Early manifestations of heart failure
Left ventricular dysfunction is the most common manifestation of early acute heart failure. Patients will have symptoms such as fatigue, decreased exercise endurance, increased heart rate, dyspnea caused by labor, and intermittent dyspnea at night. Examination will reveal that the left ventricle is enlarged, and there are moist rales, dry rales and wheezing sounds in the lungs. These are the precursors of acute heart failure.
acute pulmonary edema
Expect the unexpected, the onset of acute pulmonary edema, develops rapidly and can rapidly develop into a critical state. Patients will have sudden severe dyspnea, sitting breathing, wheezing, irritability and fear. The breathing frequency can reach 30-50 beats/min, the heart rhythm is fast, and there are rales and wheezing sounds in the lungs.
cardiogenic shock
Cardiogenic shock is characterized by hypotension lasting for more than half an hour, and the systolic blood pressure is below 90. Wet and cold skin, cyanosis, tachycardia, decreased urine output, patients' disturbance of consciousness, constant irritability, excitement and anxiety, fear and sense of dying, gradually developed into confusion and even coma.
Inducing/inducing factors
Many organic diseases can lead to acute heart failure, the common ones are cardiovascular diseases, followed by respiratory diseases. The common causes are poor compliance with treatment of chronic heart failure, cardiac overload, serious infection, serious brain injury or serious mental stress and fluctuation. Many patients will have acute heart failure after major surgery, as well as renal insufficiency, acute arrhythmia, bronchial asthma attack, pulmonary embolism, high cardiac output syndrome and so on.
Medical/medical records
Patients with heart disease or senile degenerative valvular disease are the main causes of acute heart failure in the elderly. Rheumatic valvular heart disease, dilated cardiomyopathy and acute severe myocarditis are the causes of young people.
Rescue and nursing methods of acute left heart failure. Intramuscular injection of morphine 3 ~ 5 mg as a sedative can relieve patients' nervousness, reduce the extra heart burden caused by restlessness, and closely observe the curative effect and adverse reactions.
2. Cardiotonic drugs 20 ml of 5% glucose and 0.2~0.4 mg of cedilanid were slowly injected intravenously to enhance myocardial contractility. Heart rate was detected before and during use, and oxygen saturation was monitored at the same time. If any abnormality is found, stop the injection immediately and report to the doctor in time.
3. Intravenous injection of diuretic furosemide (20 ~ 40 mg) for diuresis can reduce the burden on the heart, reduce the circulating blood volume, reduce the venous blood volume, reduce the diastolic pressure of pulmonary artery, pay attention to maintaining electrolyte balance and prevent hypokalemia.
4. Sodium nitroprusside intravenous drip dilution, play? Internal bleeding? The role of. Adjust the speed at any time according to the blood pressure, so as to increase the volume and storage of blood vessels, reduce the pressure in blood vessels, reduce the blood flow of venous return to the heart, and reduce the heart load. Note that vasodilators should be used on the premise of supplementing effective blood volume.
5. Diluted with 0.25g of spasmolytic aminophylline, slowly injected intravenously to dilate coronary artery, strengthen diuresis, relieve bronchospasm and relieve bronchial asthma.
6. Sit up straight, droop your legs, and connect your limbs in turn to reduce venous reflux.
7. High flow mask oxygen inhalation and alcohol humidification of 6 ~ 8 l/min can improve oxygen saturation and myocardial hypoxia. Adjust the oxygen flow in time, and often check whether the catheter is unobstructed to ensure the oxygen use effect.
8. Vital sign monitoring closely observes the patient's vital signs, such as heart rate, blood pressure, pulse, breathing, body temperature, urine volume, 24-hour water inflow and outflow and changes in the condition. Observe the condition and pay attention to cyanosis, cough and expectoration, as well as the amount, nature and color of sputum.
9. Prevent infection, pay attention to cold protection, keep the air fresh, ventilate 15 min in the morning, disinfect with ultraviolet rays for 30min, at room temperature of 20~24℃ and humidity of 55%~65%, so as to keep patients in a clean and humid environment. Strict aseptic operation, rational use of antibiotics before and after operation to prevent infection.
10. Psychological nursing patients often feel nervous and afraid because of their urgent onset and rapid progress. Because fear stimulates the sympathetic nervous system, the secretion of catecholamine in the body increases, which leads to the increase of blood pressure, heart rate and hypoxia, and induces the attack of acute left heart failure. Therefore, nurses should not only race against time to rescue patients, but also establish a good nurse-patient relationship, and use the language of encouragement and comfort to appease and eliminate patients' nervousness and fear, so that they can cooperate with the rescue, thus achieving the best effect of rescue treatment.
1 1. Diet care should control the time and quantity of eating, give low-salt, high-protein, high-vitamin, nutritious and digestible food, eat less and eat more, and don't be full. Diuretics should eat some foods with high potassium content, such as lean meat, seaweed and fresh vegetables.