Clinical characteristic in heart failure of old age and attending to _'s symptom

Clinical characteristic in heart failure of old age and attending to _'s symptom
It is common disease in the elderly, frequently-occurring disease to be in heart failure, with the aggravation of aging population, in heart failure morbidity rise constantly, the statistics show, the elderly over the 65 our country chronic ill rate in heart failure 1.3%[ 1] , Cause one of the common reasons the elderly die. So, are familiar with and grasp the elderly's clinical characteristic in heart failure and attend to, help to find early, treat early. Our institute accepts 92 patients in heart failure of old age for medical treatment together from January of 2006 to January of 2008, among them 19 will be misdiagnosed, the misdiagnosing rate is 20.6%. Will attend to and realize summarizing as follows now.
A clinical materials
1.1 General materials 92 the patients of this group, 55 men, 37 women; 60-89 years old, on average(70.1 7.2) Years old. Accord with the heart failure diagnostic standard [2 ] of Framingham. The dividing type in heart failure: Decline 26 whole-heartedly, right heart declines 28, left heart declines 38. The course of disease in heart failure is 3 months - 12 years, on average(5.2 4.3) Annual. The number of times that in hospital: 16 for once, 21 for 2 times, 55 3 or more times.
1.2 Cause of disease This group regards having illness coming on the main cause of disease originally as, among them coronary sclerosis heart disease, hypertension heart disease, lung source heart disease are the main reason. Single disease is causing 12 the one in heart failures; Amalgamate 36 diseases 2 kinds, 44 for disease of more than 3 kinds. Increase with age, every organ deterioration also causes one of the reasons to aggravate in heart failure. Basic disease: The patient have more more than one type of basic diseases, suffer from 18 of chronic bronchitis: 36 coronary heart diseases; 28 cases of diabetes; 42 cases of hypertension. The inducement in heart failure: 26 cases of upper airway infection, the number of the room is quiver 18, overworked or excited 9, other 39.
1.3 Clinical manifestation Palpitation, suppressing breathing heavily, sitting up straight and breathing, needing high pillow to lie in 36 cases of location uncomfortable in chest; Cough, spit and take 28 silks of blood in white foam phlegm or white sticky phlegm, phlegm; The intersection of upper abdomen and glutted uncomfortable, the intersection of appetite and scarce 18, sick and vomiting 9; Lack 8 cases of urine, edema; Generate heat 12, have a headache, dizzy, agitation, the intersection of aphasia and 9, chest ache 8, become thin 6.
2 clinical characteristics
2.1 old persons because angry vascular sclerosis and brain blood supply are insufficient, memory is bad, it is not clear that the medical history is often stated, often exist with many kinds of diseases of whole body at the same time, cause clinical symptom to be intricate, symptom in heart failure is often not typical [3 ].
2.2 old persons are on the basis of vascular sclerosis of brain, because in heart failure aggravates the blood supply of brain insufficiently, cause brain oxygen deficiency and function of nerve cell to fail, can present various nerve spiritual symptoms, it is often the elderly's symptom that appear first in heart failure to be and tired, unable or dizzy, can also present the expression indifferently or have the fidgets, mind is in a trance, have a liking for symptom of sleeping etc..
2.3 is caused by the fact that in heart failure the gastrointestinal tract and bled with hypoxemia disease, can display the stomach and receive difference, have the intersection of abdominal distension and the intersection of pain and uncomfortable or nausea, the intersection of person who vomit and the intersection of digestive tract and symptom, can appear upper digestive tract bleed, clinic is extremely apt to misdiagnose digestive tract disease.
2.4 most patient present light cough, shortness of breath and the intersection of lung and the intersection of bottom and the intersection of mobility and sound, decline acute left heart and lung extravasated blood display in early days. Pay attention to obscuring with the elderly's chronic bronchitis, pulmonary emphysema in clinic [4 ].
2.5 old person immune functions bow, symptom is various, break out repeatedly, and the condition is changed fast, should combine the clinical sign to analyze, arrhythmia, infusion, tired, excited, electrolytic disorder are often risk factor in an all-round way.
3 is observed and attended to
3.1 lightens heart load; The middle-aged and elderly people will do some work that can bear by oneself according to one's own age, ability, heart function,etc. in daily life, so will seldom lead to the fact the heart function is not complete. The nurse should pay attention to limiting the patient's activity when it is not complete that the patient presents the heart function, slight heart failure but indoor activity, when being in heart failure and serious, should stay in bed strictly, keep stool to be unobstructed, liquid sidelight speed should not too fast, 15- 20 min, infusion total amount unsuitable to exceed 1000- 1500ml every day. Educate the patient to make the physical exertion of ultra ability, take care strength is depleted after behaving to improve, can resume physical exertion according to one's own situation gradually.
3.2 diet is guided; Because of in heart failure, patient's sulk, activity is reduced, digestive function is bad, the digestive tract has extravasated blood at various degrees at the same time, so cause the appetite to fail. In addition, sodium salt is taken in too much, can aggravate the heart to decline. Should explain so nurse diet in patient and transfer disease to relation,advise it not to be diet will be flowed in half digest costly easy after should eat by heats light low, lasting angry, nutrition, much meal of small quantity. Control the food containing sodium appropriately according to the condition, in case sodium salt takes in and causes humoral retention too much and increases the heart to bear. After taking a favorable turn in appetite, should not take food too fast, avoid satiating, abdominal distension aggravates the heart burden, pay attention to keeping the stool unobstructed.
3.3 is controlled and infected; Old age in heart failure to break out, bring out, aggravate for infect more repeatedly. The nurse should carry out aseptic technical operation strictly. Strengthen the management of the ward, do the indoor air well to sterilize. Use antibiotic to observe reacting, curative effect, bad reaction,etc. after using medicine. Cough up phlegm many patient want, assist patient stand up, make, carry frequently, liquid can offer atomization suck while being getting viscous and aspirator inhale the phlegm to the intersection of serious illness and weak phlegm coughing, avoid weighing down the emergence of accumulating pneumonia. Should dry for subsequent use sterilize strictly, while being wet to take bottle and pipeline to oxygen, dry to keep, oxygen in the use wet to take bottle, sterilize every day, wet to take liquid, change and sterilize water every day.
The 3.4th condition is observed
It is the elderly's cardiovascular disease, patient's common symptom that popping on 3.4.1 to have difficulty in breathing at night, many patients have already been used to this, the ability receives the oxygen deficiency of short time, so have difficulty in breathing after breaking out and sitting slightly and relieve gradually, unwilling to trouble others, the nurse should pay attention to the nursing of foresight at this moment, want patient, careful inquiry, lie in the location for the high pillow, oxygen intake or giving diuretic, solving convulsion pharmaceutical or sedative according to the doctor's order.
Is it or flat as being heavy while lying at night to cough while moving about more on 3.4.2, have a rest or sit and arise, lighten, may circulate extravasated blood for the lung, it is caused that capillary blood volume of lung and pressure increase. The membrane blood capillary breaks when the phlegm may cause the bronchus under high pressure for the lung artery to cough the blood. So, it is one of the early symptoms in heart failure to cough, often appear before the other signs in heart failure.
3.4.3 heart
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