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NCM1o6 - CHF

NCM1o6 - CHF

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Published by: Edward Joseph P Acosta on Jan 30, 2012
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Chronic disorder in which the heart can no longer pump sufficient blood to meet metabolic demands of the body.

Types of Heart Failure  Forward Failure ² inadequate output of affected ventricle causes decrease perfusion to V/S  Backward Failure ² blood backs up behind the affected ventricle causes increase pressure in the atrium behind the affected ventricle  Low Output Failure ² not enough CO is available to meet demands of the body .

High Output Failure ² Occurs when condition causes the heart to work harder to met demands of the body Systolic Failure ² leads to problem with contraction & ejection of blood leads to problem with the heart relaxing & filling of blood Diastolic Failure ² .



Signs & Symptoms LEFT SIDED HEART FAILURE  Left ventricular hypertrophy Poor oxygen exchange Pulmonary edema Unproductive cough Dyspnea Dry hacking cough S3 heart sound RIGHT-SIDED HEART FAILURE Weight gain  Edema of dependent body parts  Anascarca  Jugular vein distention .

CARDIO  Cardiac enlargement  S3 sound Tachycardia  JVD CEREBRO  Light headedness  Dizziness  Confusion GI  Nausea  Enlarge liver  Ascites RESPI  Dyspnea  Orthopnea  Nocturnal dyspnea  Crackle RENAL  Decreased urinary frequency during the day  Nocturia .

DIAGNOSTIC TEST ‡ Chest X-ray ‡ ECG ‡ Echocardiography .

treatment for hf with electrical conduction defects  Internal cardiac defibrillator ² use to prevent dangerous heart rhythm  Heart pump (ventricular assistive device) .MEDICAL MANAGEMENT  Coronary artery revascularization with percutaneous angioplasty or bypass surgery ² if patient have underlying coronary artery disease  Cardiac resynchronization ² involving the use of left ventricular and biventricular pacing.

SURGICAL MANAGEMENT ‡ Heart valve replacement ‡ Coronary bypass surgery ‡ Heart transplant ‡ Myectomy .

PHARMACOLOGICAL MANAGEMENT ‡Intropics ‡Diuretics ‡Thiazide ‡Loop ‡Potassium-Sparing ‡Vasodilators ‡ACE Inhibitors .

Intropics Digitalis ² increase force of myocardial contraction help increase cardiac output Nursing Considerations Recognize therapeutic dose and toxic dose is narrow Observe signs of toxicity .

Diuretics 1. chloride and water o Adverse effects: Hypokalemia & Hyperkalemia Loop Diuretics o Furosemide (Lasix) o Promote excretion of sodium and water by blocking reabsorption in the Loop of Henle o Adverse Effects: Hypokalemia. Hyonatremia & Hyperglycemia . Thiazide Diuretics o Chlorothiazide (Diuril) & Hydrochlorothiazide (Hydro Diuril) o Promote excretion of sodium. 2.

weight.3. output. Potassium ² Sparing Diuretics Spironolactone (Aldactone) Inhibits action of aldosterone in the distal tubule ² leading to sodium excretion and potassium retention o Adverse Effects: Hyperkalemia o o Nursing Considerations Monitor intake. and serum electrolyte levels Caution patients to change positions slowly Administer diuretic in the morning .

Vasodilators o Hydralazine. dilating vessels. Nursing Consideration Advise patients taking nirates. Nitrates. causing pooling of blood & reducing resistance in the systemic arterial vessels. may experience headaches Remind patient to change positions slowly to prevent orthostatic hypotension . Prazosin o Vasodilator drugs: relax pulmonary arterial and venous vessels.

ACE Inhibitors o Captopril. Benazepril o Interrupt RAA cycle o These drugs promote vasodilation and diuresis by decreasing afterload and preload Nursing Consideration Carefully monitor patient for Hyperkalemia .

NURSING DIAGNOSIS ‡ Decreased cardiac output related to impaired inotropic state of the myocardium ‡ Impaired gas exchange related to increased pulmonary congestion secondary to increased left ventricular and diastolic pressure ‡ Excess fluid volume related to fluid retention secondary to decreased renal perfusion .

Salt restriction b. For decompensated patient the water intake is restricted by 1.Nursing Management o Providing supplemental oxygen at 2 to 4 L/min o maintain or improve oxygenation o Promote Rest and Activity o minimize O2 demand o Diet modification a.5 ² 2L per day  to avoid water retention and significant hyponatremia .

Avoid alcohol-can interact with cardiac agent and maycause cardiomyopathy oStop Smoking o causes vasoconstriction o Adherence and compliance to medication o Exercise should be base on the clinical condition and status as long as it will not cause show symptoms of decompensation o Caution for driving and traveling airplane o pressure changes o2 concentration o Promote pulmonary hygiene oreduce risk of atelectasis and pneumonia o Position the patient oto maximize chest exersion o Institute pressure ulcer prevention strategies .c.

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