Congestive Heart Failure

Pathophysiology ( Nicholson, 2014; Casey, 2013)
1. Ventricular Failure
  1. Systolic Failure
    1. Cardiomyopathy
    2. Inability of heart to pump blood
    3. Impaired contractile function
    4. Increased afterload (hypertension)
    5. Mechanical abnormailites (valvular heart disease)
  2. Diastolic failure
    1. Decrease in stroke volume
    2. High filling pressure
    3. Venous engorement
      1. In both pulmonary and systemic vascular systems
2. What is Congestive heart failure?
Causes of Heart failure (Casey, 2013 ; Lewis, 2014)
1. F
  1. Faulty Heart Valves
  2. A
    1. Arrhythmias
    2. I
      1. Infarction - MI, CAD,
      2. 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,
Types of Heart failure (Casey, 2013), (Lewis, 2014)
1. Right sided heart failure
  1. Causes
    1. Left sided failure
    2. Cor pulmonaale
    3. Right ventricular infarcation
  2. Effects
    1. backward blood flow to right atrium
    2. Hepatomegaly
    3. Jugular distension
  3. Signs and symtoms
    1. Peripheral edema, weight gain, ascites, JVD distension, nausea, anorexia
2. Left sided heart failure
  1. Causes
    1. Left ventricular dysfuncation
  2. Effects
    1. Blood back ups to the left atrium
    2. Pulmonary congestion
  3. Signs and symptoms
    1. Fatigue, Dyspnea, Orthopnea, Dry hacking cough, Pulmonary edema, Nocturia, Paraoxysmal nocturnal dyspnea, LV hypertrophy, S3 & S4, crackles,
Risk factors (Nicholson, 2014; Riley, 2013)
1. Modifiable
  1. Hypertension
  2. Excessive alcohol consumption
  3. Obesity
  4. Diabetes
2. Non- Modifiable
  1. 65 years and older (DeFelice & Masucci , 2010)
  2. Family history
  3. Renal failure
  4. Women
  5. Africans
Diagnosis
1. NURSING DIAGNOSIS (Cavalcanti, & Pereira, 2014).
  1. PAST AND CURRENTMEDICAL HISTORY
  2. PHYSICAL EXAMINATION
  3. ACTIVITY INTOLERANCE RELATED TO FATIQUE
  4. EXCESS FLUID VOLUME AS EVIDENCE BY EDEMA
  5. IMPAIRED GAS EXCHANGE RELATED INCREASE PRELOAD
  6. ANXIENTY RELATED TO DYSPNEA OR PERCEIVE THREAT OF DEATH
2. MEDICAL DIAGNOSIS (DeFelice & Masucci, 2010)
  1. CHEST XRAY
  2. ECHOCARDIOGRAM
  3. HEMODYNAMIC MONITORING
  4. CARDIAC ENZYMES
  5. 12 LEAD ECG
  6. EXERCISE STREE TEST
  7. B-TYPE NATRIURETIC PEPTIDE TEST
Treatments
1. Pharmacologic (Riley, 2013; Nicholson, 2014; Casey, 2013)
  1. Medications that decrease the load on heart
    1. Diuretics
    2. ARBS e.g losartan
    3. Vasofilators
    4. ACE inhibtors e.g ramipril
    5. Aldosterone antagonist
  2. Medications that increases the function of the heart
    1. Calcium channel blocker
    2. Beta Blockers e.g bisoprolol
    3. Intotropics
    4. Digoxin
  3. Medications for pain managment
    1. Morphine
2. Non- Pharmacologic (Casey, 2013; DeFelice & Masucci ,2010)
  1. Decrease sodium restriction - (2-3 g) per day (Lewis, 2014)
  2. Fluid restriction - 1.5-2 L per day
  3. Excerise Conway, 2015)
  4. Smoking cessation & Alcohol reduction if CHF is due to this (Fletcher, L., & Thomas, D. (2001)
  5. surgery
  6. ABG
  7. Heart Transplant
Collaborative Care (Lewis, 2014)
1. Physicians
  1. Cardiologists
  2. Surgeons
  3. Family doctors
2. Nursing Interventions (Chapa et al. ,2014; Nicholson, 2014; (McLaughlin, Hoy & Glackin, 2015)
  1. Providing medications to alleviate symptoms
  2. Fluid & Electrolyte mgt
  3. Dietary education
  4. Monitor daily weight
  5. O2 theraphy
  6. Decrease anxiety
  7. Energy & rest mgt
  8. Help plan end of l;ife care
3. Dietians provide education on required diet, fluid intake, sodium intake
4. Pharmacist
NURSING ASSESSMENTS (Nicholson, 2014)
1. SUBJECTIVE
  1. Nausea, Vomiting, Orthopnea, cough, chest pain, fatique,constipation, anxiety (Chapa et al. ,2014; Nicholson, 2014)
2. OBJECTIVE
  1. Peripheral edema,Abdominal distention,ascities, restlessness, confusion, hepatosplenomegaly, decrease memory loss (Riley, 2013 ; Lewis, 2014 ; DeFelice & Masucci, 2010)

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Congestive Heart Failure

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	Created by Lallise Maya about 7 years ago