CONGESTIVE HEART FAILURE

A Case Study
Presented To
Cauayan District Hospital

In Partial Fulfilment
of the Course Requirement for the Subject
NCM112 RLE

Submitted by:
Acob, Bradly George
Benitez, Justin Dominic
Buholst, Maria Aisel
Diego, Rochelle
Fernandez, Mary Grace
Lagdamen, Rovilyn
Mayo, Leah Mie
Nera, Melody
Pascual, Kim
Saldival, Melisa

September 2023

Minante I, Cauayan City, Isabela

I. INTRODUCTION

Congestive heart failure (CHF) is a progressive syndrome that reduces the patient's quality of life
while putting a financial strain on the health-care system. Despite advances in the control of
cardiovascular diseases such as myocardial infarction (MI), the incidence and prevalence of CHF
continue to rise. An accurate estimate of disease burden is difficult to obtain due to the large number
of patients with asymptomatic left ventricular (LV) dysfunction. As the population ages, there is an
epidemiological shift toward a higher prevalence of clinical heart failure with preserved LV function,
also known as stiff-heart syndrome. In fact, heart failure with preserved systolic function may
account for up to two-thirds of cases in patients over the age of 70. For all patients over the age of 40,
the lifetime risk of developing heart failure is approximately 20% regardless of age.

Despite the rising prevalence, novel screening techniques and therapeutic approaches have improved
the prognosis for patients with heart failure by focusing not only on symptom control but also on
improving the pathophysiology toward a corrective phenotype. This review examines both
established and emerging therapeutic approaches, with a focus on the practical implications. Based
on the available literature and clinical trials, the primary emphasis will be on systolic dysfunction,
with a brief discussion of heart failure with preserved systolic function following.

II. NURSING PROCESS

A. ASSESSMENT

1. Personal Data
Name Patient Y
Age 70
Sex Female
Civil Status Married
Occupation House wife
Address Mabini St. District 1, Cauayan City Isabela
Date of birth August 23, 1953
Place of birth Mabini St. District 1, Cauayan City Isabela
Nationality Filipino

2. Family history of health and illness

Minante I, Cauayan City, Isabela

 or - Deceased
or - Heart disease
- Male
- Female

3. History of past illness

Patient Y, who has been admitted to CDH since September 2, 2023, is experiencing body
weakness, positive bipedal edema, generalized edema, and difficulty of breathing. This patient
is also currently dealing with an allergic reaction to certain medications. In terms of medical
history, Patient Y had a heart disease at the age of 22 in 1975. Despite having a healthy
childhood with no illnesses, she received all the required vaccinations. Furthermore, 30 years
ago, she underwent a cholecystectomy surgery to remove her gallbladder.

4. History of present illness

Patient Y reports experiencing occasional difficulty breathing, body weakness, and generalized
edema. She mentions that these symptoms are not frequent, but sometimes she also
experiences chest pain, particularly during arguments with her husband due to
misunderstandings. Patient Y adds that her children scold her when she engages in strenuous
activities at home, as it may trigger chest pain.

5. Physical Assessment (IPPA)

a. Use 13 Areas of Assessment for patients 6 yrs old and above

Body parts Methods Finding Interpretatio Rationale

n
Head Inspection Head is Normal Naturally, the
symmetrically normal head shape
rounded with no when viewed from
Palpation lesions. above should look
like an egg,
slightly wider at
the back than the
front.

•Normal head
No presence of Normal appearance has no
tenderness or lesions and
masses. tenderness and no
signs of
abnormalities
around the head

Scalp and hair Inspection Lighter in color Normal Healthy scalp

than the should be clear of

Minante I, Cauayan City, Isabela

 Palpation complexion Can flakes and
be moist or oily irritation or
No scars noted redness, and it
Can be black, should be free of
brown Evenly dryness, or any
distributed signs of infection,
covers the whole or disruption of
scalp the skin on the
No evidence of scalp." Any
alopecia May be itchiness, irritation
thick or thin, or burning
coarse or smooth sensations might
Neither brittle be signs of an
nor dry unhealthy scalp.

Face Inspection Face is Normal •Restlessness may

symmetrical happen indirectly
Palpation due to PHN, a
complication of
shingles that
No presence of Normal involves lingering
tenderness
Masses •The face of the
client appeared
smooth and has
uniform
consistency and
with no presence
of nodules or
masses.

