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]

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.

GOOD! So always try to keep in the back of your mind the potential complications. This is what your instructor is trying to help you with. as a nurse, you're always thinking "what if" and assessing to catch a complication early on or prevent it altogether. Great job!

[yelworc123]

Ah ok, even though lungs were CTAB, although he tires easily when ambulating

[yelworc123]

Thank you! I know all of this, but its just trying to bring it all together and the fact that he has both right AND left since its chronic hf. ACE inhibitors would help with the CO to increase the volume but decrease the work of the heart and he is also taking metopropolol. And yes, very poor prognosis, due to lifestyle and lack of knowledge

[AliNajaCat]

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.

Don't forget the abdomen-- it's peripheral for purposes of this discussion. What do you think might happen there if venous return is backed up d/t right sided failure? Hint: look up hepatojugular reflex. Do it now!

[Esme12, ASN, BSN, RN]

https://allnurses.com/nursing-student-assistance/struggling-with-cardiovascular-826088.html

[Lev, MSN, RN, NP]

What about focusing on making sure that he takes his diuretic? Many patients don't like taking their lasix because it makes them urinate a lot, so they will skip doses. Is there a nursing diagnosis related to educating the patient about taking his medications as prescribed? You can do a priority diagnosis related to seeking help if he becomes short of breath and a secondary diagnosis related to taking medications and understanding the importance of adhering to the schedule. If the patient smokes, you can do further education about not smoking.