GROUP 4

Domingo, Precious Mae T.

Galapon, Grace A.

Pizarro, Angelique A.

Ronquillo, Frances Nichole M.

 HEART
FAILURE
NCM 112: Oxygenation
 Heart Failure
Heart failure is characterized by the heart’s inability to pump an adequate supply of blood to the body.
Without sufficient blood flow, all major body functions are disrupted. Heart failure is a condition or a
collection of symptoms that weakens the heart.
Heart failure can affect the right or left side of the heart or both at the same time. It can be either an acute
(short-term) or chronic (ongoing) condition.

In acute heart failure, the symptoms appear suddenly but go away fairly quickly. This condition often
occurs after a heart attack. It may also be a result of a problem with the heart valves that control the flow of
blood in the heart. In chronic heart failure, however, symptoms are continuous and don’t improve over time.
The vast majority of heart failure cases are chronic.
 Types of Heart Failure
Right-sided heart failure
• The right heart ventricle is responsible for pumping blood to the lungs to collect oxygen. Right-sided heart
failure occurs when the right side of the heart can’t perform its job effectively.
• It’s usually triggered by left-sided heart failure. The accumulation of blood in the lungs caused by left-sided
heart failure makes the right ventricle work harder. This can stress the right side of the heart and cause it to
fail.
• Right-sided heart failure can also occur as a result of other conditions, such as lung disease. Right-sided
heart failure is marked by swelling of the lower extremities. This swelling is caused by fluid backup in the
legs, feet, and abdomen.
 Types of Heart Failure
Left-sided heart failure
• Left-sided heart failure is the most common type of heart failure.
• The left heart ventricle is located in the bottom left side of the heart. This area pumps oxygen-rich blood to
the rest of the body.
• Left-sided heart failure occurs when the left ventricle doesn’t pump efficiently. This prevents the body from
getting enough oxygen-rich blood. The blood backs up into the lungs instead, which causes shortness of
breath and a buildup of fluid.
 Types of Heart Failure
There are two main types of Left-sided heart failure:
Diastolic heart failure
• Diastolic heart failure occurs when the heart muscle becomes stiffer than normal. The stiffness, which is
usually due to heart disease, means that the heart doesn’t fill with blood easily. This is known as diastolic
dysfunction. It leads to a lack of blood flow to the rest of the organs in the body.
• Diastolic heart failure is more common in females than in males.
 Types of Heart Failure
Systolic heart failure
• Systolic heart failure occurs when the heart muscle loses its ability to contract. The contractions of the heart
are necessary to pump oxygen-rich blood out to the body. This problem is known as systolic dysfunction,
and it usually develops when the heart is weak and enlarged.
• Systolic heart failure is more common in males than in females.
• Both diastolic and systolic heart failure can occur on the left or right sides of the heart. We may have either
condition on both sides of the heart.
 Types of Heart Failure
Biventricular heart failure
-In biventricular heart failure, both sides of the heart are affected. This can produce the same symptoms as both
left-sided and right-sided heart failure, such as shortness of breath and build-up of fluid.
Risk Factors
Risk factors for heart failure include:

• Coronary artery disease

• Heart attack
• Heart valve disease
• High blood pressure
• Irregular heartbeats
• Congenital heart disease
• Diabetes Mellitus
• Alcohol use
• Sleep apnea
• Smoking
• Obesity
• Medications
• Viruses
 Pathophysiology
Modifiable Factors:
•Previous myocardial infarction Non-modifiable factors:
•Angina •Age (65 or older)
•Hypertension •Race (African-American)
•Valvular Heart Disease •Family history of heart disease
•Metabolic or autoimmune disease

↓ Cardiac output
Sympathetic nervous system
stimulation RAAS (Renin-Angiotensin-
Aldosterone-System) activation

Myocardial stimulation
Renin released

Increased heart rate Angiotensin I

Angiotensin II

Aldrenal gland secretes aldosterone

Further stress on myocardium

Na+ and H2O retention

Heart Failure
 Pathophysiology

The modifiable factors that may cause heart failure are previous myocardial infarction, angina,
hypertension, valvular heart disease, and metabolic or autoimmune disease while the non-modifiable
factors are age (65 y/o or older), race (african-american) and family history of heart disease.
Heart failure or Congestive heart failure results from an inadequate or decreased cardiac output. In
order to maintain cardiac output, compensatory mechanisms are being stimulated or activated. The
sympathetic nervous system stimulates the myocardium which increases the client’s heart rate. It also
causes vasoconstriction along with the renin-angiotensin-aldosterone-system (RAAS). The kidney releases
renin which causes the formation of angiotensin. Angiotensin is converted into angiotensin II by
angiotensin converting enzyme which stimulates aldosterone and causes sodium and water retention.
Myocardial stimulation will cause the heart to beat faster. The vasoconstriction will make it harder
for the heart to pump blood. The kidney will continually hold sodium and water thus the compensatory
mechanisms causes more damage. Further stress to myocardium will eventually lead to heart failure.
Signs & Symptoms
Heart failure signs and symptoms includes:

