52 yr old male right-sided CHF

Posted
by LVN2006 LVN2006 Member

Pt. history: GERD, hiatel hernia, type 2 diabetes, neuropathy, just diagnosed with CAD and right-sided CHF.

Left-sided and right-sided CHF. If left side, do you avoid turning the pt. onto the left side because of blood in the ventricle? It worsens when it goes to the right side. So can the pt. be on either side with right-sided CHF.

Prognonsis?

hrtprncss

hrtprncss

Specializes in ICUs, Tele, etc.. Has 15 years experience. 421 Posts

progression of chf from left to right doesn't have anything to do with bed positioning, use pharmacological technique to decrease preload to alleviate symptoms, other than semi fowler's i haven't heard of right or left side lying positioning to help with sx.

LVN2006

LVN2006

44 Posts

progression of chf from left to right doesn't have anything to do with bed positioning, use pharmacological technique to decrease preload to alleviate symptoms, other than semi fowler's i haven't heard of right or left side lying positioning to help with sx.

I was asking because a nurse said I couldnt turn the pt on the left side to change the bed because of left-sided chf. this pt had right-sided which I think means the left ventricle stopped pumping and moved to the right side. he is on pharmacological tx but I wanted to about putting a pt on the side also because i read that the ventricle begins filling with blood. what condition then can you not put the pt on the side.

hrtprncss

hrtprncss

Specializes in ICUs, Tele, etc.. Has 15 years experience. 421 Posts

umm how bout any processes where the ''good lung down'' theory would work where the oxygenation and perfusion in the lungs would be optimized, also left lying position would be preferable for patients with air embolus to keep the air away from entering the pulmonary circulation. that's all i can think of right now.

papawjohn

papawjohn

435 Posts

Hey Y'all

Y'all can relax about turning your R Heart CHF Pt when giving care; you can also lower the bed to the flat position. The business of Rt vs Lt heart failure don't have NUTHIN' to do with the Rt and Lt sides of his body or with the Rt or Lt lung.

Heres the way it works in the easiest way I know to describe it. First, heart failure just means that the heart's ability to pump blood doesn't match the needs of the body. That is--the heart isn't a good enough pump to do what it's s'posed to do. (Promise--that's the whole definition of CHF: The heart fails as a pump.)

Now, remember that the heart is really TWO pumps. We're all used to dealing with the circulation all around the town...I mean, all around the body. We feel pulses. We take BPs. We blanch nail beds. This is the LEFT side of the heart.

The OTHER--right--side of the heart pumps blood through the lungs. That's it's whole job. It sucks blood out of the Superior Vena Cava, through the Pulmonary artery and from there it's sucked up by the Left Atrium.

We all know what happens when the Left Heart is in CHF, because the Left Atrium isn't able to pull the blood out of the lungs. So the lungs fill up with fluid and we get Rales/Crackles and frothy sputum and the Pt has to sit up really straight to breath.

But what happens when the Right Heart fails? You're already thinking of the answer! The blood doesn't get sucked out of the Vena Cava and not enough gets sent through the lungs and into the Left side.

What does that mean to the Pt? Let's take it in steps: First the blood will back up in the veins. You'll see big fat Jugular Vein Distention. As the back-up proceeds, you'll see dependent and peripheral edema. Ankles and hands will have pitting.

Second the lungs will be dry. Not enough blood gets thru the Right Heart to over-fill them.

Third the BP will be low. Cause not enough blood gets TO the Left Heart for it to push on thru to the arteries that we listen to as we take a BP. In fact, the Left Heart will 'think' that the Pt is dehydrated--so urine output is low and the Pt will be orthostatic.

One last thing: there is almost never a PURE Right Heart Failure or PURE Left Heart failure. The things that injure the heart don't discriminate that fine a line.

And that's the name of that tune!!

