Fluid Management Strategies in Heart Failure

Abstract

In patients with chronic heart failure, fluid retention (or hypervolemia) is often the stimulus for acute decompensated heart failure that requires hospitalization. The pathophysiology of fluid retention is complex and involves both hemodynamic and clinical congestion. Signs and symptoms of both hemodynamic and clinical congestion should be assessed serially during hospitalization. Core heart failure drug and cardiac device therapies should be provided, and ultrafiltration may be warranted. Critical care, intermediate care, and telemetry nurses have roles in both assessment and management of patients hospitalized with acute decompensated heart failure and fluid retention. Nurse administrators and managers have heightened their attention to fluid retention because the Medicare performance measure known as the risk-standardized 30-day all-cause readmission rate after heart failure hospitalization can be attenuated by fluid management strategies initiated by nurses during a patient’s hospitalization.

Empleo de la ultrafiltración extracorpórea aislada para el tratamiento de la insuficiencia cardiaca descompensada: dificultades técnicas y evolución clínica

“…En nuestra opinión, este tipo de técnicas han de ser realizadas por enfermeras con conocimientos y habilidades en este tipo de terapias (cualidades que reúne la enfermería nefrológica), lo que repercute en una mayor seguridad del paciente y en el éxito de un programa de UEA como tratamiento de la ICD. Además de en la aplicación de técnicas, la enfermera tiene un papel decisivo en una unidad de insufi ciencia cardiaca, aportando una visión integral de este tipo de pacientes, haciendo especial hincapié en el autocuidado y en el manejo de complicaciones durante los episodios agudos 25,26 .…”

Effect Imbalance Aqueous Body Fluids, and Renal Dysfunction, Cardiovascular Survival in Patients After an Acute Coronary Syndrome, Myocardial Revascularization

“…Традиционно считается, что патогенетической ос-новой для нарушения равновесия распределения баланса жидкости в организме являются состояния, сопровождающиеся снижением сократительной функции миокарда ЛЖ -хроническая и острая сер-дечная недостаточность [5]. Неосложненное течение ОКС, без признаков значительного повреждения сердечной мышцы также приводит к нарушению гомеостаза в организме, протекающим с субклини-ческими изменениями [6].…”

Chronic heart failure part 2: treatment and management

“…Other adverse effects of diuretic use include: deterioration in renal function; hypotension, especially with concomitant use of other vasodilating medications; and electrolyte imbalances (hypokalaemia and hypomagnesaemia) which could lead to arrhythmias (Sarraf et al 2009). Careful monitoring of renal function and electrolytes, blood pressure and fluid status is recommended (Albert 2012).…”