COLLEGE OF NURSING Silliman University Dumaguete City

RESOURCE UNIT ON

CONGESTIVE HEART FAILURE

Submitted by: Diao, Airies Marie U.
NCM 10 ! "1

Submitted to: Asst. #ro$. A%arna
Clini&al Instru&tor

Date Submitted: 'une (), (01* COLLEGE OF NURSING Silliman University

Dumaguete City

+ision, A lea%ing C-ristian institution &ommitte% to total -uman %evelo.ment $or t-e /ell0 1eing o$ so&iety an% environment. Mission, 1. In$use into t-e a&a%emi& learning t-e C-ristian $ait- an&-ore% on t-e 2os.el o$ 'esus C-rist3 #rovi%e an environment /-ere C-ristian $ello/s-i. an% relations-i. &an 1e nurture% an% .romote%. (. #rovi%e o..ortunities $or gro/t- an% e4&ellen&e in every %imension o$ t-e University li$e in or%er to strengt-en &-ara&ter, &om.eten&e, an% $ait-. *. Instill in all mem1ers o$ t-e University &ommunity an enlig-tene% so&ial &ons&iousness an% a %ee. sense o$ 5usti&e an% &om.assion. 6. #romote unity among .eo.les an% &ontri1ute to national %evelo.ment.

Care o$ a #atient /it- Congestive 7eart 8ailure 9C78:
Placeme t: NCM 10

Time Allotme t: 6)0minutes To!ic De"c#i!tio : T-is to.i& %eals /it- t-e &are o$ &lient /it- Congestive 7eart 8ailure in&lu%ing its &on&e.ts, Ris; $a&tors, &auses, #at-o.-ysiology, ty.es o$ -eart $ailure, Clini&al Mani$estations, Com.li&ations, Nursing Assessment, Me%i&al Management an% Nursing Management. Ce t#al Ob$ecti%e: At t-e en% o$ t-e 6)0minute /ar% &lass, t-e learners s-all 1e a1le to gain a%e<uate ;no/le%ge, %evelo. an% en-an&e 1eginning s;ills an% A&<uire a .ositive attitu%e to/ar% t-e &are o$ &lient /it- C78. S!eci&ic Ob$ecti%e" At t-e en% o$ t-e .resentation, t-e learners s-all 1e a1le to, I* P#aye# 1 minute 1 minute >e&ture %is&ussion /it#o/er#oint .resentation ( minutes II* I t#oductio 1. De$ine t-e terms a..ro.riately an% a&&urately III* De&i itio O& Te#m" A* Co +e"ti%e Hea#t Failu#e 0 Ina1ility o$ t-e -eart to .um. su$$i&ient 1loo% to meet t-e nee%s o$ t-e tissues $or o4ygen an% nutrients. 0 T-e term 78 in%i&ates myo&ar%ial %isease in /-i&- t-ere is a .ro1lem /it- &ontra&tion o$ t-e -eart 9systoli& %ys$un&tion: or $illing o$ t-e -eart 9%iastoli& %ys$un&tion: t-at may or may not &ause .ulmonary or systemi& &ongestion. 0 In t-e .ast, 78 /as o$ten re$erre% to as &ongestive -eart $ailure 9C78:, 1e&ause many .atients e4.erien&e .ulmonary or .eri.-eral &ongestion. 0 7eart $ailure is not a %isease itsel$3 instea% t-e term re$ers to a &lini&al syn%rome &-ara&teri=e% 1y mani$estations o$ volume overloa%, ina%e<uate tissue .er$usion an% .oor e4er&ise toleran&e. Co te t T'L Acti%itie" TA E%aluatio (et)od At the end of the presentation, the learners shall be able to answer the questions appropriately: 1. What is the condition of CHF and how does it affect each system of our body? . !race at least two compensatory mechanisms that the body does when the condition e"ists. #. What is the difference seen between left$sided and ri%ht$sided heart failure?

er minute as t-e -eart &ontra&ts3 it is . ventri&ular /all &om. #reloa% is %etermine% 1y t-e &on%ition o$ t-e -eart valves 9es.ness o$ t-e ventri&le. cardiac insufficiency.o$ t-e ventri&ular myo&ar%ial $i1ers 5ust 1e$ore ventri&ular &ontra&tion. t-e elasti&ity o$ t-e aorta an% large arteries. I%enti$y at least t-ree 9*: ris.resentation . A$terloa% is %etermine% 1y t-e tone o$ systemi& arterioles.ene% or t-i&. T-is in%i&ates -o/ -ar% t-e -eart must .rimarily &ontrolle% 1y t-e autonomi& nervous system.ly getting ol%er in&reases your ris. 1 minute 0 0 0 0 0 0 0 (.0 Ot-er terms use% to %enote -eart $ailure in&lu%e cardiac decompensation. C* P#eload Re$ers to t-e stret&. . D* A&te#load T-e amount o$ tension t-e -eart must generate to over&ome systemi& .um.ressure an% to allo/ a%e<uate ventri&ular em.tying.lian&e an% venous tone. to $or&e 1loo% into &ir&ulation. E* Hea#t Rate T-e num1er o$ 1eats .* Co t#actility T-e $or&e o$ &ontra&tion an% is relate% to t-e status o$ t-e myo&ar%ium. an% t-e vis&osity o$ t-e 1loo%.e&ially mitral valve:. t-e si=e an% t-i&. $a&tors o$ &ongestive >e&ture IV* Ri".ene% -eart mus&le. and ventricular failure.resen&e o$ aorti& stenosis.Facto#" %is&ussion A* A+e /it0 Sim. o$ %amage% an% #o/er#oint narro/e% arteries an% /ea. 1loo% volume. . t-e .

