2 Congestive Heart Failure

CONGESTIVE HEART FAILURE

Definition: • Congestive heart failure

(CHF), or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs.

• Can be one sided or both sided failure

ETIOLOGY

A. Narrowed arteries that supply blood to the heart muscle — coronary artery disease

B. Past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle's normal work

C. High blood pressure

ETIOLOGY

D. Heart valve disease due to past rheumatic fever or other causes

E. Primary disease of the heart muscle itself, called cardiomyopathy.

F. Heart defects present at birth — congenital heart defects.

G. Infection of the heart valves and/or heart muscle itself — endocarditis and/or myocarditis

CCF-PATHOPHYSIOLOGY

LEFT SIDED HEART FAILURE (LVF)

Pulmonary EdemaThe most severe manifestation of Left The most severe manifestation of Left Heart Failure Heart Failure

Fluid leak into the pulmonary interstitial Fluid leak into the pulmonary interstitial spaces (Pulmonary congestion/edema)spaces (Pulmonary congestion/edema)

Hypoxia and poor 02 exchangeHypoxia and poor 02 exchange

CLINICAL MANIFESTATIONS (LVF)

LEFT VENTRICULAR FAILURE• Dyspnea • Orthopnea – difficulty in breathing

at rest or when lying flat in bed (supine position causes the fluid to back up in the lung)

• Cough or wheezing• Frothy pink sputum• Crackles can be heard in the

lungs• Paroxysmal Nocturnal Dyspnea –

waking up at night short of breath.

CLINICAL MANIFESTATIONS (LVF)

• Cerebral hypoxia- result of decreased cardiac output causes:

Anxiety Irritability Restlessness Confusion Impaired memory Insomnia• Nocturia- • Oliguria-late manifestation

RIGHT SIDED HEART FAILURE (RVF)

CLINICAL MANIFESTATIONS (RVF) Shortness of breath Swelling of feet and ankles Urinating more frequently at night Pronounced neck veins Palpitations (sensation of feeling the heart beat) Irregular fast heartbeat Fatigue Weakness Fainting Hepatomegaly - liver congestion Ascites –due to liver congestion

• Jugular venous distention• S3• Rales• Pleural effusion• Edema• Hepatomegaly• Ascites

• Fatigue and weakness • Irregular heartbeats .• Weight gain- due to retention of fluid

• Anorexia, nausea & bloating develop secondary to venous congestion of GIT

• Intestinal edema- causes mal-absorption of food and intestinal hypo motility.

Clinical Manifestations

21

Heart Failure Clinical manifestations : Pulmonary Congestion (L) and Systemic Congestion (R)

Right Heart Failure Left Heart Failure

Pulmonary fluid overloadPeripheral fluid overload

A. Serum electrolytes ,urea & nitrogen B. Liver function test C. Arterial blood gases – to evaluate gas

exchangeD. Kidney functions testE. Chest X-Ray – may show pulmonary

vascular congestion, cardiomegalyF. ECG – Ventricular enlargementG. Echocardiography– to evaluate left

ventricular function

CCF- INVESTIGATIONS

CCF-MEDICATIONS

to reduce cardiac work and improve cardiac function

a. Diuretics

b. Beta blockers.

c. Digitalis –Digoxin

d. Inotropes-Dopamine, Dobutamine

e. Angiotensin – converting enzyme inhibitors

SURGICAL MANAGEMENT

Heart Transplantation A heart transplant removes a damaged or

diseased heart and replaces it with a healthy one.

The healthy heart comes from a donor who has died. It is the last resort for people with heart failure when all other treatments have failed.

The most common procedure is to take a working heart from a recently deceased organ donor (allograft) and implant it into the patient. The patient's own heart may either be removed (orthotopic procedure) or, less commonly, left in to support the donor heart (heterotopic procedure).

• HEART TRANSPLANTATION

• Heart Transplantation

•CardiomyoplastyThis is a procedure in which skeletal muscles are taken from a patient's back or abdomen.

Then they're wrapped around an ailing heart.

This added muscle, aided by ongoing stimulation from a device similar to a pacemaker, may boost the heart's pumping motion.

Assessment of patient- general condition & vital sign

Spo2 monitoring O2 support-to relieve hypoxia &

dyspnea Position client-high fowler or chair to

reduce pulmonary venous congestion Position of leg –dependant Limit sodium & H2O intake- for severe

CCF patient ,limit H2O to 1L/day RIB

CCF-Nursing Management

a. Decreased cardiac output b. Impaired gas exchange c. fluid and electrolyte imbalance

related to fluid volume excess d. Imbalanced nutrition: less than body

requirementse. Risk for impaired tissue integrityf. Activity intoleranceg. Sleep pattern disturbance h. Fear/Anxiety

NURSING DIAGNOSIS

Assess and record respiratory pattern include rate depth and rhythm.

Observe color of patient – lips and nails.

Reassure patient during distress episodes.

Put patient in upright position supported with by pillows- encourage lung expansion.

Breathlessness related to impairedPulmonary gas exchange / impaired gas exchange related to pulmonary congestion

Promote rest – reduces oxygen demand.

Administer Oxygen therapy Give medication as

prescribed to reduce pulmonary edema.- Diuretics

Strict intake and output chart

Assess patient for sign of decreased cardiac output-e.g. confusion, dizziness, irritability

Vital sign –BP,PR & Spo2 monitoring

ECG monitoring-monitor for sign of dysrhythmias

Monitor lung sound-sign of crackles & coughing

DECREASED CARDIAC OUTPUT

DECREASED CARDIAC OUTPUT

Monitor IO -detect sign of reduced renal perfusion

Medication as prescribed to increase myocardial contractility- e.g Dopamine, Digoxin

Promotes rest to reduce myocardial workload & oxygen demand

Assess and record patient’s level of tolerance to activities of daily living.

Encourage patient to verbalize activities that increase fatigue or shortness of breath.

Provide rest period between and during activities

Keep frequently used items within reach of patient.

Give encouragement and promotes independence in activities within patient’s limit.

Assist patient in activities of daily living.

SELF CARE DEFICIT RELATED TO FATIGUE / SHORTNESS OF BREATH

Assess and record skin integrity. Lift correctly to avoid dragging on the

patient’s skin. Use pressure relieving mattress as necessary. Encourage patient to move position

frequently If she/ he is unable to do so, assist patient in

changing position every 4 hourly and gently massage pressure area to promote blood circulation.

IMPAIRED SKIN INTEGRITY RELATED PHYSICAL IMMOBILITY.

Ensure bedclothes are smooth and free from crumbs.

Change pampers or bed sheet when soiled.

Keep skin clean and dry at all time.

Impaired skin integrity related physical immobility.

Assess nutritional status. Record all intake and output chart

strictly. Observe and record for nausea and

vomiting. Note vomitus for frequency,

amount and color. Refer to dietitian Advise on dietary supplements Avoid process and canned food.

INADEQUATE NUTRITIONAL INTAKE RELATED TO LOSS OF APPETITE

Offer small and frequent diet. Plan meals with patient and dietitian. Assist patient with meals as needed. Ensure pleasant environment during

meals. Soft diet as tolerated.

INADEQUATE NUTRITIONAL INTAKE RELATED TO LOSS OF APPETITE