Guided Lecture Notes
Chapter 29, Management of Patients With Complications From Heart Disease
Learning Objective 1. Describe the management of patients with heart failure (HF).
 Define and introduce the syndrome of heart failure. Differentiate and compare
systolic and diastolic HF. Note that in systolic failure, the ejection fraction (EF) is
severely reduced, but in diastolic, HF the EF is normal. Discuss briefly the
incidence of HF and the increase in this problem caused by improved survival
rates with improved treatment and caused by increases in the elderly population.
Describe the pathophysiology of HF. Explain the neurohormonal mechanisms that
lead to fluid volume overload, ventricular dilation, and ventricular hypertrophy.
(Refer to PowerPoint slides 2 and 3.)
 List and discuss the symptoms of HF with the differentiation between right- and
left-sided HF. Link the clinical symptoms to the compensatory mechanisms—
fluid overload and the problem of insufficient blood supply resulting in hypoxia.
Differentiate symptoms of right- and left-sided HF. (Refer to PowerPoint slide
4.)
Learning Objective 2. Use the nursing process as a framework for care of patients with
HF.
 Discuss the assessment of patients with HF. (Refer to PowerPoint slide 5.)
 Discuss specific nursing diagnoses common to patients with HF. (Refer to
PowerPoint slide 6)
 Discuss collaborative problems common to patients with HF. (Refer to
PowerPoint slide 7.)
 Discuss planning and goals for patients with HF. (Refer to PowerPoint slide 8.)
 Discuss specific nursing interventions used for patients with HF. Give specific
examples. An example of modification of activities would be using a chair or
stool in the kitchen to sit while doing food preparation or dishes. (Refer to
PowerPoint slides 9 and 10.)
Learning Objective 3. Develop an education plan for patients with HF.
 Discuss the development of a teaching plan for the patient with HF. Teaching
plans should include the patient’s family and be developed with consideration of
cultural and social factors. Give an example of modification of teaching related to
a cultural or social issue.
 Discuss each of the aspects of teaching listed. (Refer to PowerPoint slide 11.)
 iClicker question (Refer to PowerPoint slides 12 and 13.)
 Identify medications used for patients diagnosed with HF and the nursing
implications for patient teaching related to the different classes of medications.
(Refer to PowerPoint slides 14 and 15.)
 Discuss gerontologic considerations for patients with HF. (Refer to PowerPoint
slide 16.)
 iClicker question (Refer to PowerPoint slides 17 and 18.)
Learning Objective 4. Describe the medical and nursing management of patients with
pulmonary edema.
 Define and describe the pathophysiology, clinical manifestations, and
management of pulmonary edema. (Refer to PowerPoint slides 19 and 20.)
 Describe the nursing interventions, including the assessment of patients at risk
and the positioning of patients. Explain the rationales for the interventions.
 Define and describe the pathophysiology, clinical manifestations, and
management of cardiogenic shock. Discuss the purpose and function of the intraaortic balloon pump. (Refer to PowerPoint slides 21 and 22.)
Learning Objective 5. Describe the medical and nursing management of patients with
thromboembolism, pericardial effusion, and sudden cardiac death.
 Discuss thromboembolism as it relates to HF. Define and describe the
pathophysiology of pulmonary embolism. Briefly discuss the prevention and
management of pulmonary embolism. (Refer to PowerPoint slides 23 and 24.)
 Define and describe the pathophysiology of pericardial effusion and cardiac
tamponade. List and explain the clinical manifestations of pericardial effusion and
cardiac tamponade. (Refer to PowerPoint slides 25 and 26.)
 Describe the medical management of pericardial effusion and cardiac tamponade
and explain the procedures of pericardiocentesis and pericardiotomy. (Refer to
PowerPoint slide 27.)
 Note that sudden cardiac death or cardiac arrest is always a possibility for patients
with cardiac problems. Discuss cardiac arrest and cardiac resuscitation in the
detail required for the course and curriculum. (Refer to PowerPoint slide 28.)
 Health care providers should all take and maintain certification in cardiac life
support.
 iClicker question (Refer to PowerPoint slides 29 and 30.)