8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 1/19

Chronic disorder in which the heart can nolonger pump sufficient blood to meet

metabolic demands of the body.

CONGESTIVE HEART FAILURE

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 2/19

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 3/19

H igh Output F ailure ² Occurs when condition causes the heart towork harder to met demands of the body

S ystolic F ailure ² leads to problem with contraction & ejection of blood

D iastolic F ailure ² leads to problem with the heart relaxing & fillingof blood

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 4/19

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 5/19

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 6/19

Signs & Symptoms

LEFT SIDED HEART FAILURE RIGHT-SIDED HEART FAILURE

L eft ventricular hypertrophyPoor oxygen exchangePulmonary edemaU nproductive coughDyspneaDry hacking coughS3 heart sound

Weight gainEdema of dependent body partsAnascarcaJugular vein distention

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 7/19

CARDIO CEREBRO GI RESPI RENAL

Cardiacenlargement

S3 sound

Tachycardia JVD

L ightheadedness

Dizziness

Confusion

NauseaEnlarge liverAscites

DyspneaOrthopneaNocturnal

dyspneaCrackle

Decreasedurinaryfrequency

during the dayNocturia

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 8/19

D IAGNOSTIC TEST

Chest X - rayE CG

E chocardiography

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 9/19

Coronary artery revascularization with percutaneous angioplasty orbypass surgery ² if patient have underlying coronary artery disease

Cardiac resynchronization ² involving the use of left ventricular and biventricularpacing,treatment for hf with electrical conduction defects

I nternal cardiac defibrillator ² use to prevent dangerous heart rhythm

H eart pump (ventricular assistive device)

M ED ICALM ANAGEM ENT

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 10/19

H eart valve replacementCoronary bypass surgeryH eart transplant

Myectomy

SURGICAL M ANAGEM ENT

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 11/19

I ntropicsD iuretics

T hiazide

L oopPotassium -S paring

VasodilatorsA CE I nhibitors

P HARM ACOLOGICALM ANAGEM ENT

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 12/19

IntropicsD igitalis ² increase force of myocardial contraction helpincrease cardiac output

Nursing ConsiderationsR ecognize therapeutic dose and toxic dose is narrowObserve signs of toxicity

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 13/19

D iuretics1. T hiazide D iuretics

o Chlorothiazide ( D iuril) & H ydrochlorothiazide(H ydro D iuril)

o Promote excretion of sodium, chloride and watero A dverse effects: H ypokalemia & H yperkalemia

2. L oop D iureticso F urosemide ( L asix)o Promote excretion of sodium and water by blocking

reabsorption in the L oop of H enleo A dverse E ffects: H ypokalemia, H yonatremia &

H yperglycemia

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 14/19

3. Potassium ² S paring D iuretics

o S pironolactone ( A ldactone)o I nhibits action of aldosterone in the distal tubule ²

leading to sodium excretion and potassiumretention

o A dverse E ffects: H yperkalemia

Nursing ConsiderationsM onitor intake, output, weight, and serum electrolytelevelsCaution patients to change positions slowlyA dminister diuretic in the morning

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 15/19

Vasodilatorso H ydralazine, Nitrates, Prazosino Vasodilator drugs: relax pulmonary arterial and

venous vessels, dilating vessels, causing pooling of blood & reducing resistance in the systemic arterialvessels.

Nursing ConsiderationA dvise patients taking nirates, may experience headachesR emind patient to change positions slowly to prevent

orthostatic hypotension

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 16/19

ACE Inhibitorso Captopril, B enazeprilo I nterrupt RAA cycleo T hese drugs promote vasodilation and diuresis by

decreasing afterload and preload

Nursing ConsiderationCarefully monitor patient for H yperkalemia

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 17/19

D ecreased cardiac output related to impaired inotropic state of the myocardium

I mpaired gas exchange related to increased pulmonarycongestion secondary to increased left ventricular and diastolicpressure

E xcess fluid volume related to fluid retention secondary todecreased renal perfusion

NURSING D IAGNOSIS

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 18/19

Nursing M anagemento Providing supplemental oxygen at 2 to 4L /min

o maintain or improve oxygenationo Promote Rest and Activity

o minimize O2 demando Diet modification

a. Salt restriction b. For decompensated patient the water intake is restricted by 1.5 ² 2L per

day to avoid water retention and significant hyponatremia

8/3/2019 NCM1o6 - CHF

http://slidepdf.com/reader/full/ncm1o6-chf 19/19

c.Avoid alcohol-can interact with cardiac agent and maycause

cardiomyopathyo Stop Smoking

o causes vasoconstriction

o Adherence and compliance to medicationo Exercise should be base on the clinical condition and status as long as itwill not cause show symptoms of decompensationo Caution for driving and traveling airplane

o pressure changes o2 concentrationo Promote pulmonary hygiene

o reduce risk of atelectasis and pneumoniao Position the patient

o to maximize chest exersion

o Institute pressure ulcer prevention strategies