-eart %isease /-i&. 0 .any &on%ition t-at in&reases eit-er t-e .ro%u&tion o$ estrogen %ro. >e&ture %is&ussion V* Cau"e" o& Hea#t Failu#e /itA* Ab o#mal Loadi + Co ditio " #o/er#oint 0 Is asso&iate% /it.s.ause 0 *.ause.s 1e&ause 1loo% %oes not leave t-e ventri&les * minutes .resentation . age 1e&omes a ris. A %iet t-at?s -ig. o$ -eart %isease.in $at.al&o-ol &an /ea. 0 T-e e$$e&t o$ in&reasing volume on t-e ventri&les &an 1e e4.ressure or t-e volume loa% o$ t-e ventri&le.roves >e&ture &ontra&tility.an% %e&rease% #o/er#oint &ontra&tion o&&urs.art 1e&ause t-eir 1o%y?s . Des&ri1e in o/n un%erstan%ing t-e %i$$erent &auses o$ -eart $ailure D* Li&e"tyle 0 Se%entary li$estyle or Ina&tivity is a ris.* Et) icity A$ri&an Ameri&ans -ave a -ig-er in&i%en&e o$ -eart $ailure.laine% 1y t-e analogy t-at t-e -eart mus&le is stret&-e% li.ment o$ -eart %isease. /-en t-e ru11er 1an% is overstret&-e% it %is&ussion 1e&omes lim1 an% &annot &ontra&t3 li. %evelo. venous return stret&-es t-e -eart an% im. salt an% &-olesterol &an &ontri1ute to t-e %evelo. in . 7o/ever. C* Ge de# Men are generally at greater ris. . 78 at an earlier age.en -eart mus&le an% lea% to -eart $ailure. $or a /oman in&reases a$ter meno. $a&tor at )).t to get -eart %isease.1loo% e4&essive stret&. $a&tor $or &oronary -eart %isease. -o/ever.e a ru11er 1an%. A$ter meno. t-e ris. 0 Drin.&ontri1ute to -eart %isease. 8or /omen.e/ise /-en t-e -eart is /itoverloa%e% /it.resentation 0 Overloa% %evelo. 0 #oor %iet.ing too mu&. /omen are more a.

regurgitation o$ mitral or tri&us.um.-ase some o$ t-e -eart mus&le is re. le$t0to0rig-t s-unts.tion. >ong term al&o-ol &onsum. 0 E4am. S&ar tissues %oes not move %uring &ontra&tion. 0 7eart $ailure &an 1e . meta1oli& an% en%o&rine -eart %iseases. A-en t-e -eart un%ergoes un%ue stress. Myo&ar%itis. an% %uring t-e -ealing . se.ervolemia. Car%iomyo. re%u&e t-e a1ility o$ t-e >e&ture %is&ussion 0 * minutes .tal %e$e&ts. In t-ese &lients a%e<uate &ar%ia& out. MI.les o$ &on%itions. t-is &om.no evi%en&e o$ -eart $ailure. 0 Myo&ar%ial $i1rils are in5ure% %uring an MI.* Ab o#mal (u"cle Fu ctio Disor%ers t-at im.ensatory me&-anisms.e volume a$$e&t t-e &ar%ia& mus&le@s a1ility to .re0e4isting mil% to mo%erate -eart %isease /it.reloa% ! -y.eri.ensatory me&-anism may .en%s on $un&tional &om.les o$ &on%itions. e$$e&tively.re&i. -ig.in&lu%e &onstri&tive . 0 Disor%ers t-at greatly restri&t &ar%ia& &-am1er $illing an% myo&ar%ial $i1er stret&. an% t-e ventri&les .itate% 1y &on%itions t-at in&rease &ar%ia& an% systemi& o4ygen %eman%.ut %e. less e$$i&iently.ona%e.la&e% 1y non&ontra&ting s&ar tissues.eri&ar%itis an% &ar%ia& tam. 0 C* Co ditio " t)at !#eci!itate )ea#t &ailu#e Some &lients -ave .air t-e &ontra&tile $un&tion o$ t-e myo&ar%ial $i1rils an% re%u&e ventri&ular $illing an% stro.at-y.i% valve • Con%itions t-at in&rease a$terloa% ! -y.0 %uring &ontra&tion.ertension.-eral vas&ular resistan&e . &oronary -eart %isease. E4am.um.. stenosis. • Con%itions t-at in&rease .rovi%e ina%e<ua&y an% t-e -eart $ails.