• Shortness of breath with activity or when lying down

• Fatigue and weakness
• Swelling in the legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged mucus
• Swelling of the belly area (abdomen)
• Very rapid weight gain from fluid build-up
• Nausea and lack of appetite
• Difficulty concentrating or decreased alertness
 Laboratory & Diagnostic Procedure

• Physical exam
Doctor may perform a physical exam to check for signs of heart failure. For instance, leg swelling, irregular
heart rate, and bulging neck veins may lead the doctor to diagnose heart failure.
• Echocardiogram
An echocardiogram is the most effective way to diagnose heart failure. It uses sound waves to create detailed
pictures of the heart, which help the doctor evaluate the damage to the heart and determine the underlying
causes of condition. Doctor may use an echocardiogram along with other tests.
 Laboratory & Diagnostic Procedure

Other tests:

Chest X-ray
This test can provide images of the heart and the surrounding organs.

Heart MRI
An MRI produces images of the heart without the use of radiation.

Nuclear Scan
A very small dose of radioactive material is injected into the body to create images of the chambers of the
heart.
 Laboratory & Diagnostic Procedure
Catheterization or Coronary Angiogram
In this type of X-ray exam, the doctor inserts a catheter into the blood vessel, usually in the groin or arm. They then guide
it into the heart. This test can show how much blood is currently flowing through the heart.

Stress Exam
During a stress exam, an EKG machine monitors the heart function while we run on a treadmill or perform another type
of exercise.

Holter Monitoring
Electrode patches are placed on the chest and attached to a small machine called a Holter monitor for this test. The
machine records the electrical activity of the heart for at least 24-48 hours.
 Pharmacologic Management
These medications can include:
Medications
 blood thinners
 Improve heart’s ability to pump blood
 angiotensin converting enzyme (ACE) inhibitors
 Reduce blood clots
 angiotensin II receptor blockers (ARBs)
 Reduce heart rate, when necessary
 beta-blockers
 Remove excess sodium and replenish potassium
 calcium channel blockers
levels
 cholesterol-lowering medications
 Reduce cholesterol levels
 nitrates
 Some medications are completely off-limits to
people with heart failure, including naproxen
(Aleve, Naprosyn) and ibuprofen (Advil, Midol).
 Surgical Management
• Bypass surgery
Some people with heart failure will need surgery, such as coronary bypass surgery. During this surgery,
the surgeon will take a healthy piece of an artery and attach it to the blocked coronary artery. This allows
the blood to bypass the blocked, damaged artery and flow through the new one.
• Angioplasty
In this procedure, a catheter with a small balloon attached is inserted into the blocked or narrowed artery.
Once the catheter reaches the damaged artery, the surgeon inflates a balloon to open the artery. The
surgeon may need to place a permanent stent, or wire mesh tube, into the blocked or narrowed artery. A
stent permanently holds the artery open and can help prevent further narrowing of the artery.
 Surgical Management
• Transplant surgery
Heart transplants are used in the final stages of heart failure when all other treatments have failed. During
a transplant, the surgeon removes all or part of the heart and replaces it with a heart from a donor.
• Pacemakers
Other people with heart failure will need pacemakers to help control heart rhythms. These small devices
are placed into the chest. They can slow heart rate when the heart is beating too quickly or increased heart
rate if the heart is beating too slowly. Pacemakers are often used along with bypass surgery as well as
medications.
 Surgical Management
• Implantable cardioverter defibrillator (ICD)
An ICD is a battery-powered device that keeps track of the heart rate and will shock the heart if it detects
an abnormal heart rhythm. This shock restores the heart rate back to a normal rhythm.
Drug Study
DIGOXIN
Generic  Brand Names Dosage/ Route Classification Indication

digoxin Digitek, Digox, Adults: Inotropic Digoxin is indicated for the treatment of
Lanoxin, Toloxin Loading dose: 0.75- antiarrhythmic mild to moderate heart failure in adult
1.25 mg PO or cardiac glycoside patients, to increase myocardial
0.125-0.25 mg IV contraction in children diagnosed with
Maintenance dose: heart failure, and to maintain control
0.125-0.25 mg/day ventricular rate in adult patients
PO diagnosed with chronic atrial
fibrillation.
Drug Study
DIGOXIN
Adverse Reaction Nursing Responsibility

