Southern Luzon State University

College of Allied Medicine

Lucban, Quezon

Daryl Joyce S. Tenorio RLE (Medicine)

BSN III A Prof. Melena Quintos

Activity 1

HEART FAILURE

1. What will be the possible complications if these chronic diseases were not treated or
managed properly? Explain.
2. Formulate 3 NCP in order of priority for older person with chronic disease
(assigned to you)
3. In order to prevent complications, health education is one of the important
functions of a nurse, as a nursing student p prepare a teaching material (leaflet

What will be the possible complications if these chronic diseases were not treated or
managed properly? Explain.
 Heart failure also known as congestive heart failure, occurs when the heart muscle doesn't
pump blood as well as it should. Certain conditions, such as narrowed arteries in the heart
(coronary artery disease) or high blood pressure, gradually leave the heart too weak or stiff to fill
and pump efficiently. Some people's symptoms and heart function will improve with proper
treatment. However, heart failure can be life-threatening. People with heart failure may have
severe symptoms, and some may require heart transplantation or support with a ventricular assist
device. Heart failure is most often related to another disease or illness. The most common cause
of heart failure is coronary artery disease (CAD), a disorder that causes narrowing of the arteries
that supply blood and oxygen to the heart. Other conditions that may increase your risk for
developing heart failure include:

 Cardiomyopathy, a disorder of the heart muscle that causes the heart to become weak
 a congenital heart defect
 a heart attack
 Heart valve disease
 Certain types of arrhythmias, or irregular heart rhythms
 high blood pressure
 emphysema, a disease of the lung
 diabetes
 An overactive or underactive thyroid
 HIV
 aids
 Severe forms of anemia
 Certain cancer treatments, such as chemotherapy
 drug or alcohol misuse

DIFFERENT TYPES OF HEART FAILURE

Heart failure can occur in either the left or right side of your heart. It’s also possible for
both sides of your heart to fail at the same time. Heart failure is also classified as either diastolic
or systolic.

Left-sided heart failure

 Left-sided heart failure is the most common type of heart failure. The left heart
ventricle is located in the bottom left side of your heart. This area pumps oxygen-rich blood to
the rest of your body. Left-sided heart failure occurs when the left ventricle doesn’t pump
efficiently. This prevents your body from getting enough oxygen-rich blood. The blood backs up
into your lungs instead, which causes shortness of breath and a buildup of fluid.

Right-sided heart failure

The right heart ventricle is responsible for pumping blood to your lungs to collect
oxygen. Right-sided heart failure occurs when the right side of your heart can’t perform its job
effectively. It’s usually triggered by left-sided heart failure. The accumulation of blood in the
lungs caused by left-sided heart failure makes the right ventricle work harder. This can stress the
right side of the heart and cause it to fail.

Diastolic heart failure

Diastolic heart failure occurs when the heart muscle becomes stiffer than normal. The
stiffness, which is usually due to heart disease, means that your heart doesn’t fill with blood
easily. This is known as diastolic dysfunction. It leads to a lack of blood flow to the rest of the
organs in your body. Diastolic heart failure is more common in women than in men.

Systolic heart failure

Systolic heart failure occurs when the heart muscle loses its ability to contract. The
contractions of the heart are necessary to pump oxygen-rich blood out to the body. This problem
is known as systolic dysfunction, and it usually develops when your heart is weak and enlarged.
Systolic heart failure is more common in men than in women.

SYMPTOMS

Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).
Heart failure signs and symptoms may include:
  Shortness of breath (dyspnea) when you exert yourself or when you lie down
 Fatigue and weakness
 Swelling (edema) in your legs, ankles and feet
 Rapid or irregular heartbeat
 Reduced ability to exercise
 Persistent cough or wheezing with white or pink blood-tinged phlegm
 Increased need to urinate at night
 Swelling of your abdomen (ascites)
 Very rapid weight gain from fluid retention
 Lack of appetite and nausea
 Difficulty concentrating or decreased alertness
 Sudden, severe shortness of breath and coughing up pink, foamy mucus
 Chest pain if your heart failure is caused by a heart attack

DIAGNOSIS

An echocardiogram is the most effective way to diagnose heart failure. It uses sound
waves to create detailed pictures of your heart, which help your doctor evaluate the damage to
your heart and determine the underlying causes of your condition. Doctor may also perform
a physical exam to check for physical signs of heart failure. For instance, leg swelling, an
irregular heartbeat, and bulging neck veins may make your doctor suspect heart failure almost
immediately.