Papaw John

hrtprncss

hrtprncss

Specializes in ICUs, Tele, etc.. Has 15 years experience. 421 Posts

I was talking about semi fowler's to alleviate symptoms of dyspnea for pulmonary edematous patients who are not vented

papawjohn

papawjohn

435 Posts

Hey Again

Ms HrtPrncs (I'm trusting my memory for your handle) you're totally absolutely correct regarding your Pulmonary Edema Pt, Semi-Fowlers, etc.

But in PURE R H Failure (which is of course a rare sorta bird) our Pt doesn't HAVE PulmEdema. That's kinda the point, you see. That when one single ventricle is in failure (repeat: rare) the symptoms are caused by the back-up of pressure--thus are 'behind' the failing ventricle. So--R Heart Failure (repeat: rare) has periph edema and dry lungs.

Ms LVN, you asked about prognosis. I'm an ICU specialist (MedSurg scares the **** outa me--you can't sit and WATCH all your patients!!!). So I would defer to someone who knows more about long-term expectations. But since the Resp system is not specifically affected, I'd think there is pretty good prognosis--always assuming that the ususal Medical follow-up, life-style changes etc are made.

One clue that we look at in ICUs: see if there is a report from an Echocardiogram or Heart Catheterization in the chart. (Probably both if you're caring for this fellow in MedSurg or LTC.) Look for something called "Ejection Fraction". This measures how much of the blood thats sucked into the heart, that gets squeezed out by the contraction of the heart. Yours and mine are hopefully in the range of 60-75%. Some Pt's have an EF as low as 25% and manage a sort of life. Below 20%--very poor quality of life, very poor prognosis.

Papaw John

Tired of all these hearts---let have a good TRAIN WRECK TONITE!!!!

Shastalee99

Shastalee99

50 Posts

Hey Again

Ms HrtPrncs (I'm trusting my memory for your handle) you're totally absolutely correct regarding your Pulmonary Edema Pt, Semi-Fowlers, etc.

But in PURE R H Failure (which is of course a rare sorta bird) our Pt doesn't HAVE PulmEdema. That's kinda the point, you see. That when one single ventricle is in failure (repeat: rare) the symptoms are caused by the back-up of pressure--thus are 'behind' the failing ventricle. So--R Heart Failure (repeat: rare) has periph edema and dry lungs.

Ms LVN, you asked about prognosis. I'm an ICU specialist (MedSurg scares the **** outa me--you can't sit and WATCH all your patients!!!). So I would defer to someone who knows more about long-term expectations. But since the Resp system is not specifically affected, I'd think there is pretty good prognosis--always assuming that the ususal Medical follow-up, life-style changes etc are made.

One clue that we look at in ICUs: see if there is a report from an Echocardiogram or Heart Catheterization in the chart. (Probably both if you're caring for this fellow in MedSurg or LTC.) Look for something called "Ejection Fraction". This measures how much of the blood thats sucked into the heart, that gets squeezed out by the contraction of the heart. Yours and mine are hopefully in the range of 60-75%. Some Pt's have an EF as low as 25% and manage a sort of life. Below 20%--very poor quality of life, very poor prognosis.

Papaw John

Tired of all these hearts---let have a good TRAIN WRECK TONITE!!!!

Dear Papaw,

How do you manage to be so comical and happy? Does this happen upon graduation into the real world? If so I can't wait to be there. I try to be excited and happy, but it seems that bothers other people so I mainly keep to myself and my pts. :)

papawjohn

papawjohn

435 Posts

Hey Shastalee

Shucks, It's only life-and-death; no reason to take it SERIOUSLY.

No, really. The very very very important things are simple. Once you understand them, any reasonably intelligent person can work with the details.

And happy? Well, I'll admit to something Nurses are NEVER s'posed to admit:

I love this job. It's one of the two or three best things that ever happened to me.

Hope I can help other folks see and feel the same.

Good Luck to Y'a

AND GO TENNESSEE---BEAT FLORIDA

Papaw John

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