CNS: fatigue, generalized muscle weakness, Before giving the drugs:

agitation, hallucinations • Observe the 12 rights of medication.
• Before giving loading dose, obtain baseline data (heart rate
CV: arrhythmias, heart block and rhythm, blood pressure, and electrolytes) and ask
patient about use of cardiac glycosides within the previous
EENT: yellow-green halos around visual images, 2 to 3 weeks.
blurred vision, light flashes, photophobia, diplopia • Take apical pulse-radial pulse for 1 minute. Record and
notify prescriber of significant changes.
GI: anorexia, nausea
During giving the drugs:
• Ensure that the medication is taken properly.
After giving the drugs:
• Monitor the client for side effects and possible reaction.
• Advise client to immediately report any signs and symptoms
of the drug’s side effects.
Drug Study DIURETICS:
FUROSEMIDE
Generic  Brand Names Dosage/ Route Classification Indication

furosemide Apo-Furosemide ORAL SOLUTION, Antihypertensive, To reduce edema caused heart failure.
(CAN), TABLETS diuretic.
Furoside (CAN), Adults. 20 to 80
Lasix, mg as a single
Lasix Special dose,
(CAN), increased by 20 to
Myrosemide, 40 mg every 6 to 8
Novosemide hr
(CAN), Uritol until desired
(CAN) response occurs.
Maximum:
600 mg daily.
Children. 2 mg/kg
as a single dose,
increased by 1 to 2
mg/kg every 6 to 8
hr until desired
response occurs.
Drug Study DIURETICS:
FUROSEMIDE
Generic  Brand Names Dosage/ Route Classification Indication

Maximum:
6 mg/kg/dose.
 
I.V. INFUSION, I.V. OR
I.M. INJECTION
 
Adults. 20 to 40 mg
as a single dose,
increased by 20 mg
every 2 hr until
desired
response occurs.
Children. 1 mg/kg as
a single dose,
increased by 1 mg/kg
every 2 hr until
desired response
occurs. Maximum:
6 mg/kg/dose
Drug Study DIURETICS:
FUROSEMIDE
Adverse Reaction Nursing Responsibility

CNS: Dizziness, fever, headache, paresthesia, Before giving the drugs:

restlessness, vertigo, weakness • Observe the 12 rights of medication.
CV: Orthostatic hypotension, shock, • Obtain patient’s weight before and periodically during
thromboembolism, thrombophlebitis furosemide therapy to monitor fluid loss.
EENT: Blurred vision, oral irritation, ototoxicity, • For once-a-day dosing, give drug in the morning so patient’s
stomatitis, tinnitus, transient hearing loss (rapid sleep won’t be interrupted by increased need to urinate.
I.V. injection), yellow vision • Prepare drug for infusion with normal saline solution,
ENDO: Hyperglycemia lactated Ringer’s solution, or D5W.
GI: Abdominal cramps, anorexia, constipation, During giving the drugs:
diarrhea, gastric irritation, hepatocellular • Administer drug slowly I.V. over 1 to 2 minutes to prevent
insufficiency, indigestion, jaundice, ototoxicity.
nausea, pancreatitis, vomiting • If patient is at high risk for hypokalemia, give potassium
GU: Bladder spasms, glycosuria supplements along with furosemide, as prescribed.
HEME: Agranulocytosis (rare), anemia, After giving the drugs:
aplastic anemia (rare), azotemia, hemolytic • Expect patient to have periodic hearing tests during
anemia, leukopenia, thrombocytopenia prolonged or high-dose I.V. therapy
MS: Muscle spasms • Monitor blood pressure and hepatic and renal function as
Drug Study DIURETICS:
FUROSEMIDE
Adverse Reaction Nursing Responsibility

SKIN: Bullous pemphigoid, erythema multiforme, well as BUN, blood glucose, and serum creatinine,
exfoliative dermatitis, photosensitivity, pruritus, electrolyte, and uric acid levels, as appropriate.
purpura, rash, urticaria • Be aware that elderly patients are more susceptible to
Other: hypotensive and electrolyte altering effects and thus are at
Allergic reaction (interstitial nephritis, necrotizing greater risk for shock and thromboembolism.
vasculitis, systemic vasculitis), dehydration, • Expect to discontinue furosemide at maximum dosage if
hyperuricemia, hypochloremia, hypokalemia, oliguria persists for more than 24 hours.
hyponatremia, • Be aware that furosemide may worsen left ventricular
hypovolemia hypertrophy and adversely affect glucose tolerance and lipid
metabolism.
•  Notify prescriber if patient experiences hearing loss,
vertigo, or ringing, buzzing, or sense of fullness in her ears.
Drug may need to be discontinued.
Drug Study DIURETICS:
SPIRONOLACTONE
Generic  Brand Names Dosage/ Route Classification Indication

spironolacto Aldactone, TABLETS Aldosterone To treat edema cause by heart failure.

