Left Ventricular Failure
Ram, 50 yrs is admitted in ICU with acute left ventricular failure.
(a) Enumerate the clinical features of the above condition. (5)
(b) Using the nursing process draw out a nursing care plan for this patient. (10)
Clinical Features
Dyspnoea on exertion at first and then at rest
Orthopnoea
Inability to lie down flat on the back
Paroxysmal nocturnal dyspnoea (PND)
Disturbed sleep
Cough, frothy sputum, blood tinged sputum
Basal crepitations
An extra heart sound, S3
Tachycardia
Decreased SpO2
Oliguria
Nocturia ( increased frequency of urination at night)
↑Altered digestion
Dizziness, light headedness, confusion, restlessness and anxiety
Skin pale, cold and clammy hands
Nursing Care Plan
Keep I/O chart
Weigh the patient daily, at the same time, on the same scale, in the morning after urination
Look for lung crepitations
Look for increase or decrease of JVP
Assess the degree of oedema
Monitor pulse rate and BP
Examine skin turgor and mucous membrane - dehydration
Look for fluid overload (orthopnea, paroxismal dyspnea, dyspnea on exertion)
Nursing interventions & Managing potential complications
Monitor for K+ depletion - weak pulse, faint heart sounds, hypotneison, muscle flabbiness, diminished tendon reflexes, generalized weakness.
Reduce the risk of hypokalemia increase dietary intake of K+. Bananas, orange, tomato juice, potatoes, spinach, watermelon. Potklor if needed. When ACE inhibitors, spironolactones are used the above articles to be avoided to prevent hyperkalemia.
Avoid grapes - may cause serious drug-food interactions
Look for digitoxicity
Prolonged diuretic therapy - look for Hyponatremia - apprehension, weakness, fatigue, malaise, muscle cramps and twitching, rapid thready pulse.
Periodically monitor serum electrolytes
Hyperglycemia may occur
Elderly people : Decreased renal function makes them resistant to diuretics and more sensitive to changes in volume. Bladder distention may occur. Suprapubic palpation or USGM will reveal.
Gradually build up activity tolerance - 30minutes physical activity three to five times / week with rests in between - pt should be able to talk during activity. - activity 2 hours after any meal
Small frequent meals
Oral diuretics in the morning
Head side of the bed elevated by 10 inches
Reduce anxiety by relaxation techniques
Teach Self care
Teach the family _ give them a Home Care Checklist
