HEART FAILURE

HEART FAILURE
Heart failure (HF), often called congestive heart
failure (CHF) or congestive cardiac failure (CCF),

occurs when the heart is unable to provide

sufficient pump action to maintain blood flow to meet the needs of the body.

DEFINITION Congestive heart failure is a disorder that the heart is unable to maintain satisfactory cardiac output to meet the metabolic needs of the body (systolic failure) or is unable to receive blood in the ventricles during diastole (diastolic failure) OR Congestive heart failure is defined as inability of the heart to maintain an output at rest or during stress, necessary for the metabolic needs of the body (systolic failure) and inability to receive blood into the ventricular cavities at low pressure during diastole (diastolic failure).

CAUSES
Ischaemic heart disease
Cigarette smoking Hypertension (high blood pressure) Obesity Diabetes

Valvular heart disease

Rarer causes of heart failure include:

Viral myocarditis (an infection of the heart muscle) Infiltrations of the muscle such as amyloidosis HIV cardiomyopathy (caused by human immunodeficiency virus) Connective tissue diseases such as systemic lupus erythematosus Abuse of drugs such as alcohol and cocaine Pharmaceutical drugs such as chemotherapeutic agents Arrhythmias. Obstructive sleep apnea (a condition of sleep wherein disordered breathing overlaps with obesity, hypertension, and/or diabetes) is regarded as an independent cause of heart failure.

SYSTOLIC FAILURE DIASTOLIC FAILURE

POOR CONTRACTABILITY OF THE MOCARDIUM INCREASES THE AFTERLOAD

STIFF MYOCARDIUM CAUSES INCREAS FLOW IN THE LEFT ATRIUM PULMONARY HEART FAILURE

ACUTE FAILURE

CHRONIC FAILURE

Left-Sided Heart Failure

Manifestations
Pulmonary

include:
Weakness Fatigue Dizziness Confusion

congestion Shortness of breath Oliguria Organ failure, especially renal failure Death

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(L) SIDED HF
Tissue hypoxia occurs because heart is unable to efficiently pump blood CLINICAL SIGNS of pulmonary congestion: Dyspnea Orthopnea

Cough
Fatigue

WT. gain
Anxiety/ restless Crackles HR BP

S3
Cardiomegaly

Right-Sided Heart Failure

Manifestations include: Distended neck veins, increased abdominal

girth Hepatomegaly (liver engorgement) Hepatojugular reflux Ascites Dependent edema Weight: the most reliable indicator of fluid gain or loss

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(R) SIDED HF
Blood BACKS UP into venous circulation. High oncotic pressure pushes fluids into tissues.

CLINICAL SIGNS:
CVP JVD FATIGUE LETHARGY SUDDEN WT. GAIN DEPENDENT EDEMA LIVER CONGESTION ASCITES

ORTHOPNEA

ANOREXIA
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Assessments

Laboratory assessment- electrolytes,

BNP- B type natriuretic peptide. Normal =0

Radiographic assessment
Electrocardiography Echocardiography, TEE

Pulmonary artery catheters

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Lifestyle changes
Stop smoking
Loose weight Avoid alcohol Avoid or limit caffeine Eat a low-fat, low-sodium diet

Exercise

Lifestyle changes
Reduce stress Keep track of symptoms and weight

and report any changes or concern to the doctor Limit fluid intake See the doctor more frequently

NURSING CARE

NURSING MANAGEMENT
ASSESSMENT FINDINGS

Signs and symptoms of CHF vary somewhat depending of the child age and on whether failure occurs on the right and left sided CHF (the usual condition) may include:
1.Respiratory distress, marked by retraction, nasal flaring, grunting . tachypnea, dyspnea, orthopnea,

2.Cough
3.Tachycardia

4.Ventricular gallop

5.Pallor, mottling or cyanosis

6.Edema (peripheral and periorbital)

7.Feeding difficulties and failure to thrive

8.Restlessness and irritability

9.Weakness and easy fatigability

10.Unexplained weight gain

11.Abdominal distension
12.Neck vein distension hepatomegaly

13.Diaphoresis

14.Chest radiograph reveals cardiomegaly and pulmonary congestion. 15.Laboratory study result commonly reveal dilutional hypochloremia and hyperkalemia 16.Assess response to medical treatment plan. 17.Document vital signs and oxygen saturation hyponatreamia,

