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Medicine - Care of patients with heart failure
Medicine - Care of patients with heart failure, such as dietary care of patients with chronic heart failure: provide low-salt, low-fat, easily digestible food, small and frequent meals (intravenous protein supplementation for patients with hypoalbuminemia), and limit sodium intake.
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Medicine - Care of patients with heart failure
- bacteria
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heart failure
Care of patients with chronic heart failure
Rest and position: Those with breathing difficulties should be placed in a high pillow or semi-sitting position; in severe cases, sit upright and breathe, with legs drooped if necessary.
Oxygen therapy: If there is hypoxemia, the oxygen flow can be adjusted according to the degree of hypoxia.
Diet care: provide low-salt, low-fat, easily digestible food, small frequent meals (intravenous protein supplementation for patients with hypoalbuminemia), and limit sodium intake
Control liquid input
The amount of fluid in patients with severe heart failure should be limited to 1.5-2.0L/d
Diuretic care
Loop diuretics and thiazides
Hypokalemia may induce arrhythmia or digitalis poisoning, so serum potassium should be monitored
When taking potassium-depleting diuretics, add more potassium-rich foods, and follow your doctor's advice to supplement potassium salts when necessary. Oral potassium supplementation should be taken after meals. to relieve gastrointestinal discomfort. When peripheral intravenous potassium supplementation is performed, the KCl content per 500ml of liquid should not exceed 1.5g. It is advisable to apply diuretics in the morning or during the day to avoid frequent urination at night and affecting the patient's rest.
Disease detection: Accurately record the 24-hour fluid intake and output. If the patient's urine output is <30ml/h, the doctor should be reported
Protect skin: keep mattress clean, soft, flat and dry
Digitalis medication and care
Poisoning Prevention
① The elderly, myocardial ischemia and hypoxia, severe heart failure, hypokalemia and hypomagnesemia, decreased renal function, etc. are more sensitive to digitalis. When using it, the patient's reaction after taking the drug should be closely observed. ②Combined use with quinidine, amiodarone, verapamil, aspirin and other drugs can increase the chance of poisoning. Before administration, you should ask and evaluate whether you have used the above drugs. ③Monitor serum digoxin concentration if necessary. ④Administer strictly on time and as directed by the doctor. When using lanatoside C or lanatoside K, be sure to dilute it and inject slowly (10 to 15 minutes) intravenously, and monitor changes in heart rate, rhythm and electrocardiogram at the same time.
Observe the symptoms of digitalis poisoning
Arrhythmias, the most common of which are ventricular premature contractions, mostly in bigeminy or triplet rhythm, others include premature atrial contractions, atrial fibrillation, atrioventricular block, etc. Gastrointestinal reactions such as loss of appetite, nausea, vomiting and neurological symptoms such as headache, fatigue, blurred vision, yellow vision, green vision
Treatment of digitalis poisoning
① Stop using digitalis immediately. ②Those with hypokalemia can take oral or intravenous potassium supplements and stop using potassium-depleting diuretics. ③Correct arrhythmias; lidocaine or phenytoin can be used for tachyarrhythmias, and electrical cardioversion is generally prohibited because it can easily cause ventricular fibrillation; Patients with conduction block and bradyarrhythmias can be given intravenous atropine or a temporary pacemaker can be placed
Care of patients with acute heart failure
body position
Assist patient to get seat with legs hanging down
Oxygen therapy
Suitable for patients with hypoxemia
Quickly open two intravenous channels and use medications correctly as directed by your doctor
morphine
rapid diuretics
vasodilators
sodium nitroprusside
Nitroglycerin
positive inotropes
digitalis preparations
Aminophylline
non-pharmacological treatment
intraaortic balloon counterpulsation
Input and output management
The daily fluid intake is generally within 1500ml and no more than 2000ml
Disease monitoring
Vital signs, EKG, electrolytes
psychological care
Oxygen
acute heart failure
clinical manifestations
Left heart failure is common
Sudden severe dyspnea, respiratory rate up to 30-50 times/min, orthopnea, frequent coughing, coughing up pink frothy sputum, feeling of suffocation and extreme restlessness and fear. The complexion is gray or cyanotic, sweating profusely, the skin is clammy, and the urine output is significantly reduced.
Auscultation showed that both lungs were filled with crackles and wheezes, the heart rate was fast, diastolic galloping rhythm could be heard at the apex of the heart, and the second heart sound of the pulmonic valve was hyperactive.
Rescue and care
Position, oxygen supply, fluid replenishment, input and output, testing, psychological care
body position
Immediately assist the patient to sit in a sitting position with his legs hanging down to reduce venous return and reduce heart load. Patients are often restless and need to pay attention to safety and beware of falls and injuries.
Give oxygen
For patients with hypoxemia, oxygen therapy should be used to maintain blood oxygen saturation at ≥ 95%. First, ensure an open airway and immediately administer oxygen via nasal cannula. Adjust oxygen flow based on blood and analysis results.
Quickly open two intravenous channels, use drugs correctly according to doctor's instructions, and observe the efficacy and adverse reactions.
Cardiotonic, diuretic and vasodilator morphine
morphine
Intravenous injection of 3 to 5 mg of morphine can sedate the patient, reduce agitation, dilate small blood vessels and reduce the load on the heart. If necessary, repeat application once every 15 minutes, a total of 2 to 3 times. Elderly patients should reduce the dose or switch to intramuscular injection.
Adverse reactions: Observe the patient for respiratory depression, bradycardia, drop in blood pressure, etc.
Contraindications: Respiratory failure, coma, severe shock
rapid diuretics
Furosemide 20 to 40 mg is administered intravenously and can be repeated once after 4 hours. Can quickly diuretic and effectively reduce cardiac preload
vasodilators
sodium nitroprusside
It is an arterial and venous vasodilator. Generally, start with a small dose of 0.3 μg/(kg·min), and gradually increase the dose to 5 μg/(kg·min) as appropriate. Sodium nitroprusside is easy to decompose when exposed to light, so it should be prepared immediately and instilled in a protected place from light. The drug storage and continuous use should not exceed 24 hours. The metabolite of sodium nitroprusside contains cyanide, and the course of treatment should usually not exceed 72 hours.
Nitroglycerin: dilates small veins and reduces blood return to the heart.
inotropic drugs
digitalis preparations
Dilute lanocin and give it intravenously, the first dose is 0.4-0.8 mg, and 0.2-0.4 mg can be given as appropriate after 2 hours.
Aminophylline
Suitable for patients with bronchospasm to relieve bronchospasm
Input and output management
The daily fluid intake should generally be within 1500ml and not exceed 2000ml.
Disease monitoring
Closely monitor blood pressure, respiration, blood oxygen saturation, heart rate, electrocardiogram, check blood electrolytes, blood gas analysis, etc. Observe the patient's consciousness, mental state, skin color, temperature and sweating, changes in lung rales or wheezing, and record the amount of input and output. Strict handover of shifts.
psychological care
Fear or anxiety can increase the excitability of the sympathetic nervous system, making breathing difficulty worse. Medical staff must remain calm, skillful, and busy when rescuing, so that patients can develop trust and a sense of security.