Week 10: PTSD and Trauma Informed Care/Heart Failure

Heart Failure with Reduced Ejection Fraction (HFrEF)

Systolic Heart Failure

-pumping problem

-Failure of the heart to pump adequate blood to the body due to inadequate contractile function

-no beta blockers

Heart Failure with Preserved Ejection Fraction (HFpEF)

Diastolic Heart Failure

-filling problem

-The ventricle becomes stiff so it cannot relax and fill with blood

-blood backs up into left atrium

Heart Failure with Reduced Ejection Fraction (HFrEF)

Systolic Heart Failure

-pumping problem

-Failure of the heart to pump adequate blood to the body due to inadequate contractile function

-no beta blockers

Heart Failure with Preserved Ejection Fraction (HFpEF)

Diastolic Heart Failure

-filling problem

-The ventricle becomes stiff so it cannot relax and fill with blood

-blood backs up into left atrium

Heart failure:

heart muscle is unable to pump effectively, resulting:

-inadequate cardiac output

-myocardial hypertrophy

-pulmonary/systemic congestion

Pulmonary Edema:

severe, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure

NYC Heart Associations Functional Classification Scale:

indicates the level of activity it takes to induce manifestations of impaired function (chest pain, shortness of breath

1: has cardiac disease, no s/s

2: s/s with ordinary exertion

3: s/s with minimal exertion

4: s/s at rest

NYC Heart Association Class 1:

Client has cardiac disease but exhibits no manifestations with activity

NYC Heart Association Class 2:

Client has manifestations with ordinary exertion (everyday ADLs)

NYC Heart Association Class 3:

Client displays manifestations with minimal exertion

NYC Heart Association Class 4:

Client has manifestations at rest

American College of Cardiology and American Heart Association staging heart failure:

A: High risk for developing HF

B: Structural heart disease but no manifestations of heart failure

C: Current or prior manifestations of HF

D: Refractory end-stage heart failure, requires interventions

Non-pharmacological Interventions for Heart Failure:

-exercise routine/physically active

-consume diet low in sodium, fluid restrictions

-non smoking

S/s of Left-sided Failure:

-dyspnea, orthopnea (SOB when lying down)

-fatigue

-displaced apical pulse (hypertrophy)

-S3 heart sound (gallop)

-pulmonary congestion

-frothy sputum

-altered mental status

Left-sided heart failure:

-decreased cardiac output

-arrhythmias

-crackles

-remember LEFT IS LUNGS

-pulmonary edema

WET LUNGS

Right-sided heart failure:

-decreased cardiac output

-increased right arterial pressure

-jugular vein distention

-peripheral edema

CLEAR LUNGS

S/s of Right-sided heart failure:

-Jugular vein distention

-Ascending dependent edema (legs, ankles, sacrum)

-Abdominal distention, ascites

-Fatigue, weakness

-Polyuria at rest (nocturnal)

-Weight gain

B-type natriuretic peptides (BNP) Lab test results:

-Less than 100 pg/mL indicates no heart failure

-Greater than 400 pg/mL indicates heart failure

-BNP increases with the severity of the heart failure.

Nursing considerations for heart failure:

-monitor I and O

-assess for SOB

-administer oxygen

-position client in high-fowlers

-encourage bed rest until stable

-maintain dietary restrictions

Diuretics:

loop diuretics: furosemide (LASIX)

-can cause hypokalemia

potassium-sparing diuretics: spironolactone

Nursing considerations for loop diuretics:

-ingest foods and beverages that are high in potassium to counter the effects of hypokalemia, hyponatremia, hypomagnesemia

-OTOTOXICITY (do not push too quickly due to tinnitus)

-watch for orthostatic hypotension (fluid goes down)

-check BP/HR/electrolytes prior to administration

S/s of PTSD:

-flashbacks

-severe anxiety, fleeting or combative behavior

-dissociative subtype includes pulling back/avoidance

Is dissociative subtype a worse kind of PTSD?

