Congestive Heart Failure - created from Mind Map

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ASSESSMENT FINDINGS

COMPLICATIONS (Lewis, et al., 2014)

TREATMENT MANAGEMENT

DIAGNOSIS

ETIOLOGY

RISK FACTORS

CLINICAL MANIFESTATIONS (Kim & Banasik, 2013)

PATHOPHYSIOLOGY

NURSING INTERVENTIONS

Detect signs of systemic or cardiac disorders that cause or aggravate heart failure

Left Ventricle Failure

Right Ventricle Failure

Examples: Anemia, hyperthyroidism, alcoholism, hemochromatosis, atrial fibrillation with rapid rate, mitral regurgitation

Tachycardia, tachypnea, patient can appear visibly dysgenic or cyanotic, hypotensive, and confused or agitated because of hypoxia and poor cerebral perfusion.

Central cyanosis (affection all of the body, including warm areas such as the tongue and mucous membranes) reflected severe hypoxemia. Peripheral cyanosis of the lips, fingers and toes reflects Low blood pressure with increased oxygen extraction.

If vigorous massage improves nail bed color, cyanosis may be peripheral; increasing local blood flow does not improve color if cyanosis is central

Contender peripheral pitting edema (digital pressure leaves visible and palpable imprints (sometimes quite deep) in the feet and ankles, an enlarged pulsatile liver palpable below the right costal margin; abdominal sweeping and ascites; and visible elevation of the jugular venous pressure, sometimes with a large a or v waves that are visible even when the patine is seated or standing

A paradoxical increase in the jugular venous pressure during inspiration (Kussmaul sign) is indicative of right sided heart failure.

Peripheral edema can extend to the thighs, scrotum, lower abdominal wall, and even higher.

Pleural effusion - due to increased pressure in pleural capillaries

Dysrhythmias - enlargement of chambers --> alterations in electrical pathway

Left ventricular thrombus - due to decreased CO and enlarged LV

Hepatomegaly - due to liver lobule congested with venous blood

Renal failure - decreased CO --> decreased perfusion to kidneys

Pharmacologic

Non-pharmacologic

ACE inhibitors = block angiotensin activation leading to decreased peripheral vascular resistance, and vasodilation

Beta Blockers= prevents epinephrine and norepinephrine from working leading to decreased heart rate and contraction force (decreases O2 demand), decreases blood pressure

Angiotensin II receptor blockers= prevents vasoconstriction and blocks effects of aldosterone (prevents fluid retention)

Aldosterone antagonists= prevent fluid retention

Calcium channel blockers= causes vasodilation and slows AV – SA node conduction causing decreased heart rate (work load), peripheral vascular resistance and blood pressure, and increased coronary artery blood flow

Coronary artery vasodilators e.g. nitrates= increase blood and O2 supply to myocardium

Diuretics= decrease blood pressure and help manage signs and symptoms of fluid overload and congestion.

Positive inotropic drugs

Cardiac glycosides

Phosphodiesterase inhibitors

Recombinant human type B natriuretic peptide

Digoxin/digitalis= increases force of contractions while slowing heart rate (improved cardiac efficiency, and cardiac output while decreasing O2 need)

Watch for digoxin toxicity= CV effects (brady/tachycardia, ectopic beats), GI effects (anorexia, nausea/vomit, abdominal pain), Neuro effects (halo vision, confusion, headache)

Use digoxin immune Fab (Digibind) as antidote

Milrinone= For short term HF management in patients unresponsive to digoxin

Long term use worsens patient outcomes

Nesiritide= reduces pulmonary capillary wedge pressure and relieves dyspnea

Reduction of sodium intake

O2 therapy and rest for dyspnea management

Reduce anxiety with education, emotional support, and sedatives if needed

Cardiac transplant

Treat underlying cause

Pace makers, Implantable cardioverter-defibrillators (ICDs), Ventricular assist devices (VADs)

DASH diet

E.g. Valve repair/replacement

E.g. Coronary bypass

Primary goal is to identify underlying cause

Blood tests to identify cardiac enzymes, and other signs and symptoms such as polycythemia

Past medical history for identification of risk factors, or precipitating factors