Dysr-yt-mias.a#d %e#"u" &o#. "e&ause t-e &ir&ulatory system is a &lose &ir&uit.ulmonary em1olism. E4am.airments o$ one ventri&le &ommonly .ulmonary veins. .resentation o$ -eart $ailure arises $rom ina%e<uate . /-i&. 0 >e$t0si%e% 8ailure or >e$t +entri&ular 8ailure • Results $rom le$t ventri&ular %ys$un&tion.ac-. se.en%en&eC.sis.es o$ -eart $ailure.a#d T-e &lini&al . Re$erre% to as Bventri&ular inter%e. im. into t-e le$t atrium an% into t-e . • Congestion in t-e .loa% o$ t-e -eart.resentation3 Con&e.-ysi&al or emotional stress.ulmonary &ongestion or e%ema.illary 1e% into t-e interstitium an% t-en t-e alveoli.ressure &auses $lui% e4travasation $rom t-e . . 0 . /it#o/er#oint .ulmonary &a. anemia.revents normal 1loo% $lo/ an% &auses 1loo% to 1a&. • T-e in&rease% .u.6.-eral tissues an% t-e vis&era %ominates t-is o&&ur 1e&ause t-e rig-t si%e o$ t-e -eart &annot e5e&t 1loo% an% &annot a&&umulate all t-e 1loo% t-at normally returns to it $rom t-e venous &ir&ulation.* . o$ 1loo% into t-e rig-t atrium an% venous &ir&ulation. 0 Rig-t0si%e% $ailure or rig-t ventri&ular $ailure • T-e . -o/ever.is mani$este% as . or in&rease t-e /or. u.rimary &ause o$ rig-t0si%e% $ailure is le$t0si%e% $ailure &ausing a 1a&..ing VI* Ty!e" O& Hea#t Failu#e A* LVF %e#"u" RVF 0 T-e t-eory o$ >+8 versus R+8 is 1ase% on t-e $a&t t-at $lui% a&&umulates 1e-in% t-e &-am1er t-at $ails $irst. /-i&.eri.ulmonary .rogress to $ailure o$ t-e ot-er.t Ma.les o$ Con%itions. me%i&ation %ose &-anges. Di$$erentiate an% i%enti$y t-e %i$$eren&e on t-e ty. 0 -eart to &ontra&t.

1eri1eri.o.um.er$usion. resulting in -y. "rie$ %es&ri. I%enti$y at least t/o &om.ooling o$ 1loo% 1e-in% t-e $ailing &-am1er. >e&ture %is&ussion 1( /itminutes #o/er#oint .-eral tissues %iminis-es.ulmonary &ongestion. %ilate% an% -y.ut $alls. As &ar%ia& out. VII* Pat)o!)y"iolo+y A* Pat)olo+y o& Ve t#icula# Failu#e /* Sy"tolic Failu#e 0 T-e most &ommon &ause o$ 78. ). #aget@s %isease. 8or/ar% $ailure ! is a . &ausing venous an% .ressure to e5e&t 1loo% $or/ar% t-roug.in&reases ventri&ular $illing .oor ventri&ular . out!ut 0 7ig-0out. is sim. results $rom an ina1ility o$ t-e -eart to .at-ology o$ ventri&ular $ailure (.ut. 0 T-e le$t ventri&le loses its a1ility to generate enoug.ressures. 1loo% an% is a %e$e&t in t-e a1ility o$ t-e ventri&les to &ontra&t 9. t-e .letely.ut to -ig-0out.t-e aorta.e volume an% &ar%ia& out.ut. T-e un%erlying %isor%er is relate% not to in&rease% meta1oli& nee% o$ tissues 1ut to .:.ly not a1le to meet t-e a&&elerate% nee%s o$ t-e 1o%y • Causes in&lu%e se./ar% $ailure ! $o&uses on t-e ventri&les ina1ility to e5e&t &om. anemia an% .t Ma.0 0 &ar%ia& out.er$usion o$ tissue &ells.ut $ailure o&&urs in most $orms o$ -eart %isease.um.at-o.ut $ailure o&&urs /-en t-e -eart.ing a&tion an% a lo/ &ar%ia& out. /-i&.um.-ie%. Tra&e t-e .ite normal0out.tion o$ t-e . "a&.ing .ensatory me&-anisms C* Hi+) out!ut %e#"u" lo. Overtime..ut levels.eri. t-e >+ 1e&omes t-in0/alle%.-ysiologi & $lo/ o$ t-e &on%ition 1.ro%u&es a %e&rease in stro.sis. or 1ot-.ro1lem o$ ina%e<uate . 1loo% $lo/ to vital organs an% .ertro. %es.resentation3 Con&e.regnan&y 0 >o/0out.ut.. It results /-en re%u&e% &ontra&tility .

onse to volume o$ 1loo% in t-e -eart at t-e en% o$ %iastole.-y an% a normal E8. ventri&ular -y. 1* (i2ed Sy"tolic a d Dia"tolic Failu#e ' Mi4e% Systoli& an% Diastoli& 8ailure is seen in %isease su&.tying &a.ulmonary .$illing . Normal e5e&tion $ra&tion is greater t-an ))D o$ t-e ventri&ular volume.er&entage o$ total ventri&ular $illing volume t-at is e5e&te% %uring ea&. 0 0 0 0 0 . T-e %iagnosis o$ %iastoli& $ailure is 1ase% u.. o$ systoli& %ys$un&tion is %e&rease in t-e le$t ventri&ular e5e&tion $ra&tion0 t-e . T-e %egree o$ stret&.liant ventri&les an% results in venous engorgement in 1ot. Diastoli& $ailure is &-ara&teri=e% 1y -ig.oor systoli& $un&tion 9/ea.ressures in t-e -eart &-am1ers9usually t-e le$t ventri&le: is elevate% over time.in res.on t-e . 0 T-e mus&le $i1ers o$ t-e -eart stret&.romise% 1y %ilate% le$t ventri&ular /alls t-at are una1le to rela4. it o&&urs /-en .ertension.oor $illing an% em. -ig.ulmonary -y. an% 1iventri&ular $ailure 91ot.atients -ave e4tremely .oor E8s less t-an *)D.ene% mus&le $un&tion: is $urt-er &om.resen&e o$ .ventri&ular &ontra&tion.ressures %ue to sti$$ or non&om.as %ilate% &ar%iomyo.ulmonary vas&ular systems.systemi& an% .a&ity:. . %e&rease $illing o$ t-e ventri&les /ill result in %e&rease% stro. 0* Dia"tolic Failu#e Is an im.* Com!e "ato#y (ec)a i"m" /* Ve t#icula# Dilatio 0 Enlargement o$ t-e &-am1ers o$ t-e -eart. T-ese .e volume an% CO.ressures.0 0 T-e -allmar.is .at-y 9DCM:3 a &on%ition in /-i&.ventri&les may 1e %ilate% an% -ave .ertro.ulmonary &ongestion.aire% a1ility o$ t-e ventri&les to rela4 an% $ill %uring %iastole.

