Patho-Congestive Heart Failure

Congestive Heart Congestive Heart FailureFailure

Right Sided Heart FailureRight Sided Heart Failure Left Sided Heart FailureLeft Sided Heart Failure

By: Andrew D. Beluso, By: Andrew D. Beluso, RNRN

CHFCHF

Inability of the heart to pump Inability of the heart to pump sufficientlysufficiently

The heart is unable to The heart is unable to maintain adequate circulation maintain adequate circulation to meet the metabolic needs to meet the metabolic needs of the bodyof the body

Classified according to the Classified according to the major ventricular dysfunction- major ventricular dysfunction- Left or Right Left or Right

CHFCHFEtiology of CHFEtiology of CHF

1. CAD1. CAD 2. Valvular heart diseases2. Valvular heart diseases 3. Hypertension3. Hypertension 4. MI4. MI 5. Cardiomyopathy5. Cardiomyopathy 6. Lung diseases6. Lung diseases 7. Post-partum7. Post-partum 8. Pericarditis and cardiac 8. Pericarditis and cardiac

tamponadetamponade

New York Heart New York Heart AssociationAssociation

Class 1Class 1 Ordinary physical activity Ordinary physical activity

does NOT cause chest pain does NOT cause chest pain and fatigueand fatigue

No pulmonary congestionNo pulmonary congestion AsymptomaticAsymptomatic NO limitation of ADLsNO limitation of ADLs


Class 2Class 2 SLIGHT limitation of ADLsSLIGHT limitation of ADLs NO symptom at restNO symptom at rest Symptom with Symptom with

INCREASED activityINCREASED activity Basilar crackles and S3Basilar crackles and S3


Class 3Class 3Markedly limitation on Markedly limitation on ADLsADLs

Comfortable at rest BUT Comfortable at rest BUT symptoms present in LESS symptoms present in LESS than ordinary activitythan ordinary activity


Class 4Class 4SYMPTOMS are present SYMPTOMS are present at restat rest

CHFCHF

PATHOPHYSIOLOGYPATHOPHYSIOLOGYLEFT Ventricular pump LEFT Ventricular pump failurefailure back up of blood back up of blood into the pulmonary into the pulmonary veinsveins increased increased pulmonary capillary pulmonary capillary pressurepressure pulmonary pulmonary congestioncongestion

CHFCHF

PATHOPHYSIOLOGYPATHOPHYSIOLOGYLEFT ventricular failureLEFT ventricular failure decreased cardiac decreased cardiac outputoutput decreased decreased perfusion to the brain, perfusion to the brain, kidney and other tissues kidney and other tissues oliguria, dizziness oliguria, dizziness

CHFCHF

PATHOPHYSIOLOGYPATHOPHYSIOLOGYRIGHT ventricular RIGHT ventricular failure failure blood pooling blood pooling in the venous in the venous circulation circulation increased increased hydrostatic pressurehydrostatic pressure peripheral edemaperipheral edema

CHFCHF

PATHOPHYSIOLOGYPATHOPHYSIOLOGYRIGHT ventricular RIGHT ventricular failurefailure blood blood poolingpooling venous venous congestion in the congestion in the kidney, liver and GITkidney, liver and GIT

LEFT SIDED CHFLEFT SIDED CHFASSESSMENT FINDINGSASSESSMENT FINDINGS

1. Dyspnea on exertion1. Dyspnea on exertion 2. PND2. PND 3. Orthopnea3. Orthopnea 4. Pulmonary crackles/rales4. Pulmonary crackles/rales 5. cough with Pinkish, frothy 5. cough with Pinkish, frothy

sputumsputum 6. Tachycardia6. Tachycardia

LEFT SIDED CHFLEFT SIDED CHFASSESSMENT FINDINGSASSESSMENT FINDINGS

7. Cool extremities7. Cool extremities 8. Cyanosis8. Cyanosis 9. decreased peripheral 9. decreased peripheral

pulsespulses 10. Fatigue10. Fatigue 11. Oliguria11. Oliguria 12. signs of cerebral 12. signs of cerebral

anoxiaanoxia

RIGHT SIDED CHFRIGHT SIDED CHFASSESSMENT FINDINGSASSESSMENT FINDINGS

1. Peripheral dependent, 1. Peripheral dependent, pitting edemapitting edema

2. Weight gain2. Weight gain 3. Distended neck vein3. Distended neck vein 4. hepatomegaly4. hepatomegaly 5. Ascites5. Ascites

