy which is my anatomy reference. I know I need to get the NANDA-I, which I've seen you mention a lot. I love to have a library of resources. Yours is probably pretty spectacular.

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you do not have to break the bank to have a decent working library. for your first couple of years of practice you'll probably be fine with your med/surg texts and other references from school to go back and reread prn when you have a new patient to work with. when a specialty chooses you (note: that's usually what happens, rather than the other way around-- all of a sudden you find that, oh, endocrinology or something has stolen your heart away) you will want to get some books on that to deepen your understanding, and by then you'll have learned enough that you will be able to learn more in depth about it and want to join the nursing professional orgs that work with it.

for general purposes, not counting my specialty books, i couldn't do without the nanda-i, most current edition, joyce lefever kee's absolute classic laboratory and diagnostic tests with nursing implications, and the 5-minute clinical consult, a sort of a reader's digest condensed of a bazillion diagnoses with shorthand reminders for everything you need to know about them. there's a taber's in here somewhere, and a gray's anatomy (the book, not the video). i also have the chicago manual of style and the slim, short, and sweet strunk & white's elements of style to help me when i forget how to write clearly. i use books, not online sources for all these things, because generally when i need to look something up i need to use it right away, and i do not want to tempt my wandering brain with another link and another link and before i know it i'm playing angry birds again.

i think i'm going to start a new thread so i can see what other folks consider essential.:D

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Thank you! I have Strunk & White's. My mother is an editor and she added that to my orificenal. Tabor's was required by my program.

I have Kee's Pharmacology, which I love. I think I'll get her lab book, now. I have another which is so odious that I loathe to pick it up. I'll check out the 5-minute Clinical Consult and NANDA-I via our awesome inter-library loan program with other universities.

Come financial aid check time, I will buy some of these titles. I appreciate the recommendations!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I'm a google girl myself...:o But I love my Ackley: Nursing Diagnosis Handbook, 9th Edition and Gulanick: Nursing Care Plans, 7th Edition.

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Specializes in Cath Lab & Interventional Radiology.

[color=#3399cc]hi...

my nursing instructors had us make mind maps for each health alteration. i have attached a couple that i made using ithoughtshd on my ipad. although not listed my references were medical surgical nursing by lewis & nursing diagnosis handbook by ackley. i think that mind maps are a really good way to break down each alteration for easier understanding. during class i would then add notes from my instructors. hope this helps! good luck!

Heart+failure-1.pdf

Cad-2.pdf

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