mus&le $i1ers. /-i&.ensatory me&-anism. i$ stret&-e% 1eyon% a &ertain .0 relate% to t-e $or&e o$ t-e &ontra&tion ! 8ran.eri.&onverts angiotensin to angiotensin I.loa% o$ t-e alrea%y $ailing -eart.may initially in&rease CO 1ut t-ere is an in&rease in venous return to t-e -eart /-i&.-eral vaso&onstri&tion /-i&.i%ney %e&reases.ine. 0* Sym!at)etic e#%ou" "y"tem acti%atio T-e $irst me&-anism triggere% in t-e lo/0CO status.er$orman&e.eri.-rine an% nore. 7o/ever %ilation -as limits as a &om. 1loo% $lo/ to t-e .onse to an ina%e<uate stro. Angiotensin I is su1se<uently &onverte% to angiotensin II &ausing t-e a%renal &orte4 to 9RAAS:. T-e vaso&onstri&tion &auses an imme%iate in&rease in .oint 1e&ome ine$$e&tive an% a %ilate% -eart re<uires more o4ygen. Starling >a/. over time t-ese $a&tors a&t in a %etrimental $as-ion 1y in&reasing t-e myo&ar%ium@s nee% $or o4ygen an% t-e /or.is alrea%y volume overloa%e% /orsening t-e ventri&ular . 1* Neu#o)o#momal Re"!o "e As t-e CO $alls. sense% 1y t-e 5u4taglomerular a.results to so%ium an% /ater retention • In&rease% . -o/ever. /-i&.. t-ere is in&rease% SNS a&tivation resulting in t-e in&rease% release o$ &ate&-olamine@s 9e. • release al%osterone /-i&.reloa%.in&reases 0 0 0 0 0 .i%ney as %e&rease% volume.onse t-e .e volume an% CO. 7o/ever. In res.roves CO .aratus in t-e . In res.ine. is t-e least e$$e&tive me&-anism.-eral vaso&onstri&tion3 Initially t-is in&rease in 7R an% &ontra&tility im.-rine: t-is results in an in&rease 7R an% myo&ar%ial &ontra&tility an% .i%neys release renin.

ro%u&tion o$ en%ot-elin /-i&.0 0 0 0 .onse to over/or.t 3* Hy!e#t#o!)y An in&rease in t-e mus&le mass an% &ar%ia& /all t-i&.le$t an% rig-t0si%e% -eart $ailure "# >o/ CO &ause a %e&rease in &ere1ral .ress &ar%ia& $un&tion 1y &ausing &ar%ia& -y. • T/o &yto.onse to various $orms o$ &ar%ia& in5ury 9MI:.tion in t-e renal tu1ules &ausing /ater retention an% t-ere$ore in&rease% 1loo% volume.in01 9I>01: $urt-er %e.osterior .resentation3 Con&e.ituitary se&retes anti%iureti& -ormone 9AD7: in&reases /ater rea1sor.loa%. an% #roin$lammatory &yto.ertro. Tumor ne&rosis $a&tor 9TN8:..ersistent %ilation an% t-us $urt-er in&reases t-e &ontra&tile . 7y. . 0 0 0 >e&ture %is&ussion ) minutes /it#o/er#oint .. t-en t-e .ressure. It o&&urs slo/ly 1e&ause it ta.ines. myo&ar%ial %ys$un&tion an% ventri&ular remo%eling. Enumerate at least t/o &lini&al mani$estations on 1ot.o/er o$ t-e mus&le $i1ers lea%ing to an in&rease in CO an% maintenan&e o$ tissue .-y #roin$lammatory &yto. an% angiotensin II. &ontra&tile %ys$un&tion an% myo&yte &ell %eat-. 2enerally $ollo/s .-y.es time $or t-is in&rease% mus&le tissue to %evelo. en%ot-elin.. • En%ot-elin results in arterial vaso&onstri&tion an% an in&rease in &ar%ia& &ontra&tility an% -y.oor &oronary artery &ir&ulation. AD7.ines are release% 1y &ar%ia& myo&ytes in res. A&tivation o$ t-e SNS an% t-e neuro-ormonal res.ertro.oor &ontra&tility. angiotensin II.ines toget-er t-ese $a&tors result in an in&rease &ar%ia& /or. . &ate&-olamine@s. T-e .onse lea% to elevate% levels o$ &ate&-olamines.ertro.ing res. al%osterone.er$usion.ro%u&e% 1y vas&ular en%ot-elial &ells3 it is stimulate% 1y AD7.-i& -eart mus&le -as .is . re<uires more o4ygen to /or. an% interleu. an% strain.ness in Ma.er$usion .