ne Novospiroton Adults. antagonist,
(CAN) Initial: 25 to 200mg antihypertensive,
daily in divided diagnostic aid for
doses b.i.d. to primary
q.i.d. for at least 5 hyperaldosteronis
days. m, diuretic
 
Maintenance: 75 to
400 mg daily in
divided doses b.i.d.
to q.i.d.
Maximum: 400 mg
daily.
Children.
Initial: 1 to 3 mg/kg
daily as a
single dose or in
divided doses b.i.d.
Drug Study DIURETICS:
SPIRONOLACTONE
Generic  Brand Names Dosage/ Route Classification Indication

to q.i.d. for at least

2 wk; adjusted, as
needed, after 5
days.
 
Maximum: 3 times
initial dose.
Drug Study DIURETICS:
SPIRONOLACTONE
Adverse Reaction Nursing Responsibility

CNS: Dizziness, encephalopathy, fatigue, Before giving the drugs:

headache • Observe the 12 rights of medication.
EENT: Increased intraocular pressure, nasal • Be aware that for children or patients who have trouble
congestion, tinnitus, vision changes swallowing, pharmacist may crush spironolactone tablets,
ENDO: Gynecomastia mix with flavoured syrup, and dispense as a suspension.
GI: Abdominal pain, anorexia, constipation, • Caution patient that he may experience dizziness during
diarrhea, flatulence, nausea, vomiting. spironolactone therapy if fluid balance is altered.
GU: Impotence  
HEME: Aplastic anemia, neutropenia During giving the drugs:
RESP: Cough, dyspnea • Instruct patient to take spironolactone with meals or milk.
MS: Arthralgia, back and leg pain, muscle
weakness, myalgia After giving the drugs:
Other: Hyperkalemia • Expect to evaluate patient’s serum potassium level 1 week
after spironolactone therapy begins, after each dosage
adjustment, monthly for the first 3 months, quarterly for 1
year, and then every 6 months thereafter or as ordered.
Drug Study DIURETICS:
SPIRONOLACTONE
Adverse Reaction Nursing Responsibility

: Notify prescriber if level exceeds 5 mEq/L or patient’s renal

function deteriorates (serum creatinine level exceeding 4
mg/dl). If patient has severe heart failure, follow closely
because hyperkalemia may be fatal in such patients.
•  Evaluate spironolactone’s effectiveness by edema.
Drug Study INOTROPES:
NOREPINEPHRINE
Generic  Brand Names Dosage/ Route Classification Indication

norepinephr Levophed I.V. INFUSION Inotropes, cardiac To treat acute hypotension, cardiogenic
ine Adults. stimulant, shock, and septic shock.
bitartrate Initial: 0.5 to 1 vasopressor
(levarterenol mcg/min.
bitartrate) Increased, as
ordered, until
systolic blood
pressure reaches
desired level.
Maintenance: 2 to
12 mcg/min.
Children. 0.1
mcg/kg/min.
Maximum: 1
mcg/kg/min.
Drug Study INOTROPES:
NOREPINEPHRINE
Adverse Reaction Nursing Responsibility

:CNS: Anxiety, dizziness, headache, insomnia, Before giving the drugs:

nervousness, tremor, weakness • Observe the 12 rights of medication.
CV: Angina, bradycardia, ECG changes, edema, • Dilute norepinephrine concentrates for infusion in D5W,
hypertension, hypotension, palpitations, dextrose 5% in normal saline solution, or normal saline
peripheral vascular insufficiency (including solution. Dilutions typically range from 16 to 32 mcg/ml.
gangrene), PVCs, sinus tachycardia • Make sure solution contains no particles and isn’t
GI: Nausea, vomiting discolored before administering.
GU: Decreased renal perfusion RESP: Apnea,
dyspnea During giving the drugs:
SKIN: Pallor Other: Infusion site sloughing and • Give drug with a flow-control device.
tissue necrosis, metabolic acidosis.
After giving the drugs:
• Check blood pressure every 2 to 3 minutes, preferably by
direct intra-arterial monitoring, until stabilized and then
every 5 minutes
• Urge patient to immediately report burning, leaking, or
tingling around I.V. site
Drug Study INOTROPES:
DOBUTAMINE HYDROCHLORIDE
Generic  Brand Names Dosage/ Route Classification Indication

dobutamine Dobutrex I.V. INFUSION Inotropes, cardiac To treat low cardiac output and heart
hydrochlorid Adults. 2.5 to 10 stimulant failure.
e mcg/kg/min as
continuous
infusion adjusted
according to
hemodynamic
response.
Children. 5 to 20
mcg/kg/min as
continuous
infusion adjusted
according to
hemodynamic
response.
Drug Study INOTROPES:
DOBUTAMINE HYDROCHLORIDE
Adverse Reaction Nursing Responsibility