TREATMENT

Treating heart failure depends on the severity of your condition. Early treatment can improve
symptoms fairly quickly, but you should still get regular testing every three to six months. The
main goal of treatment is to increase your lifespan.

Medication

Early stages of heart failure may be treated with medications to help relieve your symptoms and
prevent your condition from getting worse. Certain medications are prescribed to:

 improve your heart’s ability to pump blood

 reduce blood clots
 reduce your heart rate, when necessary
  remove excess sodium and replenish potassium levels
 reduce cholesterol levels

Surgery

Some people with heart failure will need surgery, such as coronary bypass surgery. During this
surgery, your surgeon will take a healthy piece of artery and attach it to the blocked coronary
artery. This allows the blood to bypass the blocked, damaged artery and flow through the new
one. Heart transplants are used in the final stages of heart failure, when all other treatments have
failed. During a transplant, your surgeon removes all or part of your heart and replaces it with a
healthy heart from a donor.

PREVENTION

A healthy lifestyle can help treat heart failure and prevent the condition from developing in the
first place. Losing weight and exercising regularly can significantly decrease your risk of heart
failure. Reducing the amount of salt in your diet can also lower your risk.

Other healthy lifestyle habits include:

 reducing alcohol intake
 quitting smoking
 avoiding foods high in fat
 getting an adequate amount of sleep

COMPLICATIONS CAN INCLUDE:

 KIDNEY DAMAGE OR FAILURE. 

The kidneys filter waste and extra fluid out of your blood. Just like your other
organs, they need a steady supply of blood to work like they should. However, heart
failure weakens the heart's ability to pump blood so it can also reduce the blood
flow to the kidneys, which can eventually cause kidney failure if left untreated. Due
 to the fact that without the amount of blood they need, they won’t be able to remove
enough waste from your blood. In addition, decreased kidney function is common in
patients with heart failure, both as a complication of heart failure and other diseases
associated with heart failure such as diabetes. Studies suggest that, in patients with
heart failure, impaired kidney function increases the risks for heart complications,
including hospitalization and death. For the reason that damaged kidneys can't
remove as much water from the blood as healthy ones. Then it’ll start to hold onto
fluid, which boosts the blood pressure. Wherein high blood pressure makes your heart
work even harder. However, kidney damage from heart failure can require dialysis
for treatment.

 CONGESTION (FLUID BUILDUP)

In left-sided heart failure, fluid builds up first in the lungs, a condition called
pulmonary edema. Later, as right-sided heart failure develops, fluid builds up in the
legs, feet, and abdomen. Fluid buildup is treated with lifestyle measures, such as
reducing salt in the diet, as well as drugs, such as diuretics.

 HEART VALVE PROBLEMS. 

The valves of your heart, which keep blood flowing in the proper direction
through your heart, may not function properly if your heart is enlarged or if the pressure
in your heart is very high due to heart failure.

 HEART RHYTHM PROBLEMS. 

Heart rhythm problems (arrhythmias) can be a potential complication of heart

failure. There are several types of arrhythmias:

o Atrial fibrillation. A rapid quivering beat in the upper chambers of the heart. It is
a major cause of stroke, especially for people with heart failure. Atrial fibrillation
can also make other aspects of a patient's heart failure more difficult to manage.
 o Left bundle branch block. An abnormality in electrical conduction in the heart.
It develops in about 30 percent of patients with heart failure.
o Ventricular tachycardia and ventricular fibrillation. Life-threatening
arrhythmias that can occur in patients when heart function is significantly
impaired. Some patients with heart failure may be offered an implanted
defibrillator to protect them from these arrhythmias.

 ANGINA AND HEART ATTACKS

While coronary artery disease is a major cause of heart failure, patients with heart
failure are at continued risk for angina and heart attacks. Special care should be taken
with sudden and strenuous exertion, particularly snow shoveling, during colder months.

 LIVER DAMAGE. 

The liver breaks down toxins so the body can remove them. It also stores bile, a fluid
used to digest food. Heart failure can rob the liver of the blood it needs to work. Which can
lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can
lead to scarring, which makes it more difficult for your liver to function properly.