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>e&ture %is&ussion * minutes .

resentation3 Con&e.t . I%enti$y at least $our assessment >e&ture %is&ussion 6 minutes /it#o/er#oint .t Ma. /it#o/er#oint .li&ations &ause% 1y -eart $ailure.ing F. Enumerate at least t/o &om..resentation3 Con&e.E.

$in%ings in .ing .rovi%ing &are to &lients /itC78.. Ma.

ing ..>e&ture %is&ussion ) minutes /it#o/er#oint .t Ma.resentation3 Con&e.

G.ortant me%i&al management . "rie$ly %is&uss t/o im.

) minutes .

C78. I%enti$y at least t/o nursing management in t-e &are o$ &lient /it.VIII* Cli ical (a i&e"tatio " 10. .

-eart1eats Oliguria ! release o$ renin lea%s to al%osterone se&retion an% in&rease% intravas&ular volume No&turia ! /-en t-e .ulmonary vessels.um.la&e% a. • Dys.illaries into t-e . • Ort-o.! initially %ry an% non.utum.nea 9#ND: ! t-e $rig-tening sensation o$ su$$o&ation.ing t-e &ar%ia& /or. t-e 1loo% volume an% . • #aro4ysmal no&turnal %ys.i&al im.osition in&rease t-e amount o$ 1loo% returning $rom lo/er e4tremities to t-e -eart an% lungs.ression o$ t-e res.soun%s ! .ulse • #ulsus alternans ! alternating strong an% /ea.ulmonary venous 1loo% volume an% .irations may 1e la1ore% an% /-ee=ing3 a &om1ination o$ t-e in&rease% venous return to t-e lungs an% su.0 0 0 0 A* Le&t'Sided Hea#t Failu#e #ulmonary Congestion ! t-e le$t ventri&le &annot e$$e&tively .ressure in&reases $or&ing $lui% $rom t-e .ing /it.large <uantities o$ $rot-y ! 1loo%0 tinge% ! s.%e&reases 1loo% $lo/ $rom t-e .ulmonary &a.atient is slee.nea or s-ortness o$ 1reat.la&e% 1y 1loo% or interstitial $lui%. • A%ventitious 1reat..les • >o/ o4ygen saturation levels Car%iovas&ular Mani$estations • E4tra -eart soun% BS*C or ventri&ular 2allo.ro%u&tive3 it may 1e&ome moist an% -a&.nea ! %i$$i&ulty 1reat-ing /-en lying $lat3 su. ! large volume o$ $lui% entering t-e ventri&le • Enlarge% or le$t laterally %is.loa% is .ine . res. • Coug.re&i.! may 1e . out 1loo% out o$ t-e ventri&le into t-e aorta an% systemi& &ir&ulation.ressure in t-e le$t atrium in&reases /-i&.ulmonary tissues an% alveoli.iratory &enter.itate% 1y minimal to mo%erate a&tivity3 t-ere is %e&rease in t-e lung@s air volume as air is %is.ulmonary &ra&. .

eri.nea.ness 0 re%u&e% &ar%ia& out. &lammy s. irrita1ility.roving renal .ortal vessels may $or&e $lui% into t-e a1%ominal &avity Anore4ia an% nausea ! venous &ongestion o$ t-e gastrointestinal tra&t Aea. 7e.0 0 0 0 %e&rease% im.eri.illary 1e%s an% into interstitial s.ut lea%s to -y.oto4i& tissues an% slo/ removal o$ meta1oli& /astes . %i==iness.aire% &ir&ulation an% ina%e<uate removal o$ &ata1oli& /aste .-eral 1loo% vessels to &onstri&t..in ! SNS stimulation &auses .roteins an% $lui% s-i$ts out o$ t-e &a.er$usion. %ys. t-e lo/er legs #itting e%ema ! venous &ongestion in t-e .ut. restlessness. Cere1ral 7y.ose . #ale. an% &on$usion. #al. 2oo% . 4o#.ness ! ina%e<uate &ar%ia& out.a&es.lasma .atomegaly an% ten%erness in RUH ! venous engorgement o$ t-e liver As&ites ! in&rease .* Ri+)t'Sided Hea#t Failu#e 'ugular +enous Distention ! In&rease +enous #ressure In%e.en%ent e%ema ! early mani$estations 1egin in $eet an% an.les an% moves u.ressure o$ .ro%u&ts $rom tissues Aeig-t gain C* Ne.ressure over/-elming t-e o.-ysi&al a&tivity %oes not &ause un%ue $atigue.-eral vas&ular 1e%s &auses in&rease% -y%rostati& &a.itations ! SNS stimulation 8atigue an% Mus&ular /ea.Hea#t A""ociatio Failu#e Cla""i&icatio o& Hea#t P#o+ o"i " 0 0 0 0 0 0 0 0 Cla""i&icati o Si+ " a d Sym!tom" I • Or%inary . &ool.ressure /it-in t-e .illary . im.o4ia • An4iety.

