heart failure [recovered].ppt

7/30/2019 Heart failure [Recovered].ppt

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HEART FAILURE


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HEART FAILUREHeart failure (HF), often called congestive

failure (CHF) or congestive cardiac failure

occurs when the heart is unable to psufficient pump action to maintain blood fl

meet the needs of the body.


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DEFINITION

Congestive heart failure is a disorder that the heart is

maintain satisfactory cardiac output to meet the metabolic nbody (systolic failure) or is unable to receive blood in theduring diastole (diastolic failure)

OR

Congestive heart failure is defined as inability of themaintain an output at rest or during stress, necessary for thneeds of the body (systolic failure) and inability to receivethe ventricular cavities at low pressure during diastolefailure).


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CAUSES Ischaemic heart disease

Cigarette smoking

Hypertension (high blood pressure)

ObesityDiabetes

Valvular heart disease
http://en.wikipedia.org/wiki/Ischaemic_heart_diseasehttp://en.wikipedia.org/wiki/Tobacco_smokinghttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Tobacco_smokinghttp://en.wikipedia.org/wiki/Ischaemic_heart_disease


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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 erythematosu

Abuse of drugs such as alcohol and cocaine

Pharmaceutical drugs such as chemotherapeutic agents

Arrhythmias.

Obstructive sleep apnea (a condition of sleep wherein disorderebreathing overlaps with obesity, hypertension, and/or diabetesregarded as an independent cause of heart failure.
http://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Amyloidosishttp://en.wikipedia.org/wiki/Human_immunodeficiency_virushttp://en.wikipedia.org/wiki/Systemic_lupus_erythematosushttp://en.wikipedia.org/wiki/Obstructive_sleep_apneahttp://en.wikipedia.org/wiki/Obstructive_sleep_apneahttp://en.wikipedia.org/wiki/Systemic_lupus_erythematosushttp://en.wikipedia.org/wiki/Systemic_lupus_erythematosushttp://en.wikipedia.org/wiki/Human_immunodeficiency_virushttp://en.wikipedia.org/wiki/Amyloidosishttp://en.wikipedia.org/wiki/Myocarditis


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POOR CONTRACTABILITY OF

THE MOCARDIUM

INCREASES THE AFTERLOAD

SYSTOLIC

FAILURE

STIFF MYOCARDIUM

CAUSES INCREAS FLOW IN

THE LEFT ATRIUM

PULMONARY HEART FAILUR

DIASTOLICFAILURE


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ACUTE FAILURE


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CHRONIC FAILURE


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http://upload.wikimedia.org/wikipedia/commons/9/99/Heartfailure.jpg


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Left-Sided Heart Failure

Manifestationsinclude:Weakness

Fatigue

DizzinessConfusion

Pulmonarycongestion

Shortness of breat

Oliguria

Organ failure,

especially renalfailure

Death


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(L) SIDEDHFTissue hypoxia occurs because heart is unable to efficie

pump blood

CLINICAL SIGNS of pulmonary congestion:

Dyspnea Orthopnea

Cough WT. gainFatigue Anxiety/ restless

S3 Crackles

Cardiomegaly HR BP


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Right-Sided Heart Failure

Manifestations include:Distended neck veins, increased abdominal

girthHepatomegaly (liver engorgement)Hepatojugular refluxAscitesDependent edemaWeight: the most reliable indicator of fluid

gain or loss


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(R) SIDEDHFBlood BACKS UP into venous circulation. High oncot

pressure pushes fluids into tissues.CLINICAL SIGNS:

CVP SUDDEN WT. GAIN JVD DEPENDENT EDEMAFATIGUE LIVER CONGESTION

LETHARGY 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 smokingLoose weightAvoid alcoholAvoid or limit caffeineEat a low-fat, low-sodium dietExercise


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Lifestyle changes

Reduce stressKeep track of symptoms and weightand report any changes or concernto the doctor

Limit fluid intakeSee the doctor more frequently


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NURSING

CARE

NURSING MANAGEMENT


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NURSING MANAGEMENT

ASSESSMENT FINDINGS

Signs and symptoms of CHF vary somewhat depending

of the child age and on whether failure occurs on theright and left sided CHF (the usual condition) mayinclude:

1.Respiratory distress, marked by tachypnea, dyspnearetraction, nasal flaring, grunting .