CNS: Fever, headache, nervousness, restlessness Before giving the drugs:

CV: Angina, bradycardia, hypertension, • Observe the 12 rights of medication.
hypotension, palpitations, PVCs, tachycardia • Avoid giving dobutamine to patients with uncorrected
GI: Nausea, vomiting hypovolemia.
RESP: Dyspnea • Expect prescriber to order whole blood or plasma volume
SKIN: Extravasation with tissue necrosis expanders to correct hypovolemia.
and sloughing, rash • Also avoid giving dobutamine to patients with acute MI
Other: Hypokalemia because it can intensify or extend myocardial ischemia.
• Use drug cautiously in patients allergic to sulfites because
drug may cause anaphylactic-like signs and symptoms;
commercially available dobutamine injections contain
sodium bisulfite. Also use drug cautiously in patients with
atrial fibrillation because drug increases AV conduction.
Keep in mind that patient should be adequately digitalized
before administration.
• Inspect parenteral solution for particles and discoloration
before administering it.
Drug Study INOTROPES:
DOBUTAMINE HYDROCHLORIDE
Adverse Reaction Nursing Responsibility

• Give I.V. drug using an infusion pump.

• Explain the need for frequent hemodynamic monitoring.
During giving the drugs:
• Monitor blood pressure often during therapy, preferably by
continuous intraarterial monitoring; systolic increase of 10
to 20 mm Hg may indicate dobutamine induced increase in
cardiac output. If hypotension develops, expect to reduce
dosage or discontinue drug.

After giving the drugs:

• Monitor heart rate and rhythm continuously for PVCs,
which may result from drug’s stimulatory effect on heart’s
conduction system, and sinus tachycardia, which results
from positive chronotropic effect of beta stimulation and
may increase heart rate by 5 to 15 beats/ minute.
Drug Study INOTROPES:
DOBUTAMINE HYDROCHLORIDE
Adverse Reaction Nursing Responsibility

• Monitor hemodynamic parameters, such as central venous

pressure, pulmonary artery wedge pressure, and cardiac
output, as indicated, to assess drug’s effectiveness.
• Monitor urine output hourly, as appropriate, to check for
improved renal blood flow.
• Be aware that Dobutamine isn’t indicated for long-term
treatment of heart failure because it may not be effective
and may increase the risk of hospitalization and death.
Drug Study INOTROPES:
DOPAMINE HYDROCHLORIDE
Generic  Brand Names Dosage/ Route Classification Indication

dopamine Intropin, Revimine I.V. INFUSION Inotropes, cardiac To correct hypotension that is
hydrochlorid (CAN) Adults. 0.5 to 3 stimulant, unresponsive to adequate fluid volume
e mcg/kg/min for vasopressor. replacement or occurs as part of shock
vasodilation of syndrome caused by bacteremia,
renal arteries; chronic cardiac decompensation, drug
2 to 10 overdose, MI, open-heart surgery, renal
mcg/kg/min failure, trauma, or other major systemic
for positive illnesses; to improve low cardiac
inotropic effects output.
and increased
cardiac output;
10 mcg/kg/min,
increased
gradually according
to patient’s
response,
for increased
systolic and
Drug Study INOTROPES:
DOPAMINE
HYDROCHLORIDE
Generic  Brand Names Dosage/ Route Classification Indication

diastolic blood
pressures.

Children. 1 to 5
mcg/kg/min
increased gradually
in increments of
2.5 to 5
mcg/kg/min to
achieve desired
results.
Maximum: 20
mcg/kg/min.
Drug Study INOTROPES:
DOPAMINE HYDROCHLORIDE
Adverse Reaction Nursing Responsibility

CNS: Headache CV:Angina, bradycardia, Before giving the drugs:

hypertension, hypotension, palpitations, • Observe the 12 rights of medication.
peripheral vasoconstriction, sinus tachycardia, • Use drug cautiously in patients with cardiac disease,
ventricular arrhythmias particularly coronary artery disease, because dopamine
GI: Nausea, vomiting increases myocardial oxygen demand. Also use drug
RESP: Dyspnea SKIN: Extravasation with tissue cautiously in patients allergic to sulfites, which are
necrosis contained in some forms of dopamine.
• Inspect parenteral solution for particles and discoloration
before administration.
•  Dilute dopamine concentrates with a compatible I.V.
solution before administering. Typical dilution is 400 mg in
250 ml to yield 1.6 mg/ml. Don’t exceed 3.2 mg/ml.
•  If patient has hypovolemia, ensure adequate fluid
resuscitation before giving drug.
• Give drug by I.V. infusion using an infusion pump.
•  Explain the need for frequent hemodynamic monitoring.
Drug Study INOTROPES:
DOPAMINE HYDROCHLORIDE
Adverse Reaction Nursing Responsibility

