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Heart Failure, An Issue of Critical Nursing Clinics, E-Book

Heart Failure, An Issue of Critical Nursing Clinics, E-Book

Jennifer Kitchens

(2016)

Additional Information

Abstract

Heart failure is the only cardiovascular disease that is increasing. The impact on the critical care environment and the health care system, as a whole, is significant from both a cost and burden to the system perspective. There are 6.5 million hospital days a year and nearly $40 billion dollars in yearly health care costs attributed to heart failure in the United States. There are more Medicare monies spent for diagnosing and treating heart failure than any other Diagnosis Related Group. There is a 24% hospital re-admission rate for this diagnosis which leads to financial implications for health care systems. The human cost is also significant. Less than half of Americans diagnosed with heart failure survive greater than 5 years. The ongoing health care needs and cost of this chronic disease takes a significant toll on patients’ finances, time and quality of life. Over $2.9 billion dollars is spent annually on the pharmaceutical management of heart failure in the United States. This diagnosis is the leading cause of hospitalization for patients who are 65 years of age and older. Few health care providers in the critical care environment are not affected by heart failure on a routine basis. Caring for these patients and their families is both a challenging and yet a rewarding experience. This edition will provide critical care nurses with a comprehensive heart failure review which is essential in caring for this challenging population given the dynamic health and critical care environments. 

