Congestive Heart Failure 01

8/11/2019 Congestive Heart Failure 01

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CONGESTIVE HEART

FAILURE

Minerva A. Cobus


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CONGESTIVE HEART FAILURE

Is the inability of the heart to maintain an

adequate output of blood from one or

more ventricles resulting to an inadequatesupply of blood to the vital parts of the

body.


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TYPES OF CHF

LEFT-SIDED CHFUSUALLY

PULMONARY BY NATURE

RIGHT SIDED CHFUSUALLY AFFECTS

THE PERIPHERY IN GENERAL


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CAUSES

Coronary Artery Disease

Faulty Heart Valves

Cardiomyopathy

Congenital Heart Defects

Heart Arrhythmias

Kidney Failure

Hypertension (or related increase in BV)


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CAUSES

Pulmonary Emboli

Rheumatic heart

disease Cor pulmonale

anemia

Arrhythmias

Rupture of papillary

muscle Bacterial endocarditis


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PATHWAY OF BLOOD OXYGENATION

IN THE HEART


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Pathology of Ventricular Failure

Systolic failure: causes ventricle not toempty properly (most common cause of

CHF) Heart muscle has decreased ability to

contract

Also caused by increased afterload

(hypertension), or mechanical abnormalities (like valvular heart disease)

Characterized by low forward blood flow


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Pathology of Ventricular Failure

Diastolic failure: causes ventricle not to fillproperly

Disorder of heart relaxation and ventricularfilling

Usually the result of ventricular hypertrophy

Caused by chronic hypertension, aortic

stenosis, or cardiomyopathy Commonly seen in older adults


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SIGNS AND SYMPTOMS

Fatigue and weakness

Shortness of breath (dyspnea) when you

exert yourself or when you lie down Persistent wheezing or cough with white

or pink blood-tinged phlegm

Pronounced neck veins Swelling (edema) in your legs, ankles and

feet


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SIGNS AND SYMPTOMS

Swelling of your abdomen

Rapid weight gain from fluid retention

Lack of appetite and nausea Lightheadedness, dizzy spells or fainting

spells

Difficulty concentrating or decreasedalertness

Irregular or rapid heartbeat


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Compensatory Mechanisms of the

heart in CHF

Increased

sympathetic nervous

system stimulation

Ventricular

hypertrophy

Hormonal response(Renal response)


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Risk Factors for CHF

Coronary artery

disease

Hypertension

High cholesterol

levels

Advancing age

Cigarette smoking

Obesity

Proteinuria

Diabetes

Prolonged kidney

problems


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Complications of Congestive Heart

Failure

Pleural effusion

Increased pressure in pleural capillaries

Leakage of fluid from capillaries into pleural space. Arrhythmias

Left ventricular thrombus

Hepatomegaly

Liver becomes congested with venous blood

Leads to impaired liver function


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Nursing Care in Acute CHF

Decrease the intravascular volume With use of diuretics

Decrease the venous return Reduces congestion in heart and lungs

Sitting patient up facilitates breathing

Decreasing the afterload

Use of vasodilators (IV Nipride) Increasing myocardial contraction and CO

Reducing pulmonary congestion


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Nursing Care of Acute CHF

Improve Gas Exchange and Oxygenation

Give IV morphine

Place on Oxygen Intubate and place on vent as needed

Improve cardiac function

Digitalis, or newer inotropic drugs (dobutamine)

increase cardiac contractility Hemodynamic monitoring


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Nursing Care of Acute CHF

Reduce anxiety

Give Morphine

Approach patient calmly

Remember: Nursing care will focus on continual

physical assessment of the patient,

hemodynamic monitoring, and monitoring thepatients response to the treatment.


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MANAGEMENTDigitalis Therapy

The major therapy for CHF

(+) inotropic, (-) chronotropic effects

Nsg. Implication: check for HR below 60and above 120

Monitor serum potassium (Normal3.5-5.5 mEq/L)

Examples: Lanoxin (Digoxin), Crystodigin(Digitoxin), Lanatoside (Cedilanid C),Deslanoside (Cedilanid D)


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Beware of Digitalis Toxicity!!!

Bradycardia

G.I. Manifestations: Anorexia, N & V,

vomiting

Dysrythmias (most dangerous)

Yellow / green visions; halos around

the light among the elderly)

In males: gynecomastia, decreasedlibido and impotence


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DIURETIC THERAPY

To decrease cardiac workload by reducingcirculating BV

Nsg. Implications:

a. Assess for s/sx of hypokalemia when givingthiazides and loop diuretics

b. Give potassium supplements

c. Best given early AM or early PM If thiazides are ineffective, a potassium sparing

diuretic may be given.


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Examples of Diuretics:

1. ThiazidesChlorthiazide (Diuril),

Hyrochlorthiazide (Esixdrix, Hyrdodiuril)

2. Loop DiureticsFurosemide (Lasix),

Bumetamide (Burmex)

3. Potassim-sparingSpironolactone(Aldactone), Triamterene (Dyrenium)


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VASODILATORS

Decreases resistance to ventricular emptying,thereby decreasing afterload.

Most commonly used as follows:

1. Nitroprusside (Nipride)

2. Hydralazine (Apresoline)

3. Nifedipine (a Calcium-channel blocker with

vasodilator effect)4. Captopril (an antihypertensive agent with

vasodilator effect)


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Nursing Care of Chronic CHF

Angiotensin-converting enzyme (Ace) inhibitors:

Capoten, Vasotec, lisinopril (Prinivil, Zestril)

Reduces angiotension II and plasma aldosteronelevels

Increases cardiac output due to vasodilitation

Beta-adrenergic blocking agents:

Coreg (is the only beta-blocker used in mild tomoderate CHF)


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Nursing Care of Chronic CHF

Nutritional Therapy

Sodium restriction with diet

Teach patient what foods are high in sodium and toavoid them

Severe CHF has the most sodium restrictive diet

instruct family in reading labels on food items

Fluids may be restricted in moderate to severe CHF


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TREATMENT

Activity: Balanced program of activity and

rest

Oxygen therapy

Limit fats and cholesterol

Stop smoking


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NURSING MANAGEMENT

Provide oxygenation

Promote rest and activity

Decrease anxiety Facilitate fluid balance

Provide skin care

Promote nutrition Promote elimination

Facilitate learning

Congestive Heart Failure 01

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