 During giving the drugs:

• Monitor blood pressure continuously with an intra-arterial
line, as indicated.
• Place patient on continuous ECG monitoring, and assess
heart rate and rhythm for arrhythmias
.
After giving the drugs:
• Monitor patient’s hemodynamic parameters, such as central
venous pressure, pulmonary artery wedge pressure, and
cardiac output, as indicated, to assess effectiveness of
dopamine therapy.
• Monitor urine output hourly as appropriate to assess
patient for improved renal blood flow.
Drug Study ANGIOTENSIN RECEPTOR BLOCKERS:
AZILSARTAN MEDOXOMIL
Generic  Brand Names Dosage/ Route Classification Indication

azilsartan Edarbi Adults: 80 mg P.O. Pharmacologic Azilsartan medoxomil is indicated for

medoxomil daily. Consider a class: Angiotensin the treatment of hypertension in adults
starting dose of II receptor blocker 18 years of age and older. It is approved
40 mg for patients for use alone or in combination with
other antihypertensive drugs.
who
are being treated
with high-dose
Drug Study ANGIOTENSIN RECEPTOR
BLOCKERS: AZILSARTAN
MEDOXOMIL
Adverse Reaction Nursing Responsibility

CV: hypotension, orthostatic Before giving the drugs:

hypotension
• Observe the 12 rights of medication.
GI: diarrhea
GU: oliguria or progressive azotemia • Tell patient to take drug with or without food.
with acute renal failure (rare)
• Instruct patient to promptly report changes in urinary
function.
During giving the drugs:
• Advise female patient of childbearing age to immediately
notify prescriber if she becomes pregnant.
• Because of the potential for adverse effects in the
breastfeeding infant, a decision should be made whether
to discontinue breastfeeding or discontinue drug, taking
into account importance of drug to the mother.
Drug Study ANGIOTENSIN RECEPTOR
BLOCKERS: AZILSARTAN
MEDOXOMIL
Adverse Reaction Nursing Responsibility

After giving the drugs:

• As appropriate, review all significant and life-threatening
adverse reactions and interactions, especially those related
to the drugs and tests mentioned above.
Drug Study ACE INHIBITORS

Generic  Brand Names Dosage/ Route Classification Indication

benazepril Lotensin Adults: Initially, 5 Pharmacologic Lotensin is indicated for the treatment
to 10 mg/day P.O. class: of hypertension, to lower blood
as Angiotensinconver pressure. Lowering blood pressure
a single dose. ting enzyme (ACE) reduces the risk of fatal and nonfatal
Increase gradually inhibitor cardiovascular events, primarily strokes
to a Therapeutic class: and myocardial infarctions.
maintenance Antihypertensive
dosage of 20 to 40
mg/day as a single
dose or in two
divided
doses. (Start with 5
mg/day in patients
receiving diuretics.)
Drug Study ACE INHIBITORS
Adverse Reaction Nursing Responsibility

CNS: dizziness, drowsiness, fatigue, Before giving the drugs:

syncope, light-headedness, headache, • Observe the 12 rights of medication.
insomnia
CV: angina pectoris, hypotension, During giving the drugs:
tachycardia • Monitor CBC, electrolyte levels, kidney and liver function
EENT: sinusitis test results, and urinary protein level.
GI: diarrhea, nausea, anorexia • Monitor for signs and symptoms of angioedema, including
GU: proteinuria, erectile dysfunction, decreased laryngeal edema and shock.
libido, renal failure  
Hematologic: agranulocytosis After giving the drugs:
Metabolic: hyperkalemia • Tell patient to immediately report change in urination
Respiratory: cough, dyspnea, bronchi-tis, pattern, difficulty breathing, or swelling of throat or lips.
asthma, eosinophilic pneumonitis Skin: rash, • Instruct patient to record blood pressure at various
angioedema intervals daily.
Other: fever, altered taste • Tell patient to report dizziness, fainting, or light-
headedness during initial therapy.
• Caution patient to avoid salt substitutes, which may cause
hyperkalemia.
Drug Study ACE INHIBITORS

Adverse Reaction Nursing Responsibility

• As appropriate, review all other significant and life-

threatening adverse reactions and interactions, especially
those related to the drugs, tests, foods, herbs, and
behaviors mentioned above.
Drug Study BETA BLOCKERS

Generic  Brand Names Dosage/ Route Classification Indication

atenolol Tenormin ➣Hypertension Beta-adrenergic 1) Management of hypertension alone

Adults: Initially,50 blocker (selective) and in combination with other
mg P.O. once daily, antihypertensives.
increased to 100  
mg after 7 to 14 2) Management of angina pectoris
days associated with coronary
If needed atherosclerosis.
   