Table of Contents

Section Title Page Action Price
Front Cover Cover
Heart Failure\r i
Copyright\r ii
Contributors iii
Consulting Editor iii
Editors iii
Authors iii
Contents v
Preface: Heart Failure\r v
Heart Failure: A Primer\r v
Heart Failure and Atrial Fibrillation\r v
Hypertensive Crisis: A Review of Pathophysiology and Treatment\r v
Hemodynamics of Acute Right Heart Failure in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome\r vi
Mechanisms of Cardiotoxicity and the Development of Heart Failure\r vi
Characteristics, Complications, and Treatment of Acute Pericarditis\r vi
High-Output Heart Failure Caused by Thyrotoxicosis and Beriberi\r vi
Sleep and Heart Failure\r vii
Patient Safety Coalition: A Focus on Heart Failure\r vii
The Role of the Nurse Navigator in the Management of the Heart Failure Patient\r vii
Ventricular Assist Device and Destination Therapy Candidates from Preoperative Selection Through End of Hospitalization\r vii
Cardiac Transplantation: Considerations for the Intensive Care Unit Nurse\r viii
Palliative Care in Heart Failure\r viii
CRITICAL CARE NURSING\rCLINICS OF NORTH AMERICA\r ix
FORTHCOMING ISSUES ix
March 2016 ix
June 2016 ix
September 2016 ix
RECENT ISSUES ix
September 2015 ix
June 2015 ix
March 2015 ix
Preface: Heart Failure \r xi
Heart Failure 413
Key points 413
INTRODUCTION 413
HEART FAILURE DEFINED 414
COMMON CAUSAL PATHWAYS TO HEART FAILURE 414
PREVAILING PATHOPHYSIOLOGIC MECHANISMS OF HEART FAILURE 415
Neurohormonal Activation 415
Inflammation 416
DIAGNOSING HEART FAILURE 417
History and Physical 417
Diagnostics 417
Importance of Symptoms in Heart Failure 418
HEART FAILURE MANAGEMENT STRATEGIES 419
Heart Failure Self-care 420
SUMMARY 421
REFERENCES 421
Heart Failure and Atrial Fibrillation 427
Key points 427
INTRODUCTION 427
THE HEART FAILURE–ATRIAL FIBRILLATION CONNECTION 427
ANTICOAGULATION 429
RATE CONTROL 430
RHYTHM CONTROL 431
CARDIOVERSION 432
DEVICE THERAPY 434
CATHETER ABLATION 435
HYBRID ABLATION 435
SURGICAL ABLATION 436
LEFT ATRIAL APPENDAGE OCCLUSION 436
OTHER STRATEGIES 436
SUMMARY 436
REFERENCES 437
Hypertensive Crisis 439
Key points 439
INTRODUCTION 439
DEFINITIONS 440
CLINICAL PRESENTATION 440
Hypertensive Urgency 440
Hypertensive Emergency 440
PATHOPHYSIOLOGY 441
ETIOLOGY 442
PHARMACOLOGIC TREATMENT APPROACH 446
Hypertensive Urgency 446
Hypertensive Emergency 446
SUMMARY 446
REFERENCES 446
Hemodynamics of Acute Right Heart Failure in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome 449
Key points 449
INTRODUCTION 449
ACUTE RIGHT VENTRICULAR FAILURE 450
Pressure Monitoring 451
Right Atrial Pressure (Right Atrial or Central Venous Pressure) and Pulmonary Arteriole Occlusion Pressure 452
OXYGENATION 453
External Respiration 453
Internal (Tissue Respiration) 455
Compensation in shock 455
COMPENSATION 456
Acute Cor Pulmonale 457
KEY CONCEPTS 459
Application of Positive Pressure Ventilation 460
The Relationship between Left Ventricular Outflow and Arterial Perfusion Is Dynamic and Interactive 460
KEY CONCEPTS 461
SUMMARY 461
SIMPLE STRATEGIES 462
CASE PRESENTATION 465
REFERENCES 466
Mechanisms of Cardiotoxicity and the Development of Heart Failure 469
Key points 469
Introduction 469
Cancer therapies and cardiotoxicity 470
Direct Cardiomyocyte Injury 470
Thromboembolic Events 472
Hypertension 472
Biological agents and heart failure 473
Alcoholic cardiomyopathy 473
Cocaine and the development of heart failure 475
Summary 478
References 478
Characteristics, Complications, and Treatment of Acute Pericarditis 483
Key points 483
INTRODUCTION 483
STRUCTURE AND FUNCTION OF THE PERICARDIUM 484
DEFINITION OF ACUTE PERICARDITIS 484
INCIDENCE 484
CAUSES 484
DIAGNOSIS 485
PROGNOSIS 489
CLINICAL MANAGEMENT 489
Pharmacologic Management 489
Nonsteroidal antiinflammatory drugs 490
Colchicine 490
Systemic corticosteroids 491
Heparin 491
Exercise Restrictions 491
Follow-up Care 491
Patient and Family Teaching 491
DISEASE COMPLICATIONS 492
CURRENT EVIDENCE 493
SUMMARY 496
REFERENCES 496
High-Output Heart Failure Caused by Thyrotoxicosis and Beriberi 499
Key points 499
INTRODUCTION 499
THYROTOXICOSIS 500
The Thyroid 500
Signs and Symptoms of Thyrotoxicosis 501
Diagnosing Thyrotoxicosis-Induced Heart Failure 502
Managing Thyrotoxicosis-Induced Heart Failure 502
Amiodarone-Induced Thyrotoxicosis 504
BERIBERI 504
Dry Beriberi 506
Wet Beriberi 506
About Thiamine 506
Signs and Symptoms of Wet Beriberi 507
Diagnosing Wet Beriberi 507
Treating Wet Beriberi 507
CARING FOR THE PATIENT WITH HIGH-OUTPUT HEART FAILURE CAUSED BY THYROTOXICOSIS OR BERIBERI 508
SUMMARY 509
REFERENCES 509
Sleep and Heart Failure 511
Key points 511
INTRODUCTION 511
SLEEP PHYSIOLOGY 512
SLEEP-DISORDERED BREATHING 512
CONSEQUENCES OF SLEEP-DISORDERED BREATHING ON HEART FAILURE 513
IDENTIFYING PATIENTS WITH SLEEP-DISORDERED BREATHING 514
TREATMENT OF SLEEP-DISORDERED BREATHING IN HEART FAILURE 514
Noninvasive Ventilatory Support 516
Positive airway pressure therapy 516
Adaptive servo-ventilation therapy 517
Supplemental Oxygen 517
Cardiac Pacing 518
Pharmacologic Interventions 518
Miscellaneous 519
Oral sleep appliances 519
Phrenic nerve stimulation 519
CLINICAL IMPLICATIONS 519
SUMMARY 520
REFERENCES 520
Patient Safety Coalition 523
Key points 523
INTRODUCTION 523
BACKGROUND OF PATIENT SAFETY COALITIONS 524
TACTICS TO REDUCE READMISSION RATES 527
TRANSITIONS OF CARE: HOSPITAL TO SKILLED NURSING FACILITIES 527
IMPLEMENTATION OF MINIMUM CARE STANDARDS FOR THE CARE OF PATIENTS WITH HEART FAILURE 528
BETTER VERBAL COMMUNICATION 530
TRANSITIONS OF CARE: HOSPITAL TO HOME HEALTH CARE 531
OUTCOMES 533
DISCUSSION 533
SUMMARY 533
ACKNOWLEDGMENTS 534
REFERENCES 534
The Role of the Nurse Navigator in the Management of the Heart Failure Patient 537
Key points 537
THE NURSE NAVIGATOR 539
HEART SUCCESS TRANSITION CLINIC 539
VIRTUAL HEART SUCCESS TRANSITION CLINIC 542
STANDARDIZATION OF PATIENT EDUCATION 544
GROUP VISIT MODEL IMPLEMENTATION 545
HEART FAILURE NURSE NAVIGATOR 547
Job Description 547
Position summary 547
Patient education 548
Patient liaison/advocate 548
Outreach 548
Assess patient and family needs 548
Quality outcome measures 548
Professional and staff responsibilities 549
REFERENCES 549
Ventricular Assist Device and Destination Therapy Candidates from Preoperative Selection Through End of Hospitalization 551
Key points 551
PULSATILE/CONTINUOUS FLOW PHYSIOLOGY 552
PATIENT SELECTION AND PREOPERATIVE CONSIDERATIONS 554
Nutrition 555
Hemodynamics 555
Infection Prevention 556
Psychosocial Considerations 556
Exclusion Criteria 556
INTRAOPERATIVE CONSIDERATIONS 556
POSTOPERATIVE CONSIDERATIONS 558
Hemodynamics and the Ventricular Assistance Device Patient 558
Right Ventricular Function 559
Anticoagulation and Bleeding 560
Gastrointestinal Bleeding 560
Infection Prevention 561
Device Management 562
PATIENT AND CAREGIVER EDUCATION 562
SUMMARY 563
REFERENCES 563
Cardiac Transplantation 565
Key points 565
INTRODUCTION 565
PREOPERATIVE PREPARATION 566
PERIOPERATIVE PERIOD 568
POSTOPERATIVE PERIOD 569
SUMMARY 574
REFERENCES 574
Palliative Care in Heart Failure 577
Key points 577
HEART FAILURE BACKGROUND 577
WHAT IS PALLIATIVE CARE? 578
COMPLEXITIES OF HEART FAILURE AND PALLIATIVE CARE 579
Heart Failure Illness Trajectory: Unpredictable Course 579
Failure to Have the Conversation 579
Lack of Understanding of Palliative Care as an Overarching Philosophy Encompassing Hospice 580
Lack of Available Services/Teams 581
BASIC PALLIATIVE CARE FOR HEART FAILURE 581
FUTURE DIRECTION OF PALLIATIVE CARE IN HEART FAILURE 584
REFERENCES 585