Eyes Inspection Conjunctiva is Abnormal Yellow

yellow discoloration of
the conjunctiva
may be the
indication of
Palpation Normal jaundice.
No masses or
bulging Normal eyes has
no bulging or
masses and there's
no indication or
exophthalmos or
bulging Lin the
eyes
Ears Inspection Ears are equal in Normal Many variations in
size size and shape
exist within the
label of "normal
Palpation ear", but in
general, the
normal ear is one

Minante I, Cauayan City, Isabela

 which all the
structures (helix,
antihelix, tragus,
antitragus,
scaphoid/triangula
r fossa, and
external auditory
canal) are all
present and well
formed.

No masses Normal Normal ears upon

palpations are free
from tenderness,
lesions and
masses.

Nose Inspection She can breathe Normal Normal findings

Palpation normally in both might be
Percussion nostrils. No documented, nose
presence of is symmetrical
discharge and with no
tenderness. discoloration,
Frontal and swelling or
maxillary sinuses malformations.
are non-tender to Nasal mucosa is
palpate. Sinuses pinkish red with
are non-tender to no
percuss. discharge/bleeding
, swelling,
malformations or
foreign bodies. No
sinus pain noted.
Nose is patent
with good air
flow.

Mouth Inspection Lips is smooth Normal Signs of

dehydration
Palpation No suspected
lesions Normal
Upper and lower
No masses on gums. They
tongue and gums should appear
symmetrical,
moist and pinkish,
with well-defined
margins. Dark-
skinned people
may have a
melanotic line
along the gum

Minante I, Cauayan City, Isabela

 margin. And
healthy dorsal
tongue is
symmetrical, pink,
moist, and slightly
rough from the
papillae, possibly
with a thin,
whitish coating.

Neck Inspection Neck is Normal The trachea

symmetric should be midline,
Normal neck and there should
movement not be any
noticeable
enlargement of
Palpation Normal lymph nodes or
No masses or the thyroid gland
lumps with normal range
of motion

"Lymph nodes, if
palpable, should
be round and
movable and
should not be
enlarged or tender
Lungs Inspection/auscultatio Difficulty of Abnormal This may indicate
(Anterior/posterior n breathing; Rr the need for
) 18cpm immediate
Normal intervention.
Percussion Resonance Resonant
percussion note:
heard over a
normal air -filled
lung. Dull
percussion note
(the sound heard
over solid tissues)

Heart Inspection The apical pulse Normal The external chest

(Precirdium), is visible is normal in
Anterior chest Palpation Upon palpation appearance
there is no without lifts,
Auscultation vibrations heaves, or thrills.
No extra heart PMI is not visible
sounds and and is palpated in
murmurs heard. the 5th intercostal
space at the
midclavicular line
Palpation includes
assessing the

Minante I, Cauayan City, Isabela

 arterial pulse,
measuring blood
pressure, palpating
any thrills on the
chest, and
palpating for the
point of maximal
impulse. Arterial
pulse: When
palpating the
arterial pulse, the
examiner should
be able to gather
the rate, rhythm,
and
characteristics.
Usually performed
using a
stethoscope,
although louder
heart murmurs and
vascular
abnormalities can
sometimes be
audible w/o the
aid of a
stethoscope.
Auscultation of
the heart can help
gather an
understanding of
cardiac rate
rhythm, condition
of the valves, as
well as possible
anatomical
abnormalities,
such as congenital
defects or an
underlying chronic
condition.
Swollen abdomen
can be due to
underlying
conditions.

Abdomen Inspection Swollen Swollen abdomen

abdomen can be due to
Abnormal underlying
Auscultation Gurgling bowel conditions.

Minante I, Cauayan City, Isabela

 sound 10 per Auscultation of
minute Normal the abdomen is
Percussion performed
Tympanic sound Normal
over air-filled for detection of
Palpation stomach/intestina altered bowel
l section. sounds, rubs, or
Abnormal vascular bruits.
Enlarge liver Normal peristalsis
creates bowel
sounds that may
be altered or
absent by disease.
Irritation of
serosal surfaces
may produce a
sound (rub) as an
organ moves
against the serosal
surface.
Atherosclerosis
may alter arterial
blood flow so that
a bruit is
produced.
The anterior gas-
filled abdomen
normally has a
tympanic sound to
percussion, which
is replaced by
dullness where
solid viscera,
fluid, or stool
predominate. The
flanks are duller as
posterior solid
structures
predominate, and
the right upper
quadrant is
somewhat duller
over the liver.
Due to adults
conditions.

