Congestive Heart Failure

CHF or Heart Failure is defined as the inability of the heart to maintain adequate circulation to meet the tissues need for oxygen and nutrients.

There are two types of heart failure: diastolic heart failure and systolic heart failure.

Diastolic results from impaired ventricular filling.

Systolic results from pump failure that is characterized by impaired contractility.

Heart Failure

Chronic Heart FailureAcute Heart Failure(Pulmonary Edema)

Diastolic HF (Alteration in ventricular filling)

Systolic HF(Alteration in ventricular contraction)

Left Side HF Right Side HF

Causes fromAtherosclerosisLeft sided heart failureCOPDValvular stenosisValvular insufficiencyPulmonary Hypertension

Causes from:AtherosclerosisFluid over loadIMValvular stenosisValvular insufficiencyHypertensionCardiac conduction defectsCardio myopathyInfectionImmune and connective disorderEndocrine imbalance

Left Side HF

Assessment Findings:

Dyspnea, orthopnea, nocturnal dyspnea, tachypneaCrackles, wheezes, rhonchi, coughHemoptysisGallop rhythm: S3, S4Palpitations, arrhythmias, disrhythmias, tachycardiaFatigueAnxietyDiaphoresisForthy sputum (blood-tinged)Anorexia

Right Side HF

Assessment Findings:

Jugular vein distentionAnorexia, nausea, vomitingAbdominal distention, ascitesHepatomegalyLiver and spleen enlargementDependent edema, peripheral edemaWeight gain Signs of left-sided heart failureTachycardia, fatigue, nocturiaElevated CVPnocturia

Diagnostic Tests:History and physical examinationBNP (a test to determine an increase in cardiac hormone production indicating heart failure)Chest x-ray – will show left ventricular hypertrophy & increase pulmonary congestion.ABG, CBC, serum electrolytes (decreased potassium) ECG Echocardiogram will show increased size of cardiac chambers and decreased wall motion. Hemodynamic monitoring

Left Side HF Right Side HF

Pharmacologic Therapy:

ACE inhibitors (angiotension converting enzyme inhibitors

are prescribed 1st for heart failure.) They are used for: Management of heart failure due to systolic disfunction. Promotion of vasodilation & diuresis by decreasing afterload &

preload. Prototype (Capoten) Captopril

(Vasotec) Enalapril

Alternatives for pt. who can not take ACE inhibitors: ARBS (Angiotensin II receptor blockers) Hydralazin & Isosorbide Dinitrate

Pharmacologic Therapy cont. :

Beta Blockers can be used with ACE inhibitors to reduce mortality & morbidity. They are contraindicated with pt. with severe or uncontrolled asthma. Medications:Carvedilol, Metoprolol, Bisoprolol

Diuretics (for treatment of edema)Loop diuretics for pt. with renal insufficiencyPotassium-sparing diuretic to inhibit sodium reabsorption Thiazides for mild treatment Side effects can cause electrolyte imbalanceMedications:Furosemide (Lasix)

Pharmacologic Therapy cont. :

Digitalis ↑ myocardial contraction and left ventricular output

increased CO ↓conduction through the AV node Caution: check for apical pulses before administration,

watch out for toxicity that can cause dangerous dysrhymias

Medications:Digoxin (Lanoxin)

Pharmacologic Therapy cont. :Calcium Channel Blockers Interfere with the ability of muscles to contract, leading to

vasodilation & reducing systemic vascular resistanceMedications:Amlodipine (Norvasc)Nifedipine (Procardia)Diltiazem (Cardizem)

Additional Medical Management: Avoid NSAIDs, decongestants, excessive amounts of fluids Keep low sodium diet (2-3 g / day) Oxygen therapy Administer analgesics (Morphine IV) & assess RR & keep Narcan

antidote available

Nursing Diagnoses

• Decreased cardiac output r/t altered myocardial contractility

• Activity intolerance r/t imbalance between oxygen supply and demand

• Excess fluid volume r/t excess fluid intake or sodium intake

• Anxiety r/t breathlessness and restlessness from inadequate oxygenation

Assess:

I. For s/s of pulmonary & systemic fluid over load (crackles, wheezes & peripheral edema)

II. Heart soundsIII. Daily weight and I&OIV. O2 saturation & ABGs

V. Review diagnostic tests (EKG, Chest x-ray, EEG)

VI. Review labs (BNP, BUN & creatinine, serum electrolytes, CBC)

Assist:

I. Keep pt. in semi-fowler position

II. Administer IV fluids, meds, O2 – per MD order

III. Encourage bed rest until stable

IV. Take VS before, during & after activity & medication administration

V. Help maintain diet & reduce oral fluids (no caffeine, low sodium, low cholesterol)

Teach:

I. Elevate legs when seated - to reduce/prevent edema

II. Recognize s/s of fluid overload

III. Anxiety controlling techniques when short of breath

IV. Add potassium to diet (if on non-potassium sparing diuretics)

V. Limit sodium & cholesterol intake

VI. Adverse effects of smoking

VII. Once stable, pt. should exercise for 30 min. 2-3 times weekly.

VIII. Medication’s side effects