YES, dissociative subtype is associated w/higher levels of impairment, comorbidity and suicide risk

Intrusive symptoms:

Intrusive thoughts; repeated, involuntary memories; vivid; distressing dreams; flashbacks of the traumatic event

Avoidance:

Avoiding reminders of the traumatic event

Alterations in arousal and reactivity:

May include being irritable and having angry outbursts; reckless behavior; self-destructive; overly watchful

Negative mood and cognitions:

traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others

Treatment options for PTSD:

-cognitive behavioral therapy

-SSRI, SNRI medications to lower anxiety and physical agitation

-peer support group

Trauma informed care:

an approach to treatment that acknowledges the role that trauma can have on the mental health of individuals

Protective factors for PTSD:

-optimistic outlook

-frame negative circumstances as challenges

-available social support

-developing resilience

-positive coping strategy

-being able to overcome fear w/effective action

Principals for trauma informed care:

1: safety

2: trustworthiness and transparency (goal to build trust)

3: peer support

4: collaboration and mutuality (no power imbalance)

5: empowerment, voice and choice

6: humility and responsiveness (cultural, historical, gender issues)

Prevalence of heart failure:

-high mortality

-more than 50% of patients will be readmitted

Ejection Fraction:

Refers to the percentage of blood that's pumped out of the left ventricle with each contraction

-normal EF is 50-70%

-less than 40% may indicate HFrEF

How is systolic heart failure caused?

-myocardial infarction

-hypertension

-nonischemic cardiomyopathy

-valve disease (aortic stenosis, mitral regurgitation)

How is diastolic heart failure caused?

-hypertension

-aging

-previous MI (due to scaring)

-diabetes

-hypothyroidism

Left sided heart failure definition:

Failure of the left ventricle to pump blood to the rest of the body

-most common type of HF

Right sided heart failure definition:

Failure of the right ventricle to pump blood to the lungs

Acute Decompensated Heart Failure (ADHF):

when compensatory mechanism can no longer maintain an adequate cardiac output = inadequate tissue perfusion results

-onset is sudden

-MEDICAL EMERGENCY

S/s of Acute Decompensated Heart Failure:

-SOB (pulmonary congestion and fluid overload)

-congestion s/s: orthopnea, crackles, jugular venous pressure, leg edema,

-poor perfusion s/s: hypotension, tachycardia, cyanosis, changes in LOC

Treatment goals for HR:

-reduce s/s and maximize cardiac output

-restore oxygenation and optimize volume status

SGLT2 inhibitors: Dapagliflozin (Farxiga)

-given to HF patients who also have diabetes by reducing the amount of glucose and sodium reabsorbed

Nursing considerations for Farxiga:

-urinary frequency and urgency MONITOR FOR DEHYDRATION

-genital yeast infections

-monitor for hypoglycemia if combined w/other meds

Beta-adrenergic blockers: Metoprolol & Carvedilol (Coreg)

-antihypertensives

-monitor HR and BP prior to administration

-monitor for bradycardia, hypotension, erectile dysfunction, dizziness, SOB, wheezing

Chronic heart failure:

disorder in which the heart's ability to pump effectively is compromised for an extended period of time

FACES acronym for chronic heart failure:

Fatigue

Activities limited

Chest congestion

Edema or ankle swelling

Shortness of breath

Additional s/s of chronic HF:

-fatigue

-dyspnea w/minimal activity

-chronic non productive cough

-tachycardia, palpitations

-peripheral edema, weight gain

Weight values for diagnosing HF:

sudden weight gain of 2-3 lb in 1 day may indicate acute HF or an exacerbation of chronic HF

-or 5 lbs over a week should be reported

Surgical interventions for HF:

revascularization for ischemic cardiomyopathy

-balloon angioplasty w/stent placement

-coronary artery bypass graft

valve replacement

-heart transplantation