➣ Angina pectoris 3) Management of acute myocardial
Adults: Initially,50 infarction in hemodynamically stable
mg P.O. once daily, patients with a heart rate greater than
increased to 100 50 beats per minutes and a systolic
mg after 7 days if blood pressure above 100 mmHg.
needed. Some
patients may
require up to 200
mg daily.
Drug Study
BETA BLOCKERS
Adverse Reaction Nursing Responsibility

CNS: fatigue, lethargy, vertigo, drowsiness, Before giving the drugs:

dizziness, depression, disorientation, short-term • Observe the 12 rights of medication.
memory loss • Inform patient that he may experience serious reactions if
CV: hypertension, intermittent claudication, cold he stops taking drug suddenly. Advice to consult prescriber
arms and legs, orthostatic hypotension, before discontinuing.
bradycardia, arrhythmias, heart failure, • Caution patient to avoid driving and other hazardous
cardiogenic shock, myocardial re-infarction activities until he knows how drug affects concentration
EENT: blurred vision, dry eyes, eye irritation, and alertness.
conjunctivitis, stuffy nose, rhinitis, pharyngitis,
laryngospasm During giving the drugs:
GI: nausea, vomiting, diarrhea, constipation, • Advise patient to take drug at same time every day.
gastric pain, flatulence, anorexia, ischemic • Tell patient that drug may cause a temporary blood
colitis, retroperitoneal fibrosis, acute pressure decrease if he stands or sits up suddenly. Instruct
pancreatitis, mesenteric arterial thrombosis him to rise slowly and carefully.
GU: impotence, decreased libido, dysuria,
nocturia, Peyronie’s disease, renal failure After giving the drugs:
Hematologic: agranulocytosis • Instruct patient to immediately report signs and symptoms
of allergic response, breathing problems, and chest pain.
Drug Study
BETA BLOCKERS
Adverse Reaction Nursing Responsibility

Hepatic: hepatomegaly • As appropriate, review all other significant and life-

Metabolic: hypoglycemia threatening adverse reactions and interactions.
Musculoskeletal: muscle cramps, back and joint
pain
Respiratory: dyspnea, wheezing, respiratory
distress, bronchospasm, bronchial obstruction,
pulmonary emboli
Other: decreased exercise tolerance,
allergic reaction, fever, development of
antinuclear antibodies, hypersensitivity reaction
 Nursing Care Plan
ASSESSMENT DIAGNOSIS OUTCOME IDENTIFICATION PLANNING
Subjective cues: Fluid volume excess related Patient will be able to; After 8 hours of nursing interventions, patient will
“Namamaga ang mga binti at paa to related to sodium verbalize understanding of the measures to
ko” as verbalized by the patient. retention as manifested by Verbalize understanding of the prevent and lessen fluid volume excess.
presence of edema in both measures to prevent and lessen
  fluid volume excess.
Objective Cues: lower extremities. After 2 days of nursing intervention, the client will
demonstrate stabilize fluid volume with balanced
-Weight gain Demonstrate stabilized fluid intake and output, clear breath sounds, vital signs
- Presence of edema in both lower volume with balanced intake and within acceptable range, stable weight.
extremities. output, clear breath sounds, vital
  signs within acceptable range,
stable weight.
Vital signs:
BP- 150/90 mmHg
PR- 95 bpm
RR- 22 cpm
T- 37.3 C
 Nursing Care Plan
IMPLEMENTATION EVALUATION
Independent:
• Establish rapport.
To gain trust and cooperation from the client.
 
• Weigh the patient daily and compare to the previous measurement.
Bodyweight is a sensitive indicator of fluid balance, and an increase indicates fluid
volume excess.
 
• Instruct patient to follow a low-sodium diet and/or fluid restriction.
Tell the patient to restrict fluid intake to 2 to 2.5 L per day and restrict sodium intake as
prescribed. The client senses thirst because the body senses dehydration. Oral care can
alleviate the sensation without an increase in fluid intake.

• Encourage or provide oral care q2.

Heart failure causes venous congestion, resulting in increased capillary pressure. When
hydrostatic pressure exceeds interstitial pressure, fluids leak out of the capillaries and
present as edema in the legs and sacrum. Elevation of legs increases venous return to
the heart.

