It's a good time for summer
READING
Good habit of reading
Foreword
Acute heart failure is an acute clinical syndrome caused by a variety of etiologies, the patient is asthma, "fat", can not lie flat, the attack is very painful, no matter what the cause, all kinds of acute heart failure have volume overload, volume overload is the lungs, lower limbs and other parts of the body too much water, heart failure is the terminal stage of all heart disease, poor heart function can not pump, heart fluid can not go out, these excess water is volume overload, Removal of volume overload and individualized optimal volume equilibrium management is extremely important for symptomatic relief and prognosis of patients with acute heart failure, while clinical elderly patients have poor ability to compensate and adapt to rapid changes in body fluids, are more prone to pulmonary edema, gas exchange dysfunction, hypoxemia and anemia, and hypoperfusion of vital organs, and their rapid progression can be life-threatening, so their volume management is more important.
Since volume overload in acute heart failure in the elderly cannot be avoided, what can be done to alleviate it as soon as possible? And then how do you maintain the optimal capacity balance of individualization? We have given the answer through clinical research: it is safe and feasible to carry out staging and refined volume management throughout the entire treatment process of patients with acute heart failure, and can significantly improve patients' symptoms and cardiac function indicators, and reduce the recurrence rate of acute heart failure in hospitals.
READING
Research Methods:
A total of 127 elderly inpatients with acute heart failure in the Department of Cardiology of a tertiary hospital in Jiangsu Province were selected as the study objects, and they were divided into the control group (64 cases) and the experimental group (63 cases) according to the admission time. The control group received routine nursing intervention, and the experimental group implemented refined volume management in three stages: emergency period, remission period and stable period.
- First aid period
1. Quickly collect medical history, conduct nursing examination, observe jugular venous filling, and whether there are rales in the lungs.
2. Monitor blood pressure, heart rate, heart rate, respiration, and SpO2.
3. According to the doctor's diagnosis of acute heart failure "dry, wet, cold and warm" classification, the corresponding nursing measures are implemented.
4.当SpO2<90%或PaO2<60mmHg时，给予吸氧治疗使患者SpO2>95%。
5. Irritable patients should use opioids according to the doctor's instructions, and closely observe the efficacy and adverse reactions of respiratory depression.
- Remission
1. Bedside monitoring of body weight status, determination of volume reduction target, the difference between body weight and dry body weight of the patient at the time of admission as the volume reduction target, dry body weight is the body weight of the patient before the symptoms and signs of congestion; Capacity reduction to achieve the capacity reduction target is to achieve the capacity reduction target. The percentage of patients who met the volume reduction target was the percentage of the total number of patients who met the volume reduction target.
2. Dynamically evaluate the volume load every day, correctly use the inflow and output conversion table and record it standardly, and provide standard measurement tools to teach patients and their families to use it.
3. Determine the daily negative balance and fluid intake according to the patient's volume status
(1) Patients with heavy volume load: the daily urine volume target is 3000~5000ml, and the day shift nurse compares the intake and urine volume with the previous day from 14:30 to 15:00.
(2) Patients who have reached the optimal volume state: maintain a negative balance of 500ml per day, and monitor the daily decrease of body weight by about 0.5kg.
(3) For patients without obvious hypovolemia, the daily fluid intake should be less than 1500ml.
4. During the period of negative volume balance, be alert to the occurrence of hypovolemia, hypokalemia and hyponatremia to prevent water and electrolyte imbalance.
- Stabilization period
1. Gradually transition to a general balance of intake and outflow, continue to monitor the changes in patient body weight, and consolidate the effect of volume reduction.
2. After the education, patients and their families will talk about health education and explain the content of capacity management:
(1) The importance of self-capacity management during the stable period.
(2) Water and sodium salt control standards and techniques.
(3) Self-observation and care of diuretics and adverse reactions such as electrolyte imbalance and hypotension.
(4) Teach patients to standardize the method of weighing body weight, record the amount of intake and intake and dietary guidance.
