Congestive Heart Failure NCM 106

Heart Failure

• Formerly – Congestive Heart Failure(LS-HF)

• Inability of the heart to pump sufficient blood to meet needs
• Symptoms occur when heart is unable to produce sufficient Cardiac Output 55-100
CO(ml/hr) = HRxSV mL
(Stroke Volume(EDV-ESV) )
5.6 L/min= male
4.9 L/min=female
Causes

Renal Disease
Anemia
Pulmonary Embolism GABHS
Infection (RHD -Bicuspid - O2)
Delivery
• During labor and delivery, hemodynamic fluctuations can be profound.
• Each uterine contraction displaces 300 to 500 mL of blood into the general circulation.
• Stroke volume = CO by 50%-75%
• Blood loss during delivery (300 to 400 mL for a vaginal delivery and 500 to 800 mL for a cesarean
section)
Failure to take Medicine (HPN)
Arrhythmia (Cardiac Conduction System)
Infarction/Ischemia
Uncontrolled HPN
Rheumatic Heart Disease
Endocarditis
Manifestations-RHF

• Right sided Heart Failure (Systematic

Congestion)

– Anasarca (generalized
Edema/Pitting), Ascites (Caused by
Backflow), Peripheral Edema,
Jugular Vein Distention, Wt. Gain
(1kg/day), Anorexia,
Hepatospleenomegaly,
Gastrointestinal Distress.
 Congestive Heart Failure NCM 106

Pink Frothy Sputum – Blood

Manifestations-LHF and fluids

• Left Sided Heart failure – Respiratory Effect

– Pulmonary Edema, Orthopnea,

dyspnea, cough, Adventitious breath
Sounds (crackles), Insomnia, Dizziness,
Confusion and restlessness, pallor, cold
and clammy skin, easy fatigability

– Paroxysmal Nocturnal Dyspnea –

SOB,cough at night Bcoz of PNS

Hemodynamic Monitoring Devices

• Central Venous
Pressure – Monitors
pressure on Right side of
heart
– Detects adequacy of blood
– 5-10 cm/6-12 cm while in supine
• Central Swan Ganz Catheter
– Used to compute CO
» Brachial, Jugular, Inguinal Vein

Nursing Aims
1. Reduce Cardiac Workload
Complete Bed Rest Prudent diet ( low CHON, CHO, FAT)
upright position/Orthopneic Small frequent feeding
O2 inhalation(room air = 21%O2) Weight and Urine output monitoring
2. Promote Activity Tolerance
Log rolling Warm up and Cool down exercise
30 mins physical activity 3-5 x a week Avoid Extreme temp. during exercise
Avoid immediate succession of activity Ensure ability to talk during exercise
V/S before Exercise
3. Controlling Anxiety
Slow, Calm and Confident Manner use of relaxation techniques
Maintain Eye Contact
Presence of Family members
Specific and Brief directions
 Congestive Heart Failure NCM 106

4. Minimizing Powerlessness
Involve Client in decision making Encourage Verbalization
Encourage Self-care within limits
5. Managing Fluid Volume
Daily Weight monitoring – same everything Proper IVF regulation and monitoring
I and O monitoring Reposition
Adhere to low salt diet
6. Pharmacologic – 3 D’s

Digitalis –DIGOXIN, (+)inotropic, (-) Chronotropic

Therapuetic index of .5-2ng/mL (.6 – 1.2 meq/L)
NI- Check Pulse, Na Restriction, Prevent Hypokalemia (ABC diet), High Fowler’s, WO for
anorexia and visual disturbances for toxicity
Antidote = Digibind
Diuretics – Primary Drug to Excrete fluids, given in the Morning
Output IV=5-10 mins
Oral = 30 mins As a general rule,the use of calcium
Dilators - Decrease Cardiac workload channel blockers in CHF is reserved for
patients who also have hypertension
ACE Inhibitors - *Prils
and/or anginal symptoms (-)Inotropic
Calcium Channel Blockers
effects
Dihydropyridine - *pine
Non-dihydropiridine-
Verapamil, Diltiazem
Nitropusside (Nipride)- For emergency Hypertension
Hydralazine ( Apresoline) – Relaxe Smooth muscle
7. Surgical Management

1. Heart Transplant – First performed in December 1967, Christiaan Barnard, prognosis of 12

months

– Things to Consider: ABO group, Size of Donor and Recipient, geographic location, Need
for more than one organ transplant
– Explain Immunosuppressive therapy: Tacrolimus (prograf), Cyclosporine(neoral)
2. Transplant technique

Orthotopic transplant - pertaining to a tissue

transplant grafted into its normal place in the
body *Old is removed and new is placed
Heterotophic transplant- is transplantation of
a tissue to a place it is not normally found
*Old is not removed it will support New
 Congestive Heart Failure NCM 106

3. Post-operative Course

Balancing Risk for Rejection and infection, monitor complications such as hypotension and renal
failure, dyslipidemia

4. Ventricular Assistive Device

(LVAD) LV to Aorta; maybe combined with oxygenators, WOF magnetic interference

Total Artificial Heart - Experimental

In CAR and region 1

• Mostly affects middle adults (56.7%) but can also be seen in adolescents

• Aggravated by unhealthy lifestyle

• Diagnosed conditions in CAR and region 1 are CVD, RHD, CAD and CHF

“*Sabelo. Et. (2008) Al lifestyle of Cardiac Patients before hospitalization”

• Common Physical changes experienced by diagnosed clients

– Pallor

– Hand tremors

• Common manifestations

– Chest pain

– DOB

– Fatigability

– Strong and fast HR

“Lived experiences of adolescents with heart disease -Asias, et. Al (2004)”