RIGHT SIDED CHFRIGHT SIDED CHFASSESSMENT FINDINGSASSESSMENT FINDINGS

6. Body weakness6. Body weakness7. Anorexia, nausea7. Anorexia, nausea8. Pulsus alternans8. Pulsus alternans

CHFCHF

LABORATORY LABORATORY FINDINGSFINDINGS

1. CXR may reveal 1. CXR may reveal cardiomegalycardiomegaly

2. ECG may identify 2. ECG may identify Cardiac hypertrophyCardiac hypertrophy

3. Echocardiogram may 3. Echocardiogram may show hypokinetic heartshow hypokinetic heart

CHFCHF

LABORATORY FINDINGSLABORATORY FINDINGS4. ABG and Pulse oximetry 4. ABG and Pulse oximetry may show decreased O2 may show decreased O2 saturationsaturation

5. PCWP is increased in LEFT 5. PCWP is increased in LEFT sided CHF and CVP is sided CHF and CVP is increased in RIGHT sided increased in RIGHT sided CHFCHF

PCWPPCWP – Pulmonary CapillaryWedge – Pulmonary CapillaryWedge PressurePressure

CHFCHF

NURSING INTERVENTIONSNURSING INTERVENTIONS1. Assess patient's cardio-1. Assess patient's cardio-pulmonary statuspulmonary status

2. Assess VS, CVP and 2. Assess VS, CVP and PCWP. Weigh patient daily PCWP. Weigh patient daily to monitor fluid retentionto monitor fluid retention

CHFCHFNURSING INTERVENTIONSNURSING INTERVENTIONS

3. Administer 3. Administer medications- usually medications- usually cardiac glycosides are cardiac glycosides are given- DIGOXIN or given- DIGOXIN or DIGITOXIN, Diuretics, DIGITOXIN, Diuretics, vasodilators and vasodilators and hypolipidemics are hypolipidemics are prescribedprescribed

CHFCHF

NURSING NURSING INTERVENTIONSINTERVENTIONS

4. Provide a LOW sodium 4. Provide a LOW sodium diet. Limit fluid intake as diet. Limit fluid intake as necessarynecessary

5. Provide adequate rest 5. Provide adequate rest periods to prevent fatigueperiods to prevent fatigue

CHFCHF

NURSING INTERVENTIONSNURSING INTERVENTIONS6. Position on semi-fowler’s 6. Position on semi-fowler’s to fowler’s for adequate to fowler’s for adequate chest expansionchest expansion

7. Prevent complications of 7. Prevent complications of immobilityimmobility

CHFCHF

NURSING INTERVENTION AFTER NURSING INTERVENTION AFTER THE ACUTE STAGETHE ACUTE STAGE

1. Provide opportunities for 1. Provide opportunities for verbalization of feelingsverbalization of feelings

2. Instruct the patient about the 2. Instruct the patient about the medication regimen- digitalis, medication regimen- digitalis, vasodilators and diureticsvasodilators and diuretics

3. Instruct to avoid OTC drugs, 3. Instruct to avoid OTC drugs, Stimulants, smoking and alcoholStimulants, smoking and alcohol

CHFCHF

NURSING INTERVENTION NURSING INTERVENTION AFTER THE ACUTE STAGEAFTER THE ACUTE STAGE

4. Provide a LOW fat and 4. Provide a LOW fat and LOW sodium dietLOW sodium diet

5. Provide potassium 5. Provide potassium supplementssupplements

6. Instruct about fluid 6. Instruct about fluid restrictionrestriction

CHFCHF

NURSING INTERVENTION NURSING INTERVENTION AFTER THE ACUTE STAGEAFTER THE ACUTE STAGE

7. Provide adequate rest 7. Provide adequate rest periods and schedule periods and schedule activitiesactivities

8. Monitor daily weight and 8. Monitor daily weight and report signs of fluid report signs of fluid retentionretention

Thank You!Thank You!

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Patho-Congestive Heart Failure