- Discharge guidance
Evaluate the grasp of the key points of volume management, and give targeted guidance to the weak links again until the patients and their families fully grasp them.
READING
Findings:
1. After 10 days of the implementation of staged refined volume management in elderly patients with acute heart failure, the rate of achieving the volume reduction target increased from 47% to 59%.
2. NT-proBNP values and recurrence rates of acute heart failure during hospitalization were also significantly reduced.
READING
Discussion
1. Does it make sense to implement volume management in elderly patients with acute heart failure?
Controlling sodium and water retention and alleviating volume overload in patients with acute heart failure are important measures to alleviate symptoms and improve organ function. However, elderly patients with acute heart failure have poor ability to compensate and adapt to rapid changes in body fluids, and failure to correct volume overload in time will lead to serious complications, such as malignant arrhythmia or even sudden death caused by unstable cardiac electrical activity, and large-scale myocardial ischemia caused by coronary artery spasm. If the volume load is relieved too quickly, a series of problems such as hypotension and renal hypoperfusion/renal insufficiency may occur. Therefore, it is very important to explore the volume management goals and specific measures suitable for elderly patients with acute heart failure.
2. Can the implementation of staged refined volume management really improve the rate of achieving the target of volume reduction and volume reduction of patients?
The answer is that it is indeed possible to improve the rate of patient volume reduction and volume reduction target achievement, but how can this be achieved? First of all, nurses should be trained in the awareness of fine management and relevant knowledge content, so that nurses can fully understand the content requirements of staged volume management of patients with heart failure and be able to grasp and implement them. Secondly, starting from the details, the responsible nurses adopted the mutual health education method after the education to explain the relevant knowledge of volume management to patients and their families, and tracked the educational effect and evaluated the mastery of self-care skills by allowing patients and their families to describe the education content to each other, and repeatedly strengthened the training to make it not easy to forget. After learning the basic methods of volume management, patients and their families knew the volume reduction and volume reduction goals, had a quantitative concept of volume management, actively cooperated with and actively participated in volume management, and improved the feasibility of staged refined volume management. Through face-to-face communication, nurse guidance, and evaluation scenarios described by patients and their families, nurses can also find out the confusion encountered by patients and their families in cooperation with capacity management in time and solve them on the spot, which effectively improves the compliance rate of volume reduction goals.
3. How to do a good job in staging dynamic management and refined volume management, improve cardiac function and reduce the recurrence rate of acute heart failure.
Firstly, the nurse focused on assessing the volume status of patients in the emergency period, remission period and stable period, especially the urine output, fluid intake, fluid infusion and body weight management during the remission period of heart failure symptoms. Secondly, on the basis of strengthening the dynamic observation of urine output in each shift, nurses should pay attention to the urine output during the time period from 8:00 to 15:00 during the day, and report it in time and deal with it as soon as possible if the urine output is low. Continuing to consolidate the volume reduction, the patient was in a state of negative volume equilibrium, so that the patient's cardiac load was significantly reduced. Staging refined volume management runs through the whole treatment process of patients with acute heart failure, so as to achieve the optimal state of individualized volume balance, and ultimately improve the cardiac function of patients and reduce the recurrence rate of acute heart failure.
READING
Conclusions
Therefore, the implementation of staged refined volume management can help to improve cardiac function and prognosis in elderly patients with acute heart failure.
READING
END
Author Information:
Authors: Shen Ying, Liu Wenjuan, Zhu Yanmei, Zhang Xueping, Jiang Minghui, Hao Jingrong
Department of Cardiology, Xuzhou Central Hospital, Jiangsu Province
This article was published in the first issue of China Nursing Management in 2022:
Shen Ying, Liu Wenjuan, Zhu Yanmei, et al. Study on the effect of staging refined volume management in elderly patients with acute heart failure[J].Chinese Journal of Nursing Management,2022,22(1):75-78.)