Congestive Heart Failure

Congestive Heart Failure

1. Pathophysiology ( Nicholson, 2014; Casey, 2013)

   • Ventricular Failure
     • Systolic Failure
       • Cardiomyopathy
       • Inability of heart to pump blood
       • Impaired contractile function
       • Increased afterload (hypertension)
       • Mechanical abnormailites (valvular heart disease)
     • Diastolic failure
       • Decrease in stroke volume
       • High filling pressure
       • Venous engorement
         • In both pulmonary and systemic vascular systems
   • What is Congestive heart failure?

2. Causes of Heart failure (Casey, 2013 ; Lewis, 2014)

   • F
     • Faulty Heart Valves
     • A
       • Arrhythmias
       • I
         • Infarction - MI, CAD,
         • L
           • U
             • R
               • E
                 • Evaders (viruses or infections) Myocarditis, Bacterial endocarditis
               • Rheumatic heart disease, Rupture of papillary muscle, recreational use (cocaine and alcohol)
             • Uncontrolled Hypertension
           • Lineage Congenital,

3. Types of Heart failure (Casey, 2013), (Lewis, 2014)

   • Right sided heart failure
     • Causes
       • Left sided failure
       • Cor pulmonaale
       • Right ventricular infarcation
     • Effects
       • backward blood flow to right atrium
       • Hepatomegaly
       • Jugular distension
     • Signs and symtoms
       • Peripheral edema, weight gain, ascites, JVD distension, nausea, anorexia
   • Left sided heart failure
     • Causes
       • Left ventricular dysfuncation
     • Effects
       • Blood back ups to the left atrium
       • Pulmonary congestion
     • Signs and symptoms
       • Fatigue, Dyspnea, Orthopnea, Dry hacking cough, Pulmonary edema, Nocturia, Paraoxysmal nocturnal dyspnea, LV hypertrophy, S3 & S4, crackles,

4. Risk factors (Nicholson, 2014; Riley, 2013)

   • Modifiable
     • Hypertension
     • Excessive alcohol consumption
     • Obesity
     • Diabetes
   • Non- Modifiable
     • 65 years and older (DeFelice & Masucci , 2010)
     • Family history
     • Renal failure
     • Women
     • Africans

5. Diagnosis

   • NURSING DIAGNOSIS (Cavalcanti, & Pereira, 2014).
     • PAST AND CURRENTMEDICAL HISTORY
     • PHYSICAL EXAMINATION
     • ACTIVITY INTOLERANCE RELATED TO FATIQUE
     • EXCESS FLUID VOLUME AS EVIDENCE BY EDEMA
     • IMPAIRED GAS EXCHANGE RELATED INCREASE PRELOAD
     • ANXIENTY RELATED TO DYSPNEA OR PERCEIVE THREAT OF DEATH
   • MEDICAL DIAGNOSIS (DeFelice & Masucci, 2010)
     • CHEST XRAY
     • ECHOCARDIOGRAM
     • HEMODYNAMIC MONITORING
     • CARDIAC ENZYMES
     • 12 LEAD ECG
     • EXERCISE STREE TEST
     • B-TYPE NATRIURETIC PEPTIDE TEST

6. Treatments

   • Pharmacologic (Riley, 2013; Nicholson, 2014; Casey, 2013)
     • Medications that decrease the load on heart
       • Diuretics
       • ARBS e.g losartan
       • Vasofilators
       • ACE inhibtors e.g ramipril
       • Aldosterone antagonist
     • Medications that increases the function of the heart
       • Calcium channel blocker
       • Beta Blockers e.g bisoprolol
       • Intotropics
       • Digoxin
     • Medications for pain managment
       • Morphine
   • Non- Pharmacologic (Casey, 2013; DeFelice & Masucci ,2010)
     • Decrease sodium restriction - (2-3 g) per day (Lewis, 2014)
     • Fluid restriction - 1.5-2 L per day
     • Excerise Conway, 2015)
     • Smoking cessation & Alcohol reduction if CHF is due to this (Fletcher, L., & Thomas, D. (2001)
     • surgery
     • ABG
     • Heart Transplant

7. Collaborative Care (Lewis, 2014)

   • Physicians
     • Cardiologists
     • Surgeons
     • Family doctors
   • Nursing Interventions (Chapa et al. ,2014; Nicholson, 2014; (McLaughlin, Hoy & Glackin, 2015)
     • Providing medications to alleviate symptoms
     • Fluid & Electrolyte mgt
     • Dietary education
     • Monitor daily weight
     • O2 theraphy
     • Decrease anxiety
     • Energy & rest mgt
     • Help plan end of l;ife care
   • Dietians provide education on required diet, fluid intake, sodium intake
   • Pharmacist

8. NURSING ASSESSMENTS (Nicholson, 2014)

   • SUBJECTIVE
     • Nausea, Vomiting, Orthopnea, cough, chest pain, fatique,constipation, anxiety (Chapa et al. ,2014; Nicholson, 2014)
   • OBJECTIVE
     • Peripheral edema,Abdominal distention,ascities, restlessness, confusion, hepatosplenomegaly, decrease memory loss (Riley, 2013 ; Lewis, 2014 ; DeFelice & Masucci, 2010)

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