2.Cough

3.Tachycardia

4.Ventricular gallop

5 P ll ttli i


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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


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14.Chest radiograph reveals cardiomegaly and pulmonary cong

15.Laboratory study result commonly reveal dilutional hy

hypochloremia and hyperkalemia

16.Assess response to medical treatment plan.

17.Document vital signs and oxygen saturation

18.Observe infant or child during feeding or activity. diaphoresis, need for frequent rest period and inability with peers

19.Follow growth chart


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NURSING DIAGNOSIS

Decreased cardiac output related to myocardial dysfuncti

Excess fluid volume related to decreased cardiac contradecreased excretion from the kidney

Impaired gas exchange related to pulmonary venous activity intolerance related to decreased cardiac output. Risk for infection related to pulmonary congestion

Altered nutrition, less than body requirement related tometabolic demands with decreased calorie intake

Anxiety related to child diagnosis and prognosis


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NURSING INTERVENTION

IMPROVING MYOCARDIALEFFICACY

1) Administer digoxin as prescribed.

Measure heart rate; holdmedication and notify health careprovider for hemi rate less than

90bpm .

Check most recent potassium level.Hold medications and notify healthcare provider for less than 3.5gmpotassium level.


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Run lead II ECG if ordered to monitor PR interval. If fA V block occurs, notify health care provider and hold meordered

Report signs of possible digoxin toxicity, vomiting, nauchanges, bradycardia.

Double check dose of digoxin with another nuradministering the dose. Make sure the digoxin ordersignatures.


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Administer after load reduction medications as prescribed .

Measure BP before and after giving the patient the medic

the medication and notify the health care provider for low than 15mm of Hg drop from baseline) .

Observe for other signs of hypotension, dizziness, light syncope.


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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 childredietary assistance as needed.

3) Fluid restriction- not usually needed in children.


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RELIEVING RESPIRATORY DISTRESS

1) Administer oxygen therapy as prescribed.

2) Elevate head end of bed

PROMOTING ACTIVITY TOLERANCE


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PROMOTING ACTIVITY TOLERANCE

1) Organize nursing care to provide periods ofuninterrupted sleep and rest

2) Avoid unnecessary activities

3) Respond efficiently to a crying infant. Providecomfort and treat the source of distress: wet,dirty diaper, hunger.

4) Provide divisional activities that requirelimited expenditure of energy.

5) Provide small frequent feedings.

DECREASING RISK FOR INFECTIONS


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DECREASING RISK FOR INFECTIONS

Ensure good hand washing by everyone.

Avoid exposure to ill children/care taker.

Monitor signs of infections; fever, cough, runninnose, diarrhea, vomiting.


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PROVIDING ADEQUATE NUTRITION

1)For older child

Provide nutritious foods that the child likes, alongwith supplemental high calories snacks (milk shake,pudding).

2) For the infants

High calorie formula (24-30 cal/oz)

Supplement oral intake with naso-gastric feedingsallow intake through the day with continuous naso-gastric feedings at night.


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REDUCING FEAR AND ANXIETY

1.Communicate the care plan and family

2) Educate the family about CHF and provide homecare nursing referrals to reinforce teaching afterdischarge

3) Encourage question: answer question as able to or

refer to another member of health care team.

FAMILY EDUCATION AND HEALTH MAINTENANCE


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FAMILY EDUCATION AND HEALTH MAINTENANCE

1) Teach the signs and symptoms of CCF

2) Teach medication: brand name and generic name, expect

adverse effect, dose

3) Demonstrate medication administration

4) 4) With the family, design a medication administration t

schedule


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6.Provide guidelines for when to seek medical help

7.Teach infant and child cardio-pulmonary resuscitation as n

8.Reinforce dietary guidelines; provide a recipe to the pareto. Prepare high calorie formula

9.Reinforce ways to prevent infection

10.Make sure that follow up visits with health care pscheduled.

11.Educate the parents and family on infective endocarditisa provide them with written materials.

EVALUATION


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EVALUATION

1)Heart rate within normal range for age; adequateurine output

2)No unexpected weight gain

3)Clear lungs, normal respiratory rate and effort

4)Participates in diversional activities


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COMPLICATION

Pulmonary edema

Metabolic acidosis

Failure to thrive

URI

Arrhythmias

Death


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heart failure [recovered].ppt

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