Surgical Treatment and Nursing Implications

Marie Jimenez
SCL 104.4375
Medical Surgical I
Spring 2007
Session II
Prof. M. Griffiths
Surgical Treatment and Nursing Implications
There are two types of surgical treatments for clients diagnosed with congestive heart
failure. These surgical treatments include cardiac transplantation, also referred to as heart
transplantation, and dynamic cardiomyoplasty. According to Burke, cardiac transplantation “is
the primary treatment for end-stage heart failure”(Burke, 2007, p.647). Cardiac transplantation
is often the last resort for clients suffering from congestive heart failure. Cardiac transplantation
is a critical surgical procedure in which “the client’s diseased heart is removed, leaving portions
of the atria intact. The donor heart is sutured to the remaining atrial walls”(Burke, 2007, p.647).
While cardiac transplantation may be the only solution for treating clients with congestive heart
failure, there are serious risks involved with this surgical procedure such as the risk for infection
and rejection of the donor’s heart (Burke, 2007). It is important as a nurse to think and act
critically when assessing and monitoring the client’s possible rejection of the donor’s heart.
Nursing implications for cardiac transplantation include administering immunosuppressive drugs
to “prevent the rejection of the transplanted organ”(Burke, 2007, p. 647).
The other type of surgical treatment for clients diagnosed with congestive heart failure is
dynamic cardiomyoplasty which “uses the client’s own skeletal muscle (latissimus dorsi) to
enhance the function of the heart and improve circulation. The muscle is positioned around the
aorta or heart, and a cardiomyostimulator and leads are implanted to stimulate muscle
contractions”(Williams, 2003, p. 336). This type of surgical procedure may be implemented as
an alternative to cardiac transplantation for clients who refuse organ transplantation.
The prevention of congestive heart failure includes modifiable lifestyle changes relating
to diet, smoking, and alcohol. According to the Merck Manual, “the amount of sodium in the
body usually goes down if table salt, salt in cooking, and salted foods are limited. People with
severe cases of heart failure are usually given detailed information on how to limit salt intake”
(Berkow et al.,1997, p. 89). Therefore, it is important to educate and inform clients about
restricting the amount of salt in their diet in preventing heart failure. For clients who are
smokers or alcoholics, it is also important to recommend to these clients about the alcoholics
anonymous and smoking cessation programs. Providing awareness of the negative effects of
smoking and alcohol, and recommending “regular, moderate exercise to improve their overall
fitness” will greatly reduce in the prevention of congestive heart failure (Berkow et al., 1997,
Complications of congestive heart failure affecting the liver and spleen are seen with
clients exhibiting signs of hepatomegaly (enlargement of the liver) and splenomegaly
(enlargement of the spleen) “from fluid congestion, which causes impaired function, cellular
death, and scarring”(Williams, 2003, p.332). Other complications such as clotting may develop.
These complications can be seen with “thrombus and emboli can occur as a result of poor
emptying of the ventricles, which leads to stasis of blood” (Williams, 2003, p. 332). An
additional complication that may occur in congestive heart failure is cardiogenic shock which
“occurs when the left ventricle is unable to supply the tissues with enough oxygen and nutrients
to meet their needs. [It] is a life-threatening condition that requires immediate treatment
(Williams, 2003, p. 332). It is important for the nurse to recognize these complications for
congestive heart failure in order to provide the most therapeutic care to the client.
Discharge & Client Teaching
Discharge and client teaching are especially important for clients suffering from
congestive heart failure. As a nurse, it is particularly important to assess during discharge
planning about the “client’s and family’s understanding of heart failure, prescribed medications,
diet and activities, and symptoms to report to the physician”(Burke, 2007, p. 649). Educating
clients and the client’s family about the condition of congestive heart failure can greatly develop
their awareness about the disorder. According to Burke (2007), the following are nursing
interventions for discharge and client teaching of clients with congestive heart failure:
Explain heart failure and its effects on the client’s life - this helps the client
understand the reasons for ordered treatments
Discuss the warning signs of impending failure and when to contact the physician.
Teach about prescribed drugs and their potential adverse effects
Stress the importance of medications in managing heart failure
Provide verbal and written information regarding each specific medication to
encourage compliance
Instruct to keep regular follow-up appointments to monitor disease progression and
the effects of therapy
Teach the client and family about the prescribed diet
Discuss the importance of family support for dietary restrictions and avoid exposure
to cigarette smoking
Encourage exercise within prescribed limits to strengthen the heart muscle and
improve aerobic activity
Provide referrals to a home health agency and community agencies, such as heart
support groups, or the AHA, as needed for further nursing evaluation and care,
education, and psychosocial support (Burke, 2007, p. 649).
Williams, S. L., & Hopper, D. P.(2003). Understanding Medical Surgical Nursing (2nd ed.).
Philadelphia, PA: F.A. Davis Co., 332, 336.
Burke, M. K., LeMone, P., & Mohn-Brown, L. E.(2007). Medical Surgical Nursing Care
(2nd ed). Upper Saddle River, NJ: Pearson Education Inc., 647, 649.
Berkow, R., Beers, H. M., Bogin, M. R., & Fletcher, J. A. (1997). The Merck Manual of Medical
Information (Home ed.). Whitehouse Station, NJ: Merck & Co., Inc., 89