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CHF 1
Running Head: CONGESTIVE HEART FAILURECongestive Heart FailureAdrianne BazoMontana Tech Nursing DepartmentNURS 1566 Core Concepts of Adult NursingMarch 14, 2008
 
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Noel Mathis RN, BSN, MSNCongestive Heart FailureCongestive heart failure occurs when there is a malfunction in thepumping action of either the left ventricle, right ventricle, or bothwhich causes blood to pool in the pulmonary arteries and/or veins.This pooling causes pulmonary congestion (fluid build up in the lungs),reduced cardiac output, increased strain on the heart, decreasedefficiency of the heart muscle contraction, reduced stroke volume,increased heart rate, and hypertrophy; leading to increased risk of cardiac arrest and a decreased blood supply to the rest of the body.Since blood is the oxygen/nutrient supply to the cells, the effects of CHF are systemic.Risk factors for developing CHF are disorders that increase cardiacworkload and disorders that disrupt the pumping ability of the heart.Examples of such diseases are, CAD, cardiomyopathy, acutemyocardial infarction, disease of the heart valves, fluid volumeoverload hypertension, COPD, pulmonary hypertension, and anemia.My patient had triple bypass surgery six years ago, so the cause of herCHF is most likely from acute myocardial infarction.The diagnosis of CHF is primarily made from a composite of patienthistory, physical exam, laboratory studies, and radiographs. Lab
 
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studies that indicate CHF are, low serum sodium and Hct fromhemodilution and inadequate oxygen levels in the arteries from poorpulmonary perfusion. The effects of CHF cause reduced renal funcitonproducing elevated blood urea nitrogen and creatinine levels.The treatment of CHF is directed on decreasing the effects of theunderlying causes. Pharmaceuticals are used to decrease excess fluid(diuretics), and improve cardiac output (ACE inhibitors, Beta-adrenergic blockers, inotropics, and nitrates). Nonpharmaceuticalinterventions to decrease cardiac workload and increase myocardialoxygenation include intra-aortic balloon pump, ventricular assistdevices, and biventricular pacing. Also a diet low in sodium isrecommended.My patient presents with peripheral edema, low SaO2 oxygenation,rales heard in the lower 2/3 of the posterior lungs, shortness of breath, low Hct (30.5), high total carbon dioxide, high Lactatedehydrogenase (778), and high natriuretic peptide (823). Lactatedehydrogenase and natriuretic peptide are indicators of tissue damageand degree of heart failure.
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