Echocardiogram for heart shape and abnormalities

Stress Test

Electrocardiogram for heart damage and rhythm problems

Physical exam

chest x-ray, MRI, CT

Coronary Angiogram to detect blockages

Hemodynamic assessments

Ejection Fraction

Stems from disease, condition, or risk factor that may lead to heart failure

Stems from disease, condition, or risk factor that may lead to heart failure

Coronary artery disease may lead to MI, or myocardial damage reducing contractility

MI leads to decreased myocardial muscle mass and decreased contractility

Disease’s or conditions that increase peripheral vascular resistance lead to congestion and potential hypertrophy of Myocardium causing contractility problems, inability to fill, and eventual heart failure

Pericardial disease causes resistance when filling leading to congestion

Myocarditis leads to decreased contractility

Valvular stenosis or incompetency causes congestion in heart

Dysrhythmias that may lead to heart failure or congestion

Respiratory disease’s increase peripheral vascular resistance in pulmonary arteries, (e.g. Cor Pulmonale)

Hypertension increases systemic peripheral vascular resistance

Modifiable (Roger & Bush, 2015)

Non-Modifiable (University of San Francisco, 2017)

Cigarette Smoking, Lack of physical activity, Obesity, High cholesterol and sodium diet, Alcohol use

Hypertension, Diabetes Mellitus, Cardiomyopathy, Sleep Apnea, Heart Valve Disease, Irregular Heart Rhythms, Viral Infections

Diabetic medications - rosiglitazone, pioglitazone

Age, Gender, Family history, Race

Left Sided

Right Sided

Backward Effect

Forward Effect

Dyspnea on exertion, orthopnea, cough, paroxysmal nocturnal dyspnea, cyanosis, basilar crackles

Effects results from accumulation of blood in pulmonary circulation leading to pulmonary congestion and edema

Fatigue, oliguria, increased heart rate, faint pulse, restlessness, confusion, anxiety

effects caused by decreased cardiac output --> decreased tissue perfusion

Backward Effect

Forward Effect

Hepatomegaly, ascites, splenomegaly, anorexia, subcutaneous edema, jugular vein distention

Effects due to congestion in the systemic venous system

Fatigue, oliguria, increased heart rate, faint pulse, restlessness, confusion, anxiety

Heart Failure with Reduced Ejection Fraction (Systolic HF)

Heart Failure with Preserved Ejection Fraction (Diastolic HF)

The LV contracts poorly an empties inadequately, leading to increased diastolic volume and pressure and decreased ejection fraction

Predominant systolic dysfunction is common in heart failure due to myocardial infarction, myocarditis, and dilated cardiomyopathy.

Systolic dysfunction may affect primarily the LV or the right ventricle (RV); LV failure often leads to RV failure

LV filling is impaired, resulting in increased LV end-diastolic pressure at rest or during exertion

Diastolic dysfunction usually results from impaired ventricular relaxation (an active process), increased ventricular stiffness, valvular disease, or constrictive pericarditis. Acute myocardial ischemia is also cause of diastolic dysfunction.

Monitor heart rhythm. Get a 12 lead ECG

Restrict Sodium Intake

Monitor BNP Normal Range: <100pg/mL

Assess respiratory function: Listen to breathe sounds, monitor O2 saturation

Administer diuretics: Furosemide (Lasix), Bumetanide (Bummed), Hydrochlorothiazide (Microzide) Spironolactone (Aldactone)

Strict intake and output (I&O)

Monitor swelling/edema

Patients with CHF will have a low voltage ECG, after peripheral edema is resolved the ECG gains voltage again and becomes more of a normal looking ECG

Water follows salt! The patient has too much fluid on board and needs to get rid of it, restricting the sodium helps with this.

Try to stay between 300-600mg of salt in a serving

Brain Natriuretic Peptide (BNP): is a hormone made by the heart. when the heart is stressed or working hard to pump blood, it releases BNP

Fluid can back into the lungs and cause shortness of breath, especially upon exertion. Be careful about laying these patients flat as you can put them in respiratory distress

Place the patient on O2 as needed to help them keep their O2 levels adequate

We need to get all this fluid out the patient. The best way to do this is administer diuretics

Patients should have around 8 cups of fluid or just slightly under 2 liters of fluid per day

Edema is measured by pressing over a bony prominence, usually the top of the foot or the tibia and is charted by a number and whether the skin bounces back or stayed pitted (called pitting edema)

+1: mild indent, +2: moderate indent, +3: deep indent, +4: very deep indent