Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle

CONGESTIVE HEART FAILURE

Learning Objective  Define Congestive Cardiac Failure (CCF)  Explain the pathophysiology of CCF  List the etiology of CCF  List the clinical manifestation of CCF  List the investigation done for CCF  List the medication for CCF  Identify nursing problem  Plan nursing care for the nursing problem

Congestive Cardiac Failure Definition:  Inability of the heart to pump enough blood to meet the metabolic demands of the body  It is a progressive chronic condition and can be one sided or both sided failure

Etiology          Coronary artery disease Myocardial infarction Cardiomyopathy Cardiac valve malfunction Congenital heart disease Hypertension Anemia Hyperthyroidism ± increase the metabolic rate Inflammatory disease of the heart (Endacarditis, Mycarditis, Pericarditis)

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Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle

CCF ± Pathophysiology  As heart¶s pumping power is weaker than normal, blood moves through the heart and body at a slower rate, and pressure in the heart increase The chambers of the heart respond by stretching to hold more blood to pump through the body. In time, the heart muscle walls weaken and are unable to pump as strongly As a result, the kidneys often respond by causing the body to retain fluid (water) and sodium thus the body becomes congested 

Left Sided Heart Failure (LVF) When Left ventricle muscle is damaged ± it fails to contract/pump with sufficient force When ventricle fails to circulate blood, the blood will back up in the lung Increase pressure in the pulmonary circulation Fluid moves into pulmonary tissue and alveoli

Right Sided Heart Failure (RVF) When Right Ventricular fails, it cannot accept all the blood returning to the heart The blood backs up to the tissue, causing congestion of viscera and peripheral tissue Edema of leg, ankles, liver, abdominal cavity

©Cassidy Rabong 2010 Prepared By: SN. CaR http://levocetirizinedihydrochloride.blogspot.com/

Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle

Clinical manifestation LEFT VENTRICULAR FAILURE o Dyspnea (breathing difficulty) o Orthopnea ± difficulty in breathing at rest or when lying flat in bed (supine position causes the fluid to back up in the lung) o Cough or whezzing o Frothy pink sputum o Crackles can be heart in the lungs o Paroxysmal Nocturnal Dyspnea ± waking up at night short of breath. When patient lies down, there is an increase in venous return from extremities, causes congestion of the heart, leading to pulmonary edema

Clinical Manifestations ± LVF  Cerebral hypoxia ± result of decreased cardiac output causes:  Anxiety  Irritability  Restlessness  Wheezing  Dizziness  Syncope  Fatigue  Weakness  Anorexia  Hypokalemia  Increase level of aldosterone  Clubbing of the fingers  Polycythemia  S3, S4 heart sound, Pulsus Alterans  Increase pulmonary arterial pressure, pulmonary capillary wall pressure  Confusion  Impaired memory  Insomnia (difficult to sleep)  Nocturia ± pass urine at night  Oliguria (less urine output 500 mls) ± late manifestation

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Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle

Clinical Manifestations RT VENTRICULAR FAILURE  Ankle edema to the legs, sacrum and scrotum  Patient with severe peripheral edema may develop  Serous exudates and bulae (bulla)  Hepatomegaly ± liver congestion  Ascites ± due to liver congestion  Neck vein engorgement  Portal hypertension  Splenomegaly (enlarge of the spleen)  Jaundice ± yellowish color  Hemolytic anemia  Internal hemorrhoids  Leg varicosities  Weight gain  S3 and S4 heart sound  Elevated CVP (Centre Venous Pressure)reading

Investigations Serum electrolytes, urea, and nitrogen Liver function test Arterial blood gases ± to evaluate gas exchange Kidney function test Chest X-Ray ± may show pulmonary vascular congestion, cardiomegaly ECG ± ventricular enlargement Echocardiography ± to evaluate left ventricular function Pulse oximeter reading may be less than 95% indicating decrease oxygen saturation Elevated PAP PCWP (LSF); elevated CVP (RSF)

©Cassidy Rabong 2010 Prepared By: SN. CaR http://levocetirizinedihydrochloride.blogspot.com/

Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle

Medications  To reduce cardiac work and improve cardiac function  Diuretics  Beta blockers (vasodilatation)  Digitalis ± Digoxin  Inotropes ± Dopamine, Dobutamine  Angiotensin ± converting enzyme (ACE) inhibitors Surgical Management  Heart Transplantation  Cardiomyoplasty

Nursing management o Assessment of patient ± general condition and vital sign o Spo2 monitoring o O2 Support - to relieve hypoxia and dyspnea o Position client - high fowler or chair to reduce pulmonary venous congestion o Position of leg ± dependant o Limit sodium and H2O intake ± for severe CCF, limit H2O to 1L/day o RIB (Rest In Bed)/CRIB (Complete Rest In Bed)

Nursing Diagnosis  Decreased cardiac output  Impaired gas exchange  Altered fluid and electrolyte balance related to fluid volume excess  Altered nutrition: less than body requirements  Risk for impaired tissue integrity  Activity intolerance  Sleep pattern disturbance  Fear /Anxiety

©Cassidy Rabong 2010 Prepared By: SN. CaR http://levocetirizinedihydrochloride.blogspot.com/

Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle

Breathlessness related to impaired pulmonary gas exchanged  Assess and record respiratory pattern include rate depth and rhythm.  Observe color of patient ± lips and nails  Reassure patient during distress episodes  Put patient in upright position supported with by pillow ± encourage lung expansion  Promote rest ± reduces oxygen demand  Administer Oxygen Therapy  Give medication as prescribed to reduce pulmonary oedema ± Diuretics  Strict intake and output chart Decreased Cardiac Output  Assess patient for sign of decrease cardiac output ± e.g. confusion, dizziness, irritability  Vital sign - Blood Pressure, Pulse Rate, Spo2 monitoring  ECG monitoring ± monitor sign of dysrhythmias  Monitor lung sound ± sign of crackles and coughing  Monitor intake and output ± detect sign of reduced renal perfusion  Medication as prescribed to increase myocardial contractility ± e.g. Dopamine, Digoxin  Promote rest to reduce myocardial workload and oxygen demand Self Care deficit related to fatigue / shortness of breath  Assess and record patient¶s level of tolerance to activities of daily living  Encourage patient to verbalize activities that increase fatigue or shortness of breath  Provide rest period between and during activities  Keep frequently used items within reach of patient  Give encouragement and promotes independence in activities within patient¶s limit  Assist patient in activities of daily living

©Cassidy Rabong 2010 Prepared By: SN. CaR http://levocetirizinedihydrochloride.blogspot.com/

Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle

Impaired Skin Integrity related to physical immobility  Assess and record skin integrity  Lift correctly to avoid dragging on the patient¶s skin  Use pressure relieving mattress as necessary  Encourage patient to move position frequently  If she/he is unable to do so, assist patient in changing position every 4 hourly and gently massage pressure area to promote blood circulation  Ensure bedclothes are smooth and free from crumbs  Change pampers or bed sheet when soiled  Keep skin clean and dry at all time

Inadequate nutritional intake related to loss of appetite  Assess nutritional status  Record all intake and output chart strictly  Observe and record for nausea and vomiting  Note vomitus for frequency, amount and color  Refer to dietitian  Advise on dietary supplements  Avoid process and canned food  Offer small and frequent diet  Plan meals with patient with meals as needed  Ensure pleasant environment

©Cassidy Rabong 2010 Prepared By: SN. CaR http://levocetirizinedihydrochloride.blogspot.com/

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