Nails Inspection Light yellow Abnormal This may indicate

nailbeds jaundice.
Capillary Refill
Palpation time: 3 seconds Normal Normally skin has
Absence of no lesions and

Minante I, Cauayan City, Isabela

 lesions and masses on the
masses on the surface and it is
surface of the dry and moist
skin and dry,
skin folds, moist

Skin Inspection Yellow Abnormal May indicate

discoloration of jaundice and with
Palpation the skin Normal signs of edema
Absence of
lesions and Normally skin has
masses on the no lesions and
surface of the masses on the
skin and dry, surface and its dry
skin folds, moist. and moist.

6. Laboratory and diagnostic procedures

Nursing
Analysis and
responsibilities
Diagnostic/ Date Indication interpretation
Result of prior to,
laboratory ordered/ date / results
during, and
procedure done/ Purposes (related to the
after the
disease) procedure
RBC count September 2, Can show if 3.08 A low RBC
2023 you have count in heart PRIOR
anemia, or low failure patients • Assessin
levels of red can exacerbate g the
blood cells, their symptoms, patient
which can as it further • Explain
worsen heart reduces the the
failure. oxygen- purpose
carrying of the red
capacity of the blood
blood. This can cell
result in procedur
increased e, how it
fatigue, will be
shortness of performe
breath, and a d, and
decreased what the
ability to patient
engage in should
physical expect
activities. during
and after

Minante I, Cauayan City, Isabela

 the test
• Preparin
g the
patient

AFTER
• Monitori
ng the
patient:
The
nurse
should
closely
observe
the
patient
• Docume
nting and
reporting
:
Accurate
documen
tation of
the
procedur
e, any
observati
ons, and
the
patient's
response
is
crucial.

7. Anatomy and Physiology (of the affected or involved organ ONLY)

Minante I, Cauayan City, Isabela

 8. PATHOPHYSIOLOGY

Congestive Heart Failure

Pathophysiology Overview

Heart

Fatty Plague/Clogged Arteries- After flow- Hypertension

Coronary Heart disease

Stroke volume (Blood pumped each beat)

Cardiac Output (Blood pumped each minute)

Heart rate (less refilling)

Structural changes to volume The kidney intensifies the need

stroke/Dilated cardiomyopathy for blood to flow there for fluid.

Thin ventricle Releases renin, angiotensin,

aldosterone

Causes salt and water retention

Volume overload

If left side of the heart would fail (will enter the left side of the heart, waiting in the lungs)- causes
Pulmonary edema (Congestion)

If right side of the heart would fail (blood draining from the head- jugular vein distension. To
legs- swollen ankles, causes swollen veins. Fluid accumulation in the abdomen- ascites)- causes
Peripheral edema.

Minante I, Cauayan City, Isabela

 B. PLANNING
NURSING CARE PLAN

09/03/2023

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Decreased After 8 hours 1.1 Place 1.1 Decreases oxygen After 8hours
"Nanghihina cardiac of nursing patient in consumption and risk of nursing
po ako at output interventions, semi- of decompression interventions
nahihirapang related to the patient fowler's 1.2 to note response to the patient
huminga" as altered will be able position, and activities/interventions was able to
verbalize by afterload to report may elevate 1.3 to allow for timely report
the patient" and decreased legs 20-30 alterations on decrease
contractility episodes of degrees in therapeutic regimen episodes of
of the heart weakness, shock 1.4 to promote dyspnea.
OBJECTIVE: secondary dyspnea, and situation adequate rest
Objective: to participate in 1.2 Monitor 1.5 tachycardia is
-difficulty of congestive activities that vital signs usually present, even
breathing heart failure reduce 1.3 Assess at rest, to compensate
-edema on cardiac urine output for decreased
both feet workload hourly or venticular contractility
-orthopnea periodically 1.6 kidneys respond to
and weight reduced cardiac output
Vital Signs the client by retaining water and
Bp-100/80 daily noting sodium
T-35.8 total fluid
Pr-84 balance
Rr-21 1.4 provide
O2-98% quite and
comfortable
environment
1.5
auscultate
apical pulse;
asses heart
rate rhythm
1.6 monitor
urine output,
nothing
decreasing
output and
dark,
concentrated
urine

Minante I, Cauayan City, Isabela

09/04/2023

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Fluid Short term: 1. Established To assess Goal met.