II • • • • • • III • • • I+ . .itations No .toms "asilar &ra&.ressure in t-e .ulmonary or .eri. 2oo% 8air #oor I5* 0 Com!licatio " A* Pleu#al E&&u"io Results $rom in&reasing .-ysi&al a&tivity /ill &ause sym.toms at rest 1ut in&rease% . t-e organi=e% s. es.leural s.at-/ay.olari=ation 9&ontra&tion or systole: no longer o&&urs. t-is enlargement 9stret&-ing o$ t-e atrial an% ventri&ular tissues: may &ause an alteration in t-e normal ele&tri&al . A transu%ation o$ $lui% o&&urs $rom t-ese &a.e% limitations on AD> #atient $eels less &om$orta1le at rest 1ut less t-an or%inary a&tivity /ill &ause sym.rea% o$ atrial %e.e&ially in t-e atria. A-en numerous sites in t-e atria $ire s.illaries into t-e .-eral &ongestion #atient is &onsi%ere% asym.illaries.les an% S* murmur may 1e %ete&te% Mar. T-is loss o$ atrial 0 0 .toms o$ &ar%ia& insu$$i&ien&y at rest.orts no sym.a&e.tomati& Usually no limitations o$ AD>s Slig-t limitation on AD>s #atient re.ontaneously an% ra.leural &a.* Dy"#)yt)mia" C-roni& 78 &auses enlargement o$ t-e &-am1ers o$ t-e -eart.toms Sym.al.i%ly 9atrial $i1rillation:.

ulse .i&al .toms o$ 78 &an 1e &onsi%ere% in t-e &om. 0 C* Le&t Ve t#icula# T)#ombu" T-e enlarge% le$t ventri&le an% %e&rease CO &om1ine to in&rease t-e &-an&e o$ t-rom1us $ormation in t-e le$t ventri&le.ulmonary venous &ongestion. 1. 1y &al&ulating t-e .ulse $or one minute • Monitor &lients res.ortional .iratory rate. • A-en o1taining "#.ressure.i%neys an% &an lea% to renal insu$$i&ien&y or $ailure. D* He!atome+aly Can lea% es.er$usion to t-e . • Note $or . RR usually e4&ee%s I(01reat-sJmin.um. r-yt-m an% &-ara&ter. A less t-an ()D in%i&ates severely &om.e a.&ontra&tion &an re%u&e CO 1y 10D to (0D.resen&e o$ a%ventitious 1reat.onents o$ t-e syn%rome. note t-e . O1tain vital signs.ro.romise% CO.er$usion an% . Nu#"i + A""e""me t A* P)y"ical A""e""me t T-e signs an% sym. 8ailure o$ t-e le$t ventri&le as a . /it. t-e liver 1e&omes &ongeste% /it.e&ially /it.venous 1loo%.resen&e or a1sen&e o$ an aus&ultatory ga.anies &-roni& 78 results in %e&rease% .soun%s an% e4tra -eart soun%s 0 0 5* 0 . Systoli& "# ! Diastoli& "# Systoli& "# • Ta. E* Re al Failu#e T-e %e&rease CO t-at a&&om.rig-t ventri&le $ailure.%e&rease% tissue .

8ailure o$ t-e rig-t ventri&le as a . in&lu%ing so%ium. .$ul in %iagnosing le$t ventri&ular $ailure.ertro.a&ute %ys. &-lori%e. .airment o$ renal $un&tion &auses elevate% "UN. /it. E* Ot)e# dia+ o"tic A""e""me t 0 0 0 0 0 0 0 0 0 0 .e. Weight is the most reliable source of fluid gain or loss.-y or %ilation.ate .en%ent e%ema A&&urate %aily /eig-ts are nee%e% to %o&ument $lui% retention. an% &reatinine &learan&e levels. (.nea3 it is . Im.re&or%ium an% note $or an in&rease in si=e. "0ty.onse to %e&rease CO $rom eit-er le$t or rig-t ventri&ular %ys$un&tion. 7o.systemi& venous &ongestion. serum &reatinine. &lients /-o are more -o. D* Radio+#a!)ic A""e""me t C-est 40rays &an 1e -el. magnesium.e&i$i& gravity.e$ul ten% to $eel 1etter an% are more so&ially involve%. veins $or %istention an% measure a1%ominal girtE4amine t-e &lient $or %e. an% &al&ium. Urinalysis may reveal . Assess t-e ne&. ty.resenting -y.e natriureti& .i&ally t-e -eart is enlarge% re.roteinuria an% -ig.um.s.0 #al.ti%e 9"N#: is use% $or %iagnosing 78 in &lients /it.art o$ t-e neuro-ormonal res.* P"yc)o"ocial A""e""me t Assess &lient an% $amilies $or an4iety an% %e.ression. C* Labo#ato#y A""e""me t Regular evaluations o$ &lient@s serum ele&trolytes.e is a ma5or %eterminant o$ /ell01eing $or &lients in 78.otassium.

ut.roves &ontra&tility. • 8or -y.o4emia.t-e atrioventri&ular no%e3 it also im.-y.78. Di+o2i %igitalis gly&osi%es -ave 1een use% $or more t-an (00 years an% remain t-e mainstay in t-e treatment o$ 78.nea an% to im.$ul in %iagnosing t-e . in5ury or in$ra&tion 1ut it is not -el. an% any %egree o$ myo&ar%ial is&-emia. in&reasing le$t ventri&ular out.artial re1reat-er mas.a $lo/ rate o$ F to 10 >Jmin &an 1e use% to %eliver o4ygen &on&entrations o$ 60D to E0D.rovi%e% to relieve -y.also en-an&es %ieresis. &-am1er enlargement an% ventri&ular -y.&on&entrations o$ O4ygen 1y mas.rove o4ygen0&ar1on %io4i%e e4&-ange.otassium level is measure% at intervals 1e&ause t-e 0 0 5I* 0 0 0 0 .0 /* Elect#oca#dio+#am6ECG7 May %emonstrate ventri&ular -y.-y an% &an %etermine t-e e5e&tion $ra&tion. /-i&. In&reases t-e $or&e o$ myo&ar%ial &ontra&tion an% slo/s &on%u&tion t-roug.s /it.eri&ar%ial e$$usion. 1* (ulti+ated a +io+#a!)ic 6(UGA7 "ca " #rovi%e in$ormation a1out le$t ventri&ular e5e&tion $ra&tion an% velo&ity..ertro.ertro.o4ia an% %ys. 0* Ec)oca#dio+#a!)y Use$ul in %iagnosing &ar%ia& valvular &-anges.i&ally lo/ in &lients /it.lemental O4ygen ! -ig.* P)a#macolo+ic T)e#a!y 1. .resen&e or e4tent o$ 78. /-i&. (edical (a a+eme t A* Im!#o%e Ve t#icula# Pum! Pe#&o#ma ce Su. T-e serum . or &annula are . Dysr-yt-mias.are ty. . .

