(2) Promotion of a restful and comfortable environment includes the
following nursing considerations:
(a) Provide emotional support to reduce anxiety and stress.
(b) Orient the patient to the coronary care unit (CCU) routine and
environment. Take time to explain procedures.
Schedule patient care activities carefully to avoid interrupting the
(3) Patient education is necessary to prepare the patient for resuming life
outside the hospital setting. The following nursing considerations should be included:
(a) Promote compliance with prescribed medications, diet, and other
treatment measures by thoroughly explaining the need for each and the possible
consequences of noncompliance.
(b) Review all activity limitations and restrictions.
(c) Counsel the patient on the action that should be taken when he is
confronted with chest pain or other symptoms.
1-27. HEART FAILURE
a. Heart failure is the clinical state in which there is inadequate cardiac output,
resulting in poor perfusion of all organ systems.
b. In left sided heart failure, the pumping action of the left ventricle is
compromised, but the right ventricle continues to function normally. There is an
imbalance between the out-put of each ventricle. The right heart continues to pump
blood into the lungs to be oxygenated. The failing left heart, however, is unable to
return that same volume of blood to the systemic circulation. The result is an
accumulation of blood in the pulmonary blood vessels. Increased pressure in the
pulmonary vessels causes fluid to leak into the interstitial lung tissue, compromising gas
exchange. This condition is called pulmonary edema.
c. Right sided heart failure usually follows left sided failure. The increased
pressure in the pulmonary vessels causes "back pressure" to the right side of the heart.
This interferes with venous return, and consequently, the organs of the body become
congested. This condition, known as congestive heart failure (CHF), is manifested by
neck vein distention and body edema.
d. Right sided failure may occur without left sided failure. This condition, called
corpulmonale, may be caused by pulmonary hypertension secondary to lung disease or
by the presence of pulmonary emboli.