CACAPIT, LOVELY

HEART FAILURE
NDA
HEART FAILURE

Heart failure (HF) is a clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of
the ventricles to fill or eject blood. The term heart failure indicates myocardial disease in which impaired contraction of
the heart (systolic dysfunction) or filling of the heart (diastolic dysfunction) may cause pulmonary or systemic congestion.

RISK FACTORS

MODIFIABLE NON-MODIFIABLE

Smoking Age

High blood pressure Ethnic background

Diabetes Family history

Physical inactivity 

Being overweight 

High blood cholesterol. 

PATHOPHYSIOLOGY

Regardless of the etiology, the pathophysiology of HF results in similar pathophysiologic changes and clinical
manifestations. Significant myocardial dysfunction usually occurs before the patient experiences signs and symptoms of
HF such as shortness of breath, edema, or fatigue. As HF develops, the body activates neurohormonal compensatory
mechanisms. These mechanisms represent the body’s attempt to cope with the HF and are responsible for the signs and
symptoms that eventually develop (Porth, 2011). Understanding these mechanisms is important because the treatment for
HF is aimed at opposing them and relieving symptoms.
LEFT SIDED HEART FAILURE
Left-sided heart failure is caused by systolic or pumping dysfunction and this is typically due to some kind of damage to the
myocardium or the heart muscle which means it can't contract as forcefully and pump blood as efficiently. Pulmonary congestion
occurs when the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation. The
increased left ventricular end-diastolic blood volume increases the left ventricular end-diastolic pressure, which decreases blood flow
from the left atrium into the left ventricle during diastole. The blood volume and pressure build up in the left atrium, decreasing flow
through the pulmonary veins into the left atrium. Pulmonary venous blood volume and pressure increase in the lungs, forcing fluid
from the pulmonary capillaries into the pulmonary tissues and alveoli, causing pulmonary interstitial edema and impaired gas
exchange.

CLINICAL MANIFESTATION: “DROWNING”

Dyspnea

Rales (crackles)

Orthopnea

Weakness

Nocturnal Paroxysmal dyspnea

Increased Heart Rate

Nagging cough (frothy /blood tinged sputum)

Gaining weight

LAB/ DIAGNOSIS:

 Blood tests
 BNP
 Chest X-ray
 Electrocardiogram (ECG)
 Stress test
  CT scan or MRI
 Coronary angiogram
 Myocardial biopsy

MEDICAL TREATMENT:

 Take clients BP and HR right before administration

 Evaluate clients BP 30 mins post admin
 Monitor for dizziness and hypotension
 Monitor labs, especially potassium
 Note interactions between NSAIDS and antihypertensive medications
 Monitor digoxin labs and look for signs sx of digoxin toxicity.

 DIGOXIN
 DIURETICS
 ACE
 ARB
 LOW DOSE BETA BLOCKERS
 VASODILATORS; nitrates, milrinone
 Morphine sulfate
 Human B natriuretic peptide: acute episodes

NURSING DIAGNOSIS:

 Activity intolerance related to decreased CO

 Excess fluid volume related to the HF syndrome
 Anxiety-related symptoms related to complexity of the therapeutic regimem
 Powerlessness related to chronic illness and hospitalizations
 Ineffective family therapeutic regimen management

NURSING INTERVENTION

 Administer cardiac glycoside

 Monitor vitals
 Record intake and output
 Daily weights
 Meticulous skin care
 O2 therapy
 Teach about disease process
 Provide a low sodium low calorie diet
 Bland foods and small frequent meals

 Educate the client to maintain aseptic technique

 Instruct the client on how to administer IV antibiotics
 Have the client record temp daily for six weeks
 Encourage oral hygiene for six weeks with soft bristles toothbrush 2x daily
 Have the client clean any skin laceration and apply antibiotic ointment
 Client should use prophylactic antibiotics for oral procedures
 Teach the client the signs and symptoms of HF
RIGHT SIDED HEART FAILURE
When the right ventricle fails, congestion in the peripheral tissues and the viscera predominates. This occurs because the
right side of the heart cannot eject blood effectively and cannot accommodate all of the blood that normally returns to it
from the venous circulation. Increased venous pressure leads to jugular venous distention (JVD) and increased capillary
hydrostatic pressure throughout the venous system.

CLINICAL MANIFESTATION: “SWELLING”

Swelling of LEG, HANDS, & LIVER
Weight gain
Edema (pitting)
Large neck vein (JUGULAR VEIN DISTENTION)
Lethargic
Irregular Heart rate (a fib)
Nocturia (lying down allows fluid to go to kidneys)
Girth (extra fluid in abdomen so it increases in size)

LABS/ DIAGNOSIS:
 Blood tests
 BNP
 Chest X-ray
 Electrocardiogram (ECG)
 Stress test
 CT scan or MRI
 Coronary angiogram
 Myocardial biopsy

MEDICAL TREATMENT

 Take clients BP and HR right before administration

 Evaluate clients BP 30 mins post admin
 Monitor for dizziness and hypotension
 Monitor labs, especially potassium
 Note interactions between NSAIDS and antihypertensive medications
 Monitor digoxin labs and look for signs sx of digoxin toxicity.

 DIGOXIN
 DIURETICS
 ACE
 ARB
 LOW DOSE BETA BLOCKERS
 VASODILATORS; nitrates, milrinone
 Morphine sulfate
 Human B natriuretic peptide: acute episodes

NURSING DIAGNOSIS
 Activity intolerance related to decreased CO
 Excess fluid volume related to the HF syndrome
 Anxiety-related symptoms related to complexity of the therapeutic regimem
 Powerlessness related to chronic illness and hospitalizations
 Ineffective family therapeutic regimen management

NURSING INTERVENTION

 Administer cardiac glycoside

 Monitor vitals
 Record intake and output
 Daily weights
 Meticulous skin care
 O2 therapy
 Teach about disease process
 Provide a low sodium low calorie diet
 Bland foods and small frequent meals
 Educate client on signs of dig toxicity
 Have the client identify risks of acute episodes
  Educate the client on medications
 Notify HCP if side effects occur
 Call HCP if unable to take medication due to illness
 Avoid caffeine, alcohol, tea, cocoa, soda.
 Educate the client on a low sodium, low fat, low cholesterol diet
 Provide a list of potassium rich foods
 Educate on low fluid restriction
 Balance rest and activity
 Have them monitor daily weight
 Monitor signs of fluid retention
 No isometric exercise, it can overwork the heart.

Source: Brunner & Suddarths Textbook of Medical-Surgical 13th edition

 Right-sided Heart Failure

Peripheral edema Further backup of fluid and Liver congestion,

pressure into pulmonary ascites, etc
arteries, RV, RA, systemic
RAAS veins and tissues

Left-sided Heart failure

Fluid and pressure backup

in LV, LA & Pulmonary
veins & capillaries

Ejection fraction of left

ventricle due to muscle
weakness or increased
afterload
Pulmonary edema
DIASTOLIC DYSFUNCTION due to
decreased compliance of the left
ventricle

Shortness
of breath

Preload due to less filling

Stroke volume & Cardiac
because of stiffness of
Output ventricle

Fatigue and
Blood flow and O2 to others
chemoreceptors and symptoms
various tissues of the body

LA= left atrium; LV= left ventricle ; RA= right atrium; RV= right ventricle; RAAS = renin-angiotensin-aldosterone
system