Left heart failure concept map & questions Essay Example

  • Category:
    Nursing
  • Document type:
    Essay
  • Level:
    Masters
  • Page:
    2
  • Words:
    1223

LEFT HEART FAILURE 7

Title: Left Heart Failure

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Question 1

There is need for the body to maintain adequate perfusion of tissues and organs. Heart failure occurs when the heart is unable to meet the blood supply to various parts of the body. A reduction in the amount of blood being pumped to the rest of the body by the heart triggers the compensatory mechanisms. The compensatory mechanisms aim at increasing the blood volume and maintain the blood pressures. The various strategies will range from retention of fluids and an increase in the heart rate and its contractility. In addition, the remodeling of the heart occurs. The remodeling will involve the hypertrophy of the heart. Hypertrophy of the heart muscles will be aimed at increasing the force of contraction of the heart. Based on frank sterling, the increase in contractility directly influences the blood being pumped to the rest of the body. At the kidney level, the retention of fluids is meant at increasing blood volume. This is through the activation of the renin angiotensin system.

The general steps involved in heart failure compensatory mechanism will involve the following:

During heart failure, the decreased cardiac output causes systemic hypotension to ensue. Consequently the renin angiotensin system is activated. The activation of the renin angiotensin system brings about the increased retention of salt and water by the kidneys. The retaining of salts and water instead of being secreted into urine increases the blood volume. The increased blood volume increases the distension of the heart muscles. The heart chambers and muscles are forced to enlarge to accommodate the additional volume. At first the heart muscles will be able to cope with the stretch. However, after some certain degree of stretching is achieved, the heart will no longer be able to help since it weakens the strength of the contractions. Consequently, the heart failure is worsened by the fluid overload (Allen et al., 2012).

The nursing interventions will be designed to bring about diuresis, vasodilatation, increasing oxygen supply and relieving pain. The management of pulmonary edema is essential since it improves the contractility of the heart. The management of pulmonary edema is aimed at addressing the ABC’s of resuscitation (airway, breathing and circulation). The patient is given oxygen by face mask while monitoring the oxygen levels to prevent hypercapnia. The nursing interventions will include:

Diuresis:

Heart failure is often characterized by the retention of fluids within the body. The most common area in which fluids accumulate is the pulmonary system. Diuresis entails the use of pharmacological agents such as Furosemide.

There is need to increase the loss of fluids. This will in turn correct the pulmonary edema that is characteristic of heart failure. The loss of fluids will be enhanced by the use of diuretics.

The rationale of using diuretics: Diuresis will help relieve the accumulation of fluids whose persistence would limit the contraction of the heart hence worsening heart failure.

Relieving Pain:

Heart failure patients will often experience episodes of pain. The pain can be attributed to the poor blood supply which leads to ischemia. The relieving of pain will be aided by pharmacological agents such as Opiates (morphine).

Rationale of relieving pain: Relieving pain thus becomes a priority in the management of heart failure. The most commonly used class of medication are the opiates. Opiates are administered to relive the patients from pain or distress.

(Gheorghiade et al., 2013).

Question 2

Furosemide is a loop diuretic. It functions by inhibits the reabsorption of water by blocking the sodium-potasiumchloride cotransporter within the thick ascending limb of the loop of henle.it mediates these function by competitively binding the chloride binding sites on the co-transporter system. This competitive inhibition prevents the movement of sodium from the lumen of the loop of henle into the basal lateral side. As a result, the lumen becomes hypertonic hence limiting the reabsorption of water in the nephrons (Gheorghiade et al., 2013).

The use of diuretics is essential in the management of heart failure. Diuretics prevent the retention of fluids in the body. However, the use of furosemide can also worsen the patient’s condition if not well monitored. This can be attributed to the fact that the heart failure patients are unstable and there is a thin line beneficial and harmful effects of furosemide. Furosemide could pose detrimental effects to patients with heart failure since it activates the renin angiotensin as well as the sympathetic systems. Each of these systems plays a vital role in the progression of heart failure since they tend to decrease the rate of glomerular filtration rates. The renin angiotensin system causes retention of sodium and water occurs. On the other hand, the sympathetic nervous system increases the contractility and the heart rate (Lindenfeld et al., 2010).

The retention of fluid is aimed at increasing the blood volume. The distension of the heart thus occurs to cater for the increased blood volume. Continued increase in blood volume leads to over stretching of the heart muscles to a level they can no longer cope. The increased stretch thus affects the force of contraction of the heart muscles since the muscles have become fibrotic. The inability for the force of contraction to become sufficient in pumping blood worsens heart failure (Gheorghiade et al., 2013).

The renin angiotensin system is a compensatory mechanism in heart failure. It is activated when blood flow is low within the juxtaglomerular apparatus. Renin is released by the kidneys into circulation. The renin converts the angiotensinogen released by the liver to angiotensin (i). The angiotensin (I) is converted to angiotensin (ii) by the angiotensin converting enzyme. The angiotensin (ii) is vasoactive and causes the dilatation of blood vessels (Gheorghiade et al., 2013).

Furosemide is used in the management of heart failure to cause diuresis. This prevents the further accumulation of fluids within the body especially the pulmonary system. Diuresis will thus prevent the worsening of heart failure since accumulation of fluids will have decreased the compliance of the heart. Diuresis will thus allow for proper contractility of the heart muscles to be achieved hence adequate volumes of blood will be pumped to the rest of the body (Gheorghiade et al., 2013).

However, the nurses ought to administer low dosages of furosemide to prevent the detrimental effects from taking place. The drugs used in the management of edema might lead to hypotension and electrolyte imbalance in the patients. Hypotension will result into a further reduction in the perfusion of various tissues in the body. The electrolyte imbalance on the other hand would affect the contractility of the heart muscles. Low dosages will ease the monitoring and evaluation of the patients for the progression of heart failure.

The nursing interventions in the administration of furosemide will include:

  • Monitoring of the vital signs

  • Establishing the electrolyte levels

  • Measuring the urine out

  • Checking for signs of fluid overload

(Gheorghiade et al., 2013).

References

Allen LA., Stevenson LW., Grady KL., (2012). Decision making in advanced heart failure: a scientific statement from the American heart association. Circulation ;125:1928-52

Gheorghiade M., Böhm M., Greene SJ., (2013). Effect of aliskiren on postdischarge mortality and heart failure readmissions among patients hospitalized for heart failure: the ASTRONAUT randomized trial. Journal of American Medical Association;309:1125-35

Lindenfeld J., Albert NM., Boehmer JP., (2010). Executive summary: HFSA 2010 comprehensive heart failure practice guideline. Journal of Cardiac Failure;16:e1-194.