• #otassium0s.otassium.tying. "y vaso%ilation.atients /it. a -ormone t-at &auses t-e .tion mainly in t-e as&en%ing loo. it re%u&es resistan&e to le$t ventri&ular e5e&tion o$ 1loo%.ressure an% %e&reasing . %iureti&s ! su&.o.otassium.ulmonary &ongestion.aring %iureti& ! S. o$ 7enle. In .as metola=one 9 Karolo4yn:3 in-i1it so%ium an% &-lori%e rea1sor.&an -el. T-ree most &ommon %iureti&s given.loa% o$ t-e -eart. • T-ia=i%e %iureti&s ! su&.e$$e&t o$ Digo4in is en-an&e% in t-e .loa% an% im. 1* Diu#etic" #res&ri1e% to remove e4&ess e4tra&ellular $lui% 1y in&reasing t-e rate o$ urine .reloa% /-i&.roving ventri&ular em. T-is %iureti& in&reases t-e e4&retion o$ .ironala&tone 9Al%a&tone:3 1lo&. %iminis-ing t-e -earts /or. t-e e$$e&ts o$ al%osterone in t-e late %istal tu1ule an% &olle&ting %u&t C* Nut#itio al T)e#a!y 0 0 0 . ACE in-i1itors stimulate t-e .toms o$ $lui% overloa%. T-is %iureti& in&reases t-e e4&retion o$ .as $urosemi%e 9lasi4:3 8irst to 1e given an% in-i1it so%ium an% &-lori%e rea1sor.alemia an% Digo4in to4i&ity may o&&ur. • >oo.i%neys to e4&rete so%ium an% $lui% t-ere1y re%u&ing le$t ventri&ular $illing .tion mainly in t-e early %istal tu1ules. ACE in-i1itors %e&rease t-e se&retion o$ al%osterone.i%neys to retain so%ium an% /ater. 0 0* ACE I )ibito#" #romote vaso%ilation an% %iuresis 1y %e&reasing a$terloa% an% .ro%u&e% in .sym. %e&rease t-e /or.romoting %iuresis.resen&e o$ -y.

Dietary restri&tion o$ so%ium re%u&es $lui% retention an% t-e sym.re%is.* Reduce Fluid Rete tio Instru&t to &ontrol so%ium inta.revent. • It is 1est t ta.toms o$ .. Nu#"i + (a a+eme t A* Reduce P#eload8a&te#load Re%u&e #reloa% t-roug. • Dire&t %ilation o$ veins • Dilation o$ arterioles • Com1ine% a&tion on veins an% arterioles • In-i1ition o$ ACE .s in t-e 1at-room &an 1e ta. >imit 8lui% inta.otassium are im.ortant.0 0 A lo/ so%ium 9( to * gJ%ay: %iet an% avoi%an&e o$ %rin.e an% a%-ere to so%ium restri&tion on %iet to .eri.osing t-e &lient to %igitalis to4i&ity. /-i&.in&lu%e t-e $ollo/ing. &ontrol. at nig-t.t-ey are e$$e&tive it must 1e a%ministere% &autiously 1e&ause o$ t-eir si%e e$$e&t .lements an% a%e<uate %ietary . 8rom t-e use o$ loo. or eliminate e%ema.o. %iureti&s -y.vaso%ilation agents an% it varies in t-eir me&-anisms o$ a&tions.. #otassium su.s %e&rease myo&ar%ial /or.en at %ay3 avoi%ing interru.e to 1 literJ%ay t-e reason t-at e4&essive /ater ten%s to %ilute t-e amount o$ so%ium in t-e 1o%y $lui%s.ing e4&essive amounts o$ $lui% are usually re&ommen%e%.ro$ile.e %iureti&s at morning so t-at tri.alemia may o&&ur an% sensiti=es t-e myo&ar%ium to %igitalis an% . Re%u&e a$terloa% t-roug.%iureti&s3 alt-oug.-el.tion o$ slee.ulmonary &ongestion 1y %e&reasing t-e amount o$ &ir&ulating 1loo% volume /-i&.-eral an% . C* Po"itio t)e clie t 5II* 0 0 0 0 0 .