 CARDIAC CACHEXIA
If patients with heart failure are overweight to begin with, their condition tends to
be more severe. Once heart failure develops, an important indicator of a worsening
condition is the occurrence of cardiac cachexia, which is unintentional rapid weight loss
(a loss of at least 7.5 percent of normal weight within six months).
Formulate 3 NCP in order of priority for older person with chronic disease (assigned to you)
 ASSESSMENT DIAGNOSI PLANNING INTERVENTION RATIONALE EVALUATION
S
S: “Ano po ba Excess Fluid After 8 hours of nursing o Monitor urine output, noting o Urine output may be scanty After the nursing
pwedeng gawin? Volume related intervention the patient will amount and color, as well as and concentrated (especially intervention the patient
Namamaga po yung to sodium be able to verbalize time of day when diuresis during the day) because of
paa ko e” as intake as understanding of individual occurs. reduced renal perfusion.
verbalized by the evidenced by dietary/fluid restrictions.  “Opo sinusukat ko po
patient edema o Diuretic therapy may result lahat yung tubig na
o Monitor and calculate 24- in sudden increase in fluid iinumin ko kasama
Objective: hour intake and output (I&O) loss even though edema pati yung sa pagkain.
o Edema balance. Panay prutas at gulay
o Intake o Recumbency increases pati ang kinakain ko
exceeds o Maintain chair or bed rest in glomerular filtration and ngayon.” as
output semi-Fowler’s position during decreases production of verbalized by the
o 000000 acute phase. ADH, thereby enhancing patien.
diuresis.

o Establish fluid intake

schedule if fluids are o Involving patient in therapy
medically restricted, regimen may enhance sense
incorporating beverage of control and cooperation
preferences when possible. with restrictions.
Ice chips can be part of fluid
allotment.

o Weigh daily. Frequently o Documents changes edema

monitor blood urea nitrogen, in response to therapy. A
creatinine, and serum gain of 5 lb represents
potassium, sodium, chloride, approximately 2 L of fluid.
and magnesium levels.

o Inspect dependent body areas o Peripheral edema begins in

 for edema (check for pitting)
note presence of generalized
body edema (anasarca).
o Investigate reports of sudden
extreme dyspnea and air
hunger, need to sit straight
up, sensation of suffocation,
feelings of panic or
impending doom.
o Monitor BP and central
venous pressure (CVP)
o Obtain patient history to
ascertain the probable cause
of the fluid disturbance.
o Follow low-sodium diet
and/or fluid restriction such
as fresh fruits, like apples,
oranges, or bananas and any
fresh vegetables without
added butter or sauce.
o Encourage or provide oral
care.
feet and ankles and ascends
as failure worsens. Pitting
edema is generally obvious
only after retention of at
least 10 lb of fluid.
o May indicate development
of complications
(pulmonary edema and/or
embolus) and differs from
orthopnea paroxysmal
nocturnal dyspnea.
o Hypertension and elevated
CVP suggest fluid volume
excess and may reflect
developing pulmonary
congestion, HF.
o May include increased
fluids or sodium intake, or
compromised regulatory
mechanisms.
o The client senses thirst
because the body
senses dehydration. Oral
care can alleviate the
sensation without an
increase in fluid intake.
o Heart failure causes venous
o Change position frequently.
Elevate feet when sitting.
Inspect skin surface, keep
dry, and provide padding.
o Provide small, frequent,
easily digestible meals.
o Encourage verbalization of
feelings regarding limitations.
o Maintain fluid and sodium
restrictions as indicated.
congestion, resulting in
increased capillary pressure.
o Edema formation, slowed
circulation, altered
nutritional intake, and
prolonged immobility.
o Reduced gastric motility can
adversely affect digestion
and absorption.
o Expression of feelings may
decrease anxiety, which is
an energy drain that can
contribute to feelings of
fatigue.
o Reduces total body water
and prevent fluid
reaccumulation.
 ASSESSMENT DIAGNOSI PLANNING INTERVENTION RATIONALE EVALUATION
S
S: “Liyong liyo po ako Decreased After 8 hours of nursing o Auscultate apical pulse, assess o Tachycardia is usually present After 8 hours of nursing
at parang nanlalabo Cardiac Output intervention the patient will heart rate, rhythm. Document (even at rest) to compensate intervention the patient was
ang paningin” as related to be able to demonstrate dysrhythmia if telemetry is for decreased ventricular able to maintain vital signs
verbalized by the altered adequate cardiac output as available. contractility. within acceptable range.
patient myocardial evidenced by vital signs  P: 100 bpm
contractility as within acceptable limits o Palpate peripheral pulses. o Decreased cardiac output may
be reflected in diminished  R:17 bpm
Objective: evidenced by
radial, popliteal, dorsalis pedis,  BP: 130/100mmHg
elevated BP
and post tibial pulses.
 Diaphoresis
 Seen patient resting
 dyspnea o Monitor BP and pulse. o In early, moderate, or chronic comfortably.
HF, BP may be elevated
 Chest pain because of increased SVR.

