Perioperative Care of the Patient with Diastolic Heart Failure ... - AORN

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SPECIAL NEEDS POPULATIONSwww.aornjournal.orgThe nurse works with the surgeon and anesthesiaprofessional to correct any reversible predisposingfactors before surgery. 18Intraoperative Nursing CareThe key to managing a patient with DHF duringand after surgery is to maintain preoperativeparameters as closely as possible. 18 Awareness onthe nurse’s part of a patient’s increased risks forlow cardiac output and pulmonary venous congestionwill help to ensure that all precautions aretaken. Depending on the severity of the heart failure,many patients are unable to lie flat to sleep,and a patient with heart failure, therefore, maynot be able to tolerate being in the supine positionon the OR bed. The nurse works with the anesthesiaprofessional to enable the patient to remainin the lawn chair position during induction if atall possible. 19The nurse also must be aware that the adverseeffects of inadvertent perioperative hypothermiaon wound healing are even more significantfor patients with heart failure who alreadyhave a compromised cardiovascular system. 19Initiating thermoregulatory measures for patientsundergoing heart failure interventions,therefore, is extremely important. Patientsshould undergo preoperative warming (eg,forced-air warming, warmed IV solutions), andthese interventions should be continued in theOR and during recovery. 19Postoperative Nursing CareThe postanesthesia care unit nurse closely monitorsthe patient’s vital signs, respiratory status,heart rhythm, and intake and output for signsand symptoms of fluid overload. Patients with ahistory of DHF are at an increased risk of atrialfibrillation as a result of ventricular stiffnessand higher end-diastolic pressures. 9 The nurseshould monitor the patient’s heart rate andrhythm before, during, and after surgery, andshould instruct the patient to alert the nurse ifhe or she experiences chest pain, discomfort,tightness, or any difficulty breathing. The nurseshould continue to monitor the patient’s vitalsigns according to hospital policy in addition tomonitoring respiratory status, pain level, andsigns of fluid volume overload.Assessing for nausea and pain is very importantin the postoperative period, and the nursemust understand which pain medications shouldbe avoided in patients with a history of heart failure.Results of recent studies have shown thatpatients with a history of heart failure shouldavoid nonsteroidal anti-inflammatory drugs(NSAIDs) for analgesia. 23,24 Certain medications,such as NSAIDs, inhibit prostaglandin synthesis,which causes a decrease in renal blood flow andcompensatory water and sodium retention. Prostaglandindepletion directly increases vascular resistance,thus worsening the patient’s hemodynamicstatus. 23 The nurse should also instruct the patientnot to use NSAIDs at home for pain managementunless this is approved by the physician.CONCLUSIONHeart failure places a major economic burden onsociety, and those who have it lead a decreasedquality of life. As the population continues to ageand older adults undergo more surgical procedures,perioperative nurses must have an understandingof the different types of heart failure andthe differences in treatment and management ofeach type. Patients with a history of DHF have anincrease risk of surgical complications and adversesurgical outcomes. Applying sound nursinginterventions throughout the perioperative periodwill help to decrease postoperative complicationsand improve patient outcomes.References1. About heart failure. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp. Accessed February 24, 2011.2. Heart failure. MedlinePlus. http://www.nlm.nih.gov/medlineplus/ency/article/000158.htm. Accessed February24, 2011.3. Allman E, Berry D, Nasir L. Depression and coping inheart failure patients: a review of the literature. J CardiovascNurs. 2009;24(2):106-117.AORN Journal 787