“Namamanas ang Volume After 8 hours rapport precipitation After 8 hours
mga paa ko” as excess of nursing and of nursing
verbalized by the related to interventions, causative interventions,
patient. excessive the patient actors the patient
sodium will demonstrated
intake as demonstrate 2. Monitor To obtain behaviors to
Objective: manifested behaviors to and record baseline monitor fluid
• Presence by monitor fluid vital sign data status and
of bipedal presence status and reduce
edema of bipedal reduce To prevent recurrence of
• Orthopnea edema. recurrence of 3. Assess fluid fluid excess.
fluid excess. patient’s overload
Vitals signs appetite and monitor
BP: 100/70 Long term: intake and Partially met.
Temp: 36 After 2 days output After 2 days
P: 87 of nursing of nursing
R:18 intervention 4. Promote Diuretic intervention
Spo2: 97% the patient intake of may cause the patient
will stabilize diuretics the patient shall be able
fluid volume to excrete a to stabilize
as evidenced large fluid volume
by balanced volume of as evidenced
input and fluid by balanced
output input and
(I&O), vital Heart failure output (I&O),
signs within 5. Note the and renal vital signs
client’s presence of failure within
normal limits edema associated client’s
and free of with normal limits
signs of dependent and free of
edema. edema signs of
because of edema.
hydrostatic

To monitor
6. Restrict kidney
sodium function and
and fluid fluid
intake

Minante I, Cauayan City, Isabela

 C. IMPLEMENTATION

1. DRUGS
Drug name Date Route of Classification Mechanism of Pharmacokinetics Nursing responsibilities
Administered administration, action
dosage, and
frequency of
administration

Generic Name September 2- IV Loop diuretics Works to increase • Absorption: 60-67% 1. Thoroughly monitor
FUROSEMIDE 11 540 mg ( also known the excretion of absorbed after oral patient medical history
Q8 as water pills) sodium and water by administration (in acute for any conditions
the kidneys by HF and in renal contraindicated for use of
Brand Name inhibiting their failure); also absorbed furosemide
Lasix reabsorption from from IM sites. 2. Monitor patient’s intake
the proximal and • Distribution: crosses and output constantly.
distal tubules, as placenta, enters Changes in the output
well as the loop of breastmilk. may indicate fluid
Henle. It works • Protein binding: 91- volume loss or
directly acts on the 99% dehydration.
cells of the nephron • Metabolism: minimally 3. Monitor vital signs
and indirectly metabolized by liver, before and after
modifies the content some no hepatic administering.
of the renal filtrate. metabolism 4. Check patients labs and
• Excretion: via kidney electrolytes levels
by glomerular filtration periodically throughout
of tubular secretion. the course of treatment.
Drug name Date Route of Classification Mechanism of Pharmacokinetics Nursing responsibilities
Administered administration, action
dosage and
frequency of
administration
• Absorbed from stomach
Generic September 2- Oral Nonsteroidal Inhibit the and SI 1. Give drug with food or
Name 11, 2023 80mg tab anti- activity of the • Poorly water soluble- after meals if GI upset
Aspirin OD inflammatory enzyme called limitation occurs
drugs cyclooxygenase • Converted to salicylic 2. Give drug with full glass
Brand Name (NSAIDs (COX) which acid in gut, liver and of water to reduce risk of
Acetylsalicylic lead to the plasma tab/capsule lodging in
acid formation of • 80-85% bound to plasma the esophagus.
prostaglandins protein-can cross 3. Do not crush, cut or
that cause placenta and CSF chew
inflammation, • Metabolized in liver by
swelling, pain conjugation with 4. Report any adverse
and fever. glycine-salicylic acid reactions noted
Drug name Date Route of Classification Mechanism of Pharmacokinetics Nursing responsibilities
Administered administration, action
dosage and
frequency of
administration
Generic
Name September 2, Oral Angiotensin Block the • Absorption: 1. Monitor BP to drug
2023 50mg tab receptor blockers vasoconstrictor Bioavailability is 33% trough (prior to a
Losartan OD (ARBs), and aldosterone- • Distribution: volume of schedule dose).
Antihypertensive secreting effects distribution of losartan 2. Monitor drug
of angiotensin II is 34 I, 99.7% bound to effectiveness
Brand Name by selectively albumin 3. Inadequate response
Cozaar blocking the • Biotransformation: may be improved by
binding of about 14% of orally splitting the daily dose
angiotensin II to administered losartan into twice-daily dose.
the AT1 receptor convert to active 4. Monitor CBC,
found in many metabolite electrolytes, liver and
tissues • Elimination: about 4% kidney function with
of the dose is excreted long term theraphy.
unchanged in the urine
and about 6% is
excreted in urine as
active metabolite
Drug name Date Route of Classification Mechanism of Pharmacokinetics Nursing responsibilities
Administered administration, action
dosage and
frequency of
administration
1. Monitor BP and pulse
Generic September 2- Oral Beta- Produces its • Primarily excreted in frequently during dose
Name 11, 2023 6.25mg adrenergic antihypertensive the bile and feces adjustment period and
Carvedilol OD blocking effect partly by • The half-life of periodically during therapy.
agents reducing total carvedilol is between 2. Assess for orthostatic
Brand Name peripheral 7-10 hours hypotension when assisting
Coreg resistance by • The plasma patient up from supine
blocking alpha1- clearance has been position.
adrenoceptors reported as 3. If heart rate decreases below
and by 0.52L/KG or 500- 55 beats/min, decrease dose.
preventing beta- 700ml/min 4. Monitor intake and output
adrenoceptor- ratios and daily weight.
mediated
compensatory
mechanisms
Drug name Date Route of Classification Mechanism Pharmacokinetics Nursing responsibilities
Administered administration, of action
dosage and
frequency of
administration