18.Observe infant or child during feeding or activity. Assess for diaphoresis, need for frequent rest period and inability to keep up with peers 19.Follow growth chart

NURSING DIAGNOSIS Decreased cardiac output related to myocardial dysfunction. Excess fluid volume related to decreased cardiac contractility and decreased excretion from the kidney Impaired gas exchange related to pulmonary venous congestion activity intolerance related to decreased cardiac output. Risk for infection related to pulmonary congestion Altered nutrition, less than body requirement related to increased metabolic demands with decreased calorie intake Anxiety related to child diagnosis and prognosis

NURSING INTERVENTION IMPROVING EFFICACY MYOCARDIAL

1) Administer digoxin as prescribed. Measure heart rate; hold medication and notify health care provider for hemi rate less than 90bpm . Check most recent potassium level. Hold medications and notify health care provider for less than 3.5gm potassium level.

Run lead II ECG if ordered to monitor PR interval. If first degree A V block occurs, notify health care provider and hold medication as ordered Report signs of possible digoxin toxicity, vomiting, nausea, visual changes, bradycardia.

Double check dose of digoxin with another nurse before administering the dose. Make sure the digoxin order has two signatures.

Administer after load reduction medications as prescribed .

Measure BP before and after giving the patient the medication. Hold the medication and notify the health care provider for low BF (greater than 15mm of Hg drop from baseline) . Observe for other signs of hypotension, dizziness, light headedness, syncope.

MAINTAINING FLUID AND ELECTROLYTE BALANCE

1) Administer diuretics as prescribed Obtain daily weight. Keep strict intake and out put record. Monitor serum electrolyte provide potassium supplement as needed.
2) Sodium restriction not usually needed in the children: provide dietary assistance as needed. 3) Fluid restriction- not usually needed in children.

RELIEVING RESPIRATORY DISTRESS 1) Administer oxygen therapy as prescribed. 2) Elevate head end of bed

PROMOTING ACTIVITY TOLERANCE

1) Organize nursing care to provide periods of uninterrupted sleep and rest

2) Avoid unnecessary activities 3) Respond efficiently to a crying infant. Provide comfort and treat the source of distress: wet, dirty diaper, hunger. 4) Provide divisional activities limited expenditure of energy. that require

5) Provide small frequent feedings.

DECREASING RISK FOR INFECTIONS

Ensure good hand washing by everyone.

Avoid exposure to ill children/care taker.

Monitor signs of infections; fever, cough, running nose, diarrhea, vomiting.

PROVIDING ADEQUATE NUTRITION 1) For older child Provide nutritious foods that the child likes, along with supplemental high calories snacks (milk shake, pudding). 2) For the infants High calorie formula (24-30 cal/oz) Supplement oral intake with naso-gastric feedings allow intake through the day with continuous nasogastric feedings at night.

REDUCING FEAR AND ANXIETY 1.Communicate the care plan and family 2) Educate the family about CHF and provide home care nursing referrals to reinforce teaching after discharge 3) Encourage question: answer question as able to or refer to another member of health care team.

FAMILY EDUCATION AND HEALTH MAINTENANCE

1) Teach the signs and symptoms of CCF

2) Teach medication: brand name and generic name, expected adverse effect, dose 3) Demonstrate medication administration 4) 4) With the family, design a medication administration time

schedule

6. Provide guidelines for when to seek medical help 7. Teach infant and child cardio-pulmonary resuscitation as needed 8. Reinforce dietary guidelines; provide a recipe to the parents on how to. Prepare high calorie formula

9. Reinforce ways to prevent infection

10.Make sure that follow up visits with health care providers is scheduled. 11.Educate the parents and family on infective endocarditis guidelines a provide them with written materials.

EVALUATION 1) Heart rate within normal range for age; adequate urine output

2) No unexpected weight gain

3) Clear lungs, normal respiratory rate and effort 4) Participates in diversional activities

COMPLICATION Pulmonary edema Metabolic acidosis Failure to thrive URI Arrhythmias Death