What to do about heart failure? Common knowledge about nursing care for heart failure

Heart failure is considered a relatively serious condition clinically. Proper care must be provided at this time, otherwise the patient's life will be in danger. However, many people do not understand the common sense of heart failure care. The following experts will give a detailed introduction.

1. General care

(1) Ensure that patients get enough rest: The principles of activity and rest should be determined according to the condition of heart function: patients with heart function level one may not be restricted in activity, but should increase lunch break time; patients with mild heart failure (heart function level two) may get up and do some light activity, but they need to increase the intervals between activities and sleep time; patients with moderate heart failure (heart function level three) should rest in bed and limit the amount of activity; patients with severe heart failure (heart function level four) must strictly rest in bed, in a semi-recumbent or sitting position. Bedridden patients should be taken care of for their daily life to facilitate their lives. After the condition improves, you can gradually increase your activity to avoid adverse consequences such as muscle atrophy, venous thrombosis, skin damage, digestive dysfunction, and mental disorder caused by long-term bed rest.

(2) Diet: Patients should consume a low-calorie diet. After the condition improves, you can supplement calories and high nutrition appropriately. The diet should be low in salt, easy to digest and light; choose foods rich in vitamins, potassium, magnesium and containing appropriate amounts of fiber; avoid eating gas-producing foods that aggravate breathing difficulties; avoid irritating foods; eat small meals frequently and determine the potassium content in food based on blood potassium levels.

(3) Maintaining smooth bowel movements: This is a very important measure in caring for patients with heart failure. It is necessary to train the patient to have bowel movements in bed and increase dietary fiber in the diet. If constipation occurs, use small doses of laxatives and laxatives. When the condition permits, help the patient sit up and use the toilet, and pay attention to the patient's heart rate and reactions to prevent accidents.

(4) Oxygen inhalation: The general flow rate is 2 to 4 L/min. The changes in the patient's respiratory rate, rhythm, and depth should be observed after oxygen inhalation, and the degree of improvement in dyspnea should be assessed at any time.

(5) Strengthen skin and oral care: Patients who are bedridden for a long time should turn over frequently to prevent local pressure and skin damage. Strengthen oral care to prevent oral mucosal infection caused by dysbacteriosis due to drug treatment.

(6) Control the rate of intravenous fluid infusion: generally 1 to 1.5 ml (20 to 30 drops) per minute.

2. Psychological care for patients

Patients often feel like they are dying due to severe hypoxia. Tension and anxiety can increase the heart rate and increase the burden on the heart. Bedside monitoring should be strengthened, and spiritual comfort and psychological support should be given to reduce anxiety and increase the sense of security.

3. Observation of the condition and symptomatic care

(1) Pay attention to the clinical manifestations of early heart failure: If you experience exertional dyspnea or paroxysmal nocturnal dyspnea, increased heart rate, fatigue, dizziness, insomnia, irritability, decreased urine output, etc., you should contact your doctor promptly and strengthen observation. Such as rapid onset of extreme irritability, profuse sweating, bluish lips and other symptoms, accompanied by chest tightness, coughing, and difficulty breathing. If you have cyanosis and cough up large amounts of white or pink foamy sputum, you should be alert to the occurrence of acute pulmonary edema and be prepared to cooperate with rescue immediately.

(2) Regularly observe changes in water and electrolytes and acid-base balance: Hypokalemia may cause fatigue, abdominal distension, palpitations, increased U waves on the electrocardiogram and arrhythmia, and may induce digitalis poisoning. In a few cases, due to decreased renal function and excessive potassium supplementation, hyperkalemia may occur. In severe cases, it may cause cardiac arrest. Symptoms of hyponatremia include fatigue, loss of appetite, nausea, vomiting, and drowsiness.

4. Complication prevention and care

(1) Respiratory tract infection: Ensure indoor air circulation, open windows twice a day for ventilation, avoid gusty winds, keep warm in cold weather, encourage bedridden patients to turn over, and assist with back patting to prevent respiratory tract infection and aspiration pneumonia.

(2) Thrombosis: Due to long-term bed rest and the use of diuretics, the hemodynamic changes caused by the use of diuretics make the lower limb veins prone to thrombosis. Patients should be encouraged to move their lower limbs and contract their lower limb muscles in bed, and assisted in massaging their lower limb muscles. Soak your lower limbs in warm water to accelerate blood circulation and reduce venous thrombosis. When local swelling occurs in the distal part of the patient's limbs, it indicates that venous thrombosis has occurred and the patient should contact a doctor as soon as possible.

5. Observe the response to therapeutic drugs

(1) Digitalis drugs: Indicators of effective digitalis treatment include slower heart rate, relief of dyspnea, disappearance of edema, weight loss, increased urine volume, and emotional stability. Before giving digitalis drugs, the patient should be asked whether he or she has nausea or vomiting, and the heart rate should be listened to. If the heart rate is lower than 60 beats per minute or the rhythm changes (such as from regular to irregular, or from irregular to regular), digitalis poisoning should be considered, and the drug should be stopped immediately. At the same time, the doctor should be contacted to take appropriate treatment measures.

(2) Vasodilators: Too fast an intravenous drip can cause a sudden drop in blood pressure or even shock. During medication, especially when first using vasodilators, it is necessary to monitor blood pressure changes and adjust the drip rate according to blood pressure. If blood pressure drops by more than 20% of the original blood pressure or heart rate increases by 20 beats/min, the medication should be discontinued and the patient should be advised to move slowly when getting up and changing position to prevent a hypotensive reaction.

(3) Diuretics: Continuous and large-scale use of diuretics can cause hemodynamic changes and electrolyte imbalance. Pay attention to changes in water and electrolytes and acid-base balance. Excessive diuresis can lead to a decrease in circulating blood volume and an increase in blood viscosity, making venous thrombosis more likely to occur; potassium-excreting diuretics can cause hypokalemia, hyponatremia, and hypochloremia, and should be used simultaneously with potassium-sparing diuretics. Or supplement potassium chloride during diuresis to prevent hypokalemia from inducing digitalis poisoning and arrhythmias. When hypokalemia occurs, patients experience fatigue, abdominal distension, palpitations, increased U waves on the electrocardiogram, and arrhythmias. Potassium-sparing diuretics can cause hyperkalemia, induce arrhythmias and even cardiac arrest, so they should be used with caution in patients with renal insufficiency. When hyponatremia occurs, patients experience fatigue, loss of appetite, decreased urine volume, and apathetic expression. Therefore, diuretics should be used intermittently, and body weight should be measured regularly and daily intake and output recorded.