Page 145 - Critical Care Nursing Demystified

130 CRITICAL CARE NURSING DeMYSTIFIED

Administer NTG sublingually and prepare for IV nitroglycerin if the patient’s
BP is greater than 90 mm Hg to help reduce pain and increase coronary
artery perfusion.
Give supplemental oxygen to help increase myocardial oxygenation.
Administer morphine sulfate to help decrease pain and anxiety and decrease
preload.
Perform a stat 12-lead ECG to see if changes indicative of an MI have oc-
curred.
Observe for complications of MI, which can include pericarditis, cardiac
tamponade, ventricular aneurysm, and cardiogenic shock.

Heart Failure (HF)

What Went Wrong?
Heart failure (HF) is a term used to describe a syndrome of cardiac conditions
that affect the structure and function of the heart. In this syndrome, blood is
not effectively pumped out of the heart (systolic failure) or allowed to fill it
(diastolic failure). The end result is remodeling of the heart. Remodeling occurs Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
when long-term activation of compensatory mechanisms to increase cardiac
output leads to
Increased afterload
Peripheral and pulmonary edema

Chamber dilation or hypertrophy
Regardless of the cause, progressive, dysfunctional remodeling leads to pro-
gressively worsening ventricular dysfunction.
Etiologies of heart failure include those listed in Table 3–15. The most com-
mon causes of HF include ischemia of the heart and hypertension.

TABLE 3–15 Etiology of Heart Failure
Structural abnormalities Valvular dysfunction/heart disease; stenosis or
regurgitation
Cardiomyopathy
Functional abnormalities Hypertension
MI
Unrelieved fast dysrhythmias