Generic September 2- Oral Anti-diabetic Decreases • Absorbed predominately 1. Lab test: obtain baseline and
Name 11, 2023 50/500 drug in the hepatic from the small intestine. It periodic kidney and liver
Sitigliptin- OD biguanide glucose is rapidly distributed function test; drug
Metformin class for the production, following absorption and contraindicated in the
treatment of decrease does not bind to plasma presence of renal or hepatic
Brand type 2 intestinal insufficiency.
proteins
Name diabetes absorption of 2. Monitor blood glucose and
Fortamet mellitus. glucose and • It is excreted unchanged in lipid profile periodically
improve urine. 3. Monitor known or suspected
insulin • The elimination half-life of alcoholics carefully for
sensitivity by metformin during multiple decreased in liver function
increasing dosages in patients with 4. Monitor cardiopulmonary
peripheral good renal function is status throughout course of
glucose approximately 5 hours. therapy
uptake and
utilization
 2. MEDICAL MANAGEMENT

IVFs, BT, nebulization, oxygen therapy, etc.

Medical Date performed/
General Indication Client’s reaction
management/ changed/
description / purpose to treatment
treatment discontinued
IVF: PNSS 1L x September 2, 2023 Intravenous fluid Medication Improved fluid
24 hrs PNSS or Normal administration: balance: PNSS can
Saline Solution) is Intravenous fluid aid in reducing
a sterile solution PNSS can serve as edema and
that contains 0.9% a carrier for improving overall
sodium chloride in medications that fluid balance by
water. It is may be prescribed promoting diuresis
isotonic, meaning to manage heart (increased urine
it has the same failure symptoms output) and
concentration of or other related reducing fluid
salt as the body's conditions. overload
cells and fluids. It symptoms such as
is clear and swelling in the
colorless. legs
02 support September 3-5 Oxygen support Respiratory Improved
refers to the distress: Patients oxygenation:
administration of experiencing Oxygen therapy
supplemental difficulty can help increase
oxygen to a patient breathing, oxygen levels in
in need. shortness of the blood,
breath, or promoting better
respiratory distress oxygenation of
may benefit from tissues and organs.
oxygen therapy to This can lead to
alleviate improved energy
symptoms and levels, reduced
improve shortness of
oxygenation. breath, and
enhanced overall
well-being.

