impaired gas exchange
is a good nursing diagnosis to use here.
it sounds like there might be more right sided heart failure going on. heart failure is a funny duck because it can occur in various degrees and can be combinations of left and right sided. unless the doctor specifically describes the degree of heart failure going on it's hard to know what is happening. sometimes you can try to figure it out from the patient's symptoms. with right-sided failure there is usually peripheral edema and engorgement of the kidney and organs of the abdomen with blood which the heart can no longer efficiently pump out fast enough which results in all the edema. the edema occurs because fluid goes out into the cellular spaces by osmosis as the blood is backed up in the vascular system. in other words, there's a long line of blood waiting at the right ventricle to get in and get pumped out and it ain't happening as fast as it should. i think you are right. the peripheral and abdominal edema are related to the chf. and, yes, digoxin is given to improve heart contractility.
drug therapy for heart failure includes:
- ace inhibitors to dilate blood vessels and decrease systemic vascular resistance. this reduces the workload on the heart.
- vasodilators will increase cardiac output by improving ventricular outflow and decreasing afterload. vasodilators will be given if the patient cannot tolerate ace inhibitors.
- digoxin strengthens myocardial contractility.
- beta-adrenergic blockers are given to prevent left ventricular dilation and hypertrophy.
it's hard to say if her heart problem is related to preload (the heart itself not taking in enough volume of blood to pump out) or after load (the heart not having enough force to pump out sufficient volume with each beat). as a second semester student i think it would be safe for you to fudge a little and say: decreased cardiac output r/t altered stroke volume aeb peripheral edema, abdominal edema, shortness of breath, and crackles or rales in the lungs
. the concepts of cardiac output, preload, and afterload are kind of complex. they are generally really delved into when you study icu procedures because this is where the icu nurses can make direct measurements of cardiac function with pulmonary catheters by doing central venous pressure measurements, wedge pressures and cardiac outputs. however, for this patient you have assessment data to support using this nursing diagnosis without going into all the fancy icu stuff.
please don't put yourself down. none of us are smart about any of these things until we take the time to really study up on them.
here are some links with information on chf and the drugs used to treat it. you might want to bookmark some of these links or print out the information on them because you'll definitely want to get back to it when this stuff comes up in your nursing classes later.
- can someone help me understand this... (chf thread on general nursing student discussion forum). has links to websites with information on chf.
- "cardiac preload and afterload" in the general nursing student discussion forum
- "student question: preload" on the cardiac nursing forum with a real nice answer that explains it.
- "preload, afterload, contractility" thread in the cardiac nursing forum
- "right ventricular infarct question" thread in the ccu - (coronary/cardiac) forum
- a chart listing the medications used for chf. the drugs are arranged by drug categories. initial dose, target dose, recommended maximal dose and major adverse reactions are also listed for each drug.