June 2011 Vol 93 No 6 NAAB4. Grossman S, Brown D. Congestive heart failure and pulmonaryedema. Emedicine. http://emedicine.medscape.com/article/757999-overview. Accessed February 24,2011.5. De Keulenaer G, Brutsaert D. Systolic and diastolicheat failure: different phenotypes of the same disease?Eur J Heart Fail. 2007;9(2):136-143.6. Figueroa MS, Peters JI. Congestive heart failure: diagnosis,pathophysiology, therapy, and implications forrespiratory care. Respir Care. 2006;51(4):403-412.7. Hammill BG, Curtis LH, Bennett-Guerrero E, et al.Impact of heart failure on patients undergoing majornoncardiac surgery. Anesthesiology. 2008;108(4):559-567.8. Satpathy C, Mishra T, Satpathy R, Satpathy H, BaroneE. Diagnosis and management of diastolic dysfunctionand heart failure. Am Fam Physician. 2006;73(5):841-846.9. Gutierrez C, Blanchard DG. Diastolic heart failure:challenges of diagnosis and treatment. Am Fam Physician.2004;69(11):2609-2616.10. Chatterjee K, Massie B. Systolic and diastolic heartfailure: differences and similarities. J Card Fail. 2007;13(7):569-576.11. White MM, Howie-Esquivel J, Caldwell MA. Improvingheart failure symptom recognition: a diary analysis.J Cardiovasc Nurs. 2010;25(1):7-12.12. Wu EB, Yu CM. Management of diastolic heartfailure—a practical review of pathophysiology andtreatment trial data. Int J Clin Pract. 2005;59(10):1239-1246.13. Groban L, Kitzman DW. Diastolic function: a barometerfor cardiovascular risk? Anesthesiology. 2010;112(6):1303-1306.14. Feld Y, Dubi S, Reisner Y, Schwammenthal E, ElamiA. Future strategies for the treatment of diastolic heartfailure. Acute Card Care. 2006;8(1):13-20.15. Redderson LA, Keen C, Nasir L, Berry D. Diastolicheart failure: state of the science on best treatmentpractices. J Am Acad Nurse Pract. 2008;20(10):506-514.16. Hamlin SK, Villars PS, Kanusky JT, Shaw AD. Role ofdiastole in left ventricular function, II: diagnosis andtreatment. Am J Crit Care. 2004;13(6):453-468.17. Sürücü H, Tatli E, Değirmenci A, Okudan S, Boz H.Subtle systolic dysfunction may be associated with thetendency to develop diastolic heart failure in patientswith preserved left ventricular ejection fraction. Echocardiography.2009;26(4):365-370.18. Alsaddique AA, Royse AG, Royse CF, Fouda MA.Management of diastolic heart failure following cardiacsurgery. Eur J Cardiothoracic Surg. 2009;35(2):241-249.19. Pierce JD, Dalton K, Duke K, Spaniol JR. Heart failureguidelines and implications for surgically treating heartfailure. AORN J. 2009;90(6):874-892.20. Hernandez AF, Newby LK, O’Connor CM. Preoperativeevaluation for major noncardiac surgery: focusingon heart failure. Arch Intern Med. 2004;164(16):1729-1736.21. Hernandez AF, Whellan DJ, Stroud S, Sun JL,O’Conner CM, Jollis JG. Outcomes in heart failure patientsafter major noncardiac surgery. J Am Coll Cardiol.2004;44(7):1446-1453.22. Fleisher LA. Implications of preoperative heart failure:the next frontier in perioperative medicine? Anesthesiology.2008;108(4):551-552.23. Dal Corso E, Bondiary AL, Zanolla L, Vassanelli C.Nurse educational activity on non-prescription therapiesin patients with chronic heart failure. Eur J CardiovascNurs. 2007;6(4):314-320.24. Feenstra J, Heerdink ER, Grobbee DE, Stricker BH.Association of nonsteroidal anti-inflammatory drugswith first occurrence of heart failure and with relapsingheart failure: the Rotterdam Study. Arch Intern Med.2002;162(3):265-270.Kim Naab, MS, RN, PCCN, is a cardiac interventionstaff nurse at Piedmont Hospital,Atlanta, GA. Ms Naab has no declared affiliationthat could be perceived as posing apotential conflict of interest in the publicationof this article.788 AORN Journal
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