heart failure question

[yelworc123]

i had to do a clinical presentation on a patient with CHF. He had EF of 25-30%, mitral valve insufficiency, venous stasis ulcers, came in SOB, gained 50 IBS, and plan was to diurese him which worked well. My focus was on intake and output and making sure he understood weighing himself once discharged. But my instructor asked what was my concern using the ABC's? Is he at risk for Respiratory or circulatory compromise? and what is the medical therapy. I am a little confused-its circulatory compromisee right, his left ventricle is not pumping well due to the low EF, he had sxs of both left and right HF.

[NICUismylife, ADN, BSN, RN]

Short answer: yes. He is at risk for respiratory or circulatory compromise.

Think about it as fluid volume overload. When that happens, where does the additional fluid have the potential to end up?

[yelworc123]

but I have to say whether is respiratory or circulatory compromise???

[NICUismylife, ADN, BSN, RN]

I'm trying to draw the answer out of you without just telling you. Look into fluid volume overload. There is a big complication that can occur that is important to be aware of and assess for...

[Banana nut, BSN, RN, EMT-B]

Monitoring I&O will not be a good indication to his breathing pattern or his heart rhythm. Why do you think that is?

What interventions can we use to make him breath more effectively? How can we help his heart pump more effectively? How can we measure if what we are doing is working?

Also "his left ventricle is not pumping well due to the low EF" you may be confused. He has a low EF because of left vent HF, not the other way around. Do you see the difference? what is the difference? is there a difference?

"impaired gas exchange" is one of the causes of his SOB why do you think this is? this is respiratory compromise.

A low CO is contributing to circulatory compromise. do you see the difference?

Im a student too so im just throwing stuff out there and we can learn together!

Best of luck!

[yelworc123]

So, incentive spirometer for breathing, turn cough deep breathe.

And yes, he has low EF cos of the LV function is decreased, he had mild lv hypertrophy.

So, I guess he has both left and right sided HF since its chronic; he is not getting enough blood out, so low CO, its backing up into the lungs, hence the SOB.

I see that the low CO is a circulatory issue, but I am trying to figure out is he at risk for respiratory OR circulatory compromise? I am thinking both really, for the reasons stated above

[yelworc123]

crackles due to accumulation of fluid in the lungs? edema

[NICUismylife, ADN, BSN, RN]

I'm trying to draw the answer out of you without just telling you. Look into fluid volume overload. There is a big complication that can occur that is important to be aware of and assess for...

And to add to this. Right sided heart failure causes edema where? And left side causes fluid build up where? And what are potential ramifications?

I don't get the feeling that your instructor is looking for a nursing dx but rather a complication that you should be watching for.

[NICUismylife, ADN, BSN, RN]

crackles due to accumulation of fluid in the lungs? edema

Posted at the same time.

BINGO!

[Banana nut, BSN, RN, EMT-B]

I think your right, with CHF exacerbation you get a back up of fluid systemically, that is why he has gained 50lbs and he is drowning in his own sputum. He is compromised in both organ systems dude to fluid overload and pump failure. Many times if you fix the fluid issue both systems can recover relatively depending on how effective the pump is in the first place.

[NICUismylife, ADN, BSN, RN]

I think your right, with CHF exacerbation you get a back up of fluid systemically, that is why he has gained 50lbs and he is drowning in his own sputum. He is compromised in both organ systems dude to fluid overload and pump failure. Many times if you fix the fluid issue both systems can recover relatively depending on how effective the pump is in the first place.

Unfortunately with an EF of 25-30, this poor guy has a very ineffective pump. I'm guessing his prognosis is very poor.

[yelworc123]

right sided causes fluid to back up into extremities-hence the peripheral edema and left sided causes it to build up into the lungs, so breathing is obviously a problem. And its not getting out to extremities cos of low CO and the EF of 25-30, so hypoxia is a big things, so pedal pulses and cap refill. My focus was more on the fluids and weight gain, but I guess I needed my nursing care to focus on the respiratory issues too.