3. SURGICAL MANAGEMENT

Patent ductus arteriosus ligation:

• Before birth, the baby has a blood vessel that runs between the aorta (the main artery to
the body) and the pulmonary artery (the main artery to the lungs), called the ductus arteriosus. This
small vessel most often closes shortly after birth when the baby starts to breathe on their own. If it
does not close. It is called a patent ductus arteriosus. This could cause problems later in life.
• In most cases, the doctor will close off the opening using medicine. If this does not
work, then other techniques are used.
• Sometimes the PDA can be closed with a procedure that does not involve surgery. The
procedure is most often done in a laboratory that uses -rays. In this procedure, the surgeon makes a
small cut in the groin. A wire and tube called a catheter is inserted into an artery in the leg and passed
up to the heart. Then, a small metal coil or another device is passed through the catheter into the

Minante I, Cauayan City, Isabela

infant's ductus arteriosus artery. The coil or other device blocks the blood flow, and this corrects the
problem.
• Another method is to make a small surgical cut on the left side of the chest. The
surgeon finds the PDA and then ties off or clips the ductus arteriosus, or divides and cuts it. Tying off
the ductus arteriosus is called ligation. This procedure may be done in the neonatal intensive care unit
(NICU).

Coarctation of the aorta repair:

• Coarctation of the aorta occurs when a part of the aorta has a very narrow section. The
shape looks like an hourglass timer. The narrowing makes it difficult for blood to get through to the
lower extremities. Over time, it can lead to problems such as extremely high blood pressure.
• To repair this defect, a cut is most often made on the left side of the chest, between the
ribs. There are several ways to repair coarctation of the aorta.
• The most common way to repair it is to cut the narrow section and make it bigger with
a patch made of GORE-TEX, a man-made (synthetic) material.
• Another way to repair this problem is to remove the narrow section of the aorta and
stitch the remaining ends together. This can most often be done in older children.
• A third way to repair this problem is called a subclavian flap. First, a cut is made in the
narrow part of the aorta. Then, a patch is taken from the left subclavian artery (the artery to the arm) to
enlarge the narrow section of the aorta.
• A fourth way to repair the problem is to connect a tube to the normal sections of the
aorta, on either side of the narrow section. Blood flows through the tube and bypasses the narrow
section.
• A newer method does not require surgery. A small wire is placed through an artery in
the groin and up to the aorta. A small balloon is then opened up in the narrow area of the aorta. A stent
or small tube is left there to help keep the aorta open. The procedure is done in a laboratory with x-
rays. This procedure is often used when the coarctation reoccurs after it has been fixed.

Minante I, Cauayan City, Isabela

Atrial septal defect (ASD) repair:
• The atrial septum is the wall between the left and right atria (upper chambers) of the
heart. A hole in that wall is called an ASD. In the presence of this defect, blood with and without
oxygen can be mixed up over time, causing medical problems and arrhythmias.
• Sometimes, an ASD can be closed without open-heart surgery. First, the surgeon makes
a tiny cut in the groin. Then the surgeon inserts a wire into a blood vessel that goes to the heart. Next,
two small umbrella-shaped "clamshell" devices are placed on the right and left sides of the septum.
These two devices are attached to each other. This closes the hole in the heart. Not all medical centers
do this procedure.
• Open-heart surgery may also be done to repair ASD. In this operation, the septum can
be closed using stitches. Another way to cover the hole is with a patch.

Minante I, Cauayan City, Isabela

Ventricular septal defect (VSD) repair:
• The ventricular septum is the wall between the left and right ventricles (lower
chambers) of the heart. A hole in the ventricular septum is called a VSD. This hole lets blood with
oxygen mix with used blood returning to the lungs. Over time, irregular heartbeats and other heart
problems can happen.
• By age 1, most small VSDs close on their own. However, those VSDs that do stay open
after this age may need to be closed with surgery.
• Larger VSDs and small ones in certain parts of the ventricular septum, or ones that
cause heart failure or endocarditis, (inflammation) need open-heart surgery. The hole in the septum is
most often closed with a patch.
• Some septal defects can be closed without surgery. The procedure involves passing a
small wire into the heart and placing a small device to close the defect.