• Change position frequently. Elevate feet when sitting. Inspect skin surface, keep
dry, and provide padding as indicated
Edema formation, slowed circulation, altered nutritional intake, and prolonged
 Nursing Care Plan
IMPLEMENTATION EVALUATION
immobility (including bed rest) are cumulative stressors that affect skin integrity and After 8 hours of nursing interventions, patient verbalized
require close supervision/ preventive interventions. understanding of the measures to prevent and lessen fluid volume
  excess.
• Provide small, frequent, easily digestible meals.
Reduced gastric motility can adversely affect digestion and absorption. Small, frequent After 2 days of nursing intervention, the client demonstrates
meals may enhance digestion/ prevent abdominal discomfort. stabilized fluid volume with balanced intake and output, clear breath
  sounds, vital signs within acceptable range, stable weight.
• Institute/instruct patient regarding fluid restrictions as appropriate.  
This helps reduce extracellular volume. Goal was met.
 
• Maintain fluid and sodium restrictions as indicated.
Reduces total body water and prevents fluid reaccumulation.

Dependent
• Administer Diuretic as prescribed by the doctor.
It causes the kidneys to excrete more water and sodium, which can reduce edema and
treat hypertension.
 
Collaborative:
• Consult with a dietitian.
It may be necessary to provide a diet that meets caloric needs within sodium restriction
to the patient.
 Nursing Care Plan
ASSESSMENT DIAGNOSIS OUTCOME IDENTIFICATION PLANNING
Subjective cues: Fatigue related to inadequate After nursing interventions, the Short-term:
patient will report improved sense After 8 hours of nursing interventions, the patient will be
“Ang dali kong mapagod.” as tissue oxygenation secondary able to identify and perform the measures to improve
verbalized by the patient. to congestive heart failure as of energy, performance, and well- sense of energy.
evidenced by weakness, being; absence of weakness,  
  lethargy and drowsiness and vital
Objective Cues: limited range of motion, lack Long-term:
of energy, increased in rest signs is within normal range. After 7 days of nursing interventions, the patient
-weakness requirements, decreased demonstrates improved sense of energy, performance,
-limited range of motion and well-being; absence of weakness, lethargy, and
performance, lethargy, drowsiness, and vital signs is within normal range.
-lack of energy drowsiness, hypertension,
-increase in rest requirements and tachypnea.
-decreased performance
-lethargy
-drowsiness
 
Vital signs:
BP- 140/100 mmHg
PR- 94 bpm
RR- 22 cpm
T- 37.5 C
 Nursing Care Plan
IMPLEMENTATION EVALUATION
Independent:
• Establish rapport.
-To gain trust and cooperation from the patient.

• Ask the patient to rate fatigue.

-To determine the degree of fatigability and helps in developing a plan for managing
fatigue.

• Assess and monitor vital signs.

-To evaluate the cardiopulmonary response to activity.

• Assess the patient’s readiness to increase activity.

-Older adults with CHF can be quite fearful of overexerting their hearts or causing
discomfort.

• Encourage the client to express feelings about fatigue.

-facilitates problem solving and successful coping.

• Review medication regimen.

-Certain medications are known to cause fatigue.

• Assist with self-care needs and ambulation.

-To help patient conserve energy for other tasks.
 Nursing Care Plan
IMPLEMENTATION EVALUATION
Independent: After 8 hours of nursing interventions, the patient is able to identify
• Provide supplemental oxygen, as indicated. and perform the measures to improve sense of energy.
-The presence of hypoxemia reduces oxygen available for cellular uptakes and
contributes to fatigue. After 7 days of nursing intervention, the patient demonstrates
improved sense of energy as evidenced by an increase in
• Advise patient to eat at regular intervals and drink plenty of fluids. performance and normal rest periods as well as there is no
-To sustain energy levels. weakness, lethargy, and drowsiness and vital signs is within normal
range
Dependent:
• Administer or adjust medication dose as ordered by the doctor. Goal was met.
-Some medications can make patients feel tired.

Collaborative:
• Consult with a nutritionist.
-Consulting with a nutritionist could get you started on a nutritional supplement
regimen.
 REFERENCE:
https://www.healthline.com/health/heart-failure
https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
https://www.pdfdrive.com/2011-nurses-drug-handbook-tenth-edition-e45601751.html
https://go.drugbank.com/drugs/DB00390
https://www.scribd.com/doc/123689031/Digoxin-drug-study
https://www.nursingtimes.net/clinical-archive/cardiovascular-clinical-archive/heart-failure-1 -pathogenesis-presentation-and-diagnosis-21-08-2017
https://m.youtube.com/watch?v=zeSDuiTbM9o
https://www.slideshare.net/virajmohanpandey/chronic-congestive-heart
https://www.slideshare.net/rahildalal9/congestive-heart-failure-38139668
https://www.slideshare.net/thunderrajesh/rajesh-ppt-28772056
https://nurseslabs.com/heart-failure/
https://www.ncbi.nlm.nih.gov/books/NBK430873/
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