9DO7: an% t-e "ureau o$ 8oo% an% Drugs 9"8ND: -ave no/ aut-ori=e% a -ealt.nea. o$ -eart %isease.-ysi&al a&tivities outsi%e in e4treme &ol%.-ysi&al a&tivity.rotein a %ay.&laim lin.er$orming . a lea%ing resear&-er. a&tivities • Avoi% . t-e a&tivity i$ s-ortness o$ 1reat-.atient s-oul% 1e given t-e $ollo/ing sa$ety gui%elines. • En% /it.tion o$ soy .i%ly.8o/ler .as .lie% $or t-e &laim.e#ed by eati + "oy !#otei : DOH T-e De. t-e .. • Ensure t-at you are a1le to tal.a $e/ minutes o$ /arm0u. De&rease t-e intensity o$ t-e a&tivity. -ot.erio%. T-e S&lean Com.-ysi&al a&tivity3 i$ you &annot %o so. 0 5III* A otated Readi +" 0 Hea#t di"ea"e #i".rotein ingre%ients.la&e% in a -ig. D* (o ito# &o# ade9uate ca#diac out!ut "e$ore un%erta.lo. • Sto.en%ent .&ool0%o/n a&tivities an% a &ool0%o/n .eter o$ soy . or %i==iness %evelo.osition as mu&. a. T-e legs are maintaine% in a %e. T-e -ealt. • "egin /it. %uring t-e .s.-ysi&al a&tivity. elevating t-e legs in&reases venous return ra.osition or &-air to re%u&e .artment o$ 7ealt.ing . • Aait ( -ours a$ter eating a meal 1e$ore .ulmonary venous &ongestion an% to relieve %ys. .er$orming t-e .ing t-e &onsum.ain. or -umi% /eat-er. as .&laim language all rea% B() grams o$ soy .ossi1le3 t-ey s-oul% not 1e elevate%.0 0 T-e &lient is .art o$ a %iet lo/ in saturate% $at an% &-olesterol may re%u&e .any. manu$a&turer an% mar.rotein01ase% $oo%s re%u&e% t-e ris.

rotein may also e4ert ot-er 1ene$i&ial &-anges t-at may re%u&e t-e ris. In t-e #-ili.nine 8ili. Moreover. . B7o/ever. in&lu%ing restoring normal 1loo% vessel elasti&ity.. o$ -eart %isease.roval o$ a similar &laim in t-e US 1y t-e 8oo% an% Drug A%ministration in 1GGG.t-roug.rotein an% may -el.t-e ris. &ar%iovas&ular %isease is t-e lea%ing &ause o$ %eat-. BT-is is a 1rea.er sai%.Ameri&a.e to stress t-at it is also essential to re&ogni=e t-e im.. "ra=il an% Sout.ut -ealt. o$ -eart %isease. 7eart %isease ris.. Similar soy . As a result o$ t-is aut-ori=ation.&laim in$ormation on t-eir $oo% an% 1everage la1els.lies grams o$ soy .$or -eart -ealt. as an anti0 &oagualant to re%u&e 1loo% &lotting.inos -ave t/o or more mo%i$ia1le $a&tors on &oronary -eart %isease. S&lean Mar./it.&laim $ollo/s t-e a.orea.rove% in .. $oo% manu$a&turers in t-e #-ili.ine Star.ro&ess asso&iate% /it.rotein -eart -ealt. T-e #-ili.rotein. /e /oul% li. also .also suggest t-at soy .ing it easier $or &onsumers to %etermine /-i&$oo%s an% 1everages &ontains soy .. a&ting as an antio4i%ant to in-i1it t-e o4i%ation .&laims -ave also 1een a.revention o$ &ar%iovas&ular %iseaseC s-e a%%e%.rotein ! DO7.inos %ying every -our.C Lristine 2au. one in (0 a%ult 8ili.. #er&ent resear&. . 9 Anonymous. De&em1er *1:. 9(00G.etitione% 1y t-e S&lean Com.eting Communi&ations Manager.ortan&e o$ t-e total %iet in t-e .."0): .in t-e #-ili.ines.-eart %isease..ines.revent -eart %isease. ma. T-is -ealt.Claims initiative in (00(. lo/ere% 1y eating soy . A serving o$ 9name o$ $oo%: su.any an% t-e UL 1y t-e 'oint 7ealt.ines /ill no/ 1e a1le to .

:.s. Elsevier Saun%ers 9. St.1 6G ! 1 G:.16*( ! 16*E:. '. >ouis. 9(00G:. M 7a/.7. "la&. . MO. M 7a/.s.M... >ouis..e%. Elsevier Saun%ers 9. '.. Medical-Surgical Nursing: Clinical Management For ositive !utcomes. 9(00G:. "la&. '..M. St..7..e%. 9Ft. 9Et.:.. Medical-Surgical Nursing: Clinical Management For ositive !utcomes. MO.5IV* 5V* O!e Fo#um E%aluatio Resour&es. '.

.. D. 9.F(6 ! F*F:. >i. 9(010:.. Anonymous. "are. #-ila%el.. M..ins.in&ott Ailliams M Ail.. Medical Surgical Nursing: "ssessment and Management of Clinical roblems #th $d.em. De&em1er *1:.>.man. M.sen. >ouis Missouri. M "u&-er.-ia. 91(t. Elsevier Saun%ers. #A.Surgical Nursing: Critical %hin&ing for Collaborative Care 'th $d. 9(00G... .. (runner ) Suddarth*s %e+tboo& !f Medical-Surgical Nursing. >. '. /!. M Aor.F(1 0F** : Ignatavi&ius.le.ine Star..C. 9(00E:. L. St. M.. T-e #-ili. . S. 9... Mos1y Elsevier. 9(00 :.7. St. M C-eever. Dir.>e/is. >ouis Missouri. 7in."0) . #... E6G 0 E 1: Smelt=er. Medical .. S. 7eit. 9.e%. 2. O?"rien. >.2. Arti&le.. D. >. ".:.er. R. S..eart disease ris& lo-ered by eating soy protein .