 Dizziness o Kidneys respond to reduced

o Monitor urine output, noting
 Blurry Vission cardiac output by retaining
decreasing output and
concentrated urine. water and sodium.
Vital Signs
 P:130 bpm o Allows detection of left-sided
 R:14 bpm o Assess for abnormal heart and heart failure that may occur
lung sounds. with chronic renal failure.
 BP:
160/100mmHg o Decreased perfusion and
o Assess patient’s skin oxygenation of tissues
secondary to anemia and pump
temperature and peripheral
ineffectiveness may lead to
pulses.
decreased in temperature and
peripheral pulses that are
diminished and difficult to
palpate.

o Results of the test provide

 clues to the status of the
o Monitor results of laboratory disease and response to
and diagnostic tests. treatments.

o Provides information regarding

o Monitor oxygen saturation the heart’s ability to perfuse
and ABGs. distal tissues with oxygenated
blood

o Decreases the risk for

o Implement strategies to development of cardiac output
treat fluid and electrolyte due to imbalances.
imbalances.
o Reduces cardiac workload and
o Encourage periods of rest and minimizes myocardial oxygen
assist with all activities. consumption.

o Allows for better chest

o Assist the patient in assuming a expansion, thereby improving
high Fowler’s position. pulmonary capacity.

o Instruct patient to get adequate

bed rest and sleep. o To promote relaxation to the
body.
o Instruct the SO not to leave the
client unattended.
o To ensure safety and
o Provide quiet environment: reduce risk for falls that may
lead to injury.
explain
therapeutic management, help
patient avoid stressful o Psychological rest helps
situations, listen and respond to reduce emotional stress, which
expressions of feelings. can produce vasoconstriction,
elevating BP and increasing
heart rate.
 o Elevate legs, avoiding pressure
under knee. Encourage active
and passive exercises. Increase
activity as tolerated. o Decreases venous stasis, and
may reduce incidence of
thrombus or embolus
formation.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: “Hindi po ako Impaired Gas After 8 hours of nursing o Assess respiratory rate, use of o These are warning signs of After 8 hours of nursing
makahinga” as Exchange intervention the patient will accessory muscles, signs of increasing respiratory intervention the patient was
verbalized by the related to be able to Patient will be air hunger, lung excursion, distress that requires able to verbalize
patient fatigue and able to verbalize cyanosis, and significant immediate attention. “lumuwag luwag na po ang
decreased improvement in gas changes in vital signs. paghinga ko”
Objective: lung exchange.
expansion o Auscultate lung fields for
 Chest pain secondary to presence of crackles.
CHF o Decreased breath sound can
 Productive be a sign of fluid overload
cough o Monitor oxygen saturation or altered ventilation.
 Rales on and ABG findings.
auscultation o A pulse oximetry value of
92% or less, decreased
  Difficulty of PaO2, and increased
breathing o Observe color of skin, PaCO2 are signs of
mucous membranes decreasing oxygenation.
 Pale and nail beds, noting presence
conjunctiva, of peripheral cyanosis. o Cyanosis of nail beds may
nail beds and represent vasoconstriction
buccal mucosa o Position the patient in a High or the body’s response to
 Fatigue Fowler’s position with head fever/ chills.
of the bed elevated up to 90°.
Vital Signs o Promote
 P:130 bpm o Keep back dry. maximal inspiration,
 R:14 bpm enhance expectoration of
o Promote adequate rest secretions in order to
periods. improve ventilation.

o Keep environment allergen o To avoid coughing.

free
o Rest will prevent fatigue
o Administer oxygen therapy as and decrease oxygen
ordered. demands for metabolic
demands.

o To reduce irritant effects on

airways

o Patients with ADHF, high-

o Administer vasodilators as flow oxygen is given via
ordered. non rebreathing mask,
positive airway pressure
devices, or endotracheal
intubation and mechanical
 intubation.
 Hydralazine
o These medications increase
venous dilation and decrease
pulmonary congestion, that
will enhance gas exchange.

o Used in conjunction
 Nitrates with nitrates in patients who
cannot tolerate medications
such as ACE inhibitor/ARB
due to renal dysfunction.

o Acts as a coronary
o Have an airway emergency
vasodilator and used in
equipment available at the
combination with
bedside.
hydralazine.

o A likelihood of cardiac
arrest for patients with
severe decompensated heart
failure.