Minante I, Cauayan City, Isabela

Tetralogy of Fallot repair:
• Tetralogy of Fallot is a heart defect that exists from birth (congenital). It usually
includes four defects in the heart and causes the baby to turn a bluish color
• Open-heart surgery is needed, and it is often done when the child is between 6 months
and 2 years old.
• The surgery involves closing the VSD with a patch and opening the thickened muscle
(stenosis). A patch is placed on the right ventricle and main pulmonary artery to improve blood flow
to the lungs.
• The child may have a shunt procedure done first. A shunt moves blood from one area
to another. This is done if the open-heart surgery needs to be delayed because the child is too sick to
go through surgery.
• During a shunt procedure, the surgeon makes a surgical cut in the left side of the chest.
• Once the child is older, the shunt is closed and the main repair in the heart is
performed.

Minante I, Cauayan City, Isabela

Transposition of the great vessels repair:
• In a normal heart, the aorta comes from the left side of the heart, and the pulmonary
artery comes from the right side. In transposition of the great vessels, these arteries come from the
opposite sides of the heart. The child may also have other birth defects.
• Correcting transposition of the great vessels requires open-heart surgery. If possible,
this surgery is done shortly after birth.
• The most common repair is called an arterial switch. The aorta and pulmonary artery
are divided. The pulmonary artery is connected to the right ventricle, where it belongs. Then, the aorta
and coronary arteries are connected to the left ventricle, where they belong.

Minante I, Cauayan City, Isabela

Truncus arteriosus repair:
• Truncus arteriosus is a rare condition that occurs when the aorta, coronary arteries, and
pulmonary artery all come out of one common trunk. The disorder may be very simple, or very
complex. In all cases, it requires open-heart surgery to repair the defect.
• Repair is usually done in the first few days or weeks of the infant's life. The pulmonary
arteries are separated from the aortic trunk, and any defects are patched. Usually, children also have a
ventricular septal defect, and that is also closed. A connection is then placed between the right
ventricle and the pulmonary arteries.
• Most children need one or two more surgeries as they grow.

Minante I, Cauayan City, Isabela

Tricuspid atresia repair:
• The tricuspid valve is between the upper and lower chambers on the right side of the
heart. Tricuspid atresia occurs when this valve is deformed, narrow, or missing.
• Babies born with tricuspid atresia are blue because they cannot get blood to the lungs to
pick up oxygen.
• To get to the lungs, blood must cross an atrial septal defect (ASD), ventricular septal
defect (VSD), or a patent ductus arteriosus (PDA). (These conditions are described above.) This
condition severely restricts blood flow to the lungs.
• Soon after birth, the baby may be given a medicine called prostaglandin E. This
medicine will help keep the patent ductus arteriosus open so that blood can continue to flow to the
lungs. However, this will only work for a while. The child will eventually need surgery.
• The child may need a series of shunts and surgeries to correct this defect. The goal of
this surgery is to allow blood from the body to flow into the lungs. The surgeon may have to repair the
tricuspid valve, replace the valve, or put in a shunt so that blood can get to the lungs.

Total anomalous pulmonary venous return (TAPVR) correction:

• TAPVR occurs when the pulmonary veins bring oxygen-rich blood from the lungs back
to the right side of the heart, instead of the left side of the heart, where it most often goes in healthy
people.
• This condition must be corrected with surgery. The surgery may be done in the
newborn period if the infant has severe symptoms. If it is not done right after birth, it is done in the
first 6 months of the baby's life.
• TAPVR repair requires open-heart surgery. The pulmonary veins are routed back to the
left side of the heart, where they belong, and any abnormal connections are closed.
• If a PDA is present, it is tied off and divided.

Minante I, Cauayan City, Isabela

Hypo plastic left heart repair:
• This is a very severe heart defect that is caused by a very poorly developed left heart. If
it is not treated, it causes death in most babies who are born with it. Unlike babies with other heart
defects,
those with hypoplastic left heart do not have any other defects. Operations to treat this defect are done
at specialized medical centers. Usually, surgery corrects this defect.

• A series of three heart operations is most often needed. The first operation is done in
the first week of the baby's life. This is a complicated surgery where one blood vessel is created from
the pulmonary artery and the aorta. This new vessel carries blood to the lungs and the rest of the body.

• The second operation, called a Fontan operation, is most often done when the baby is 4
to 6 months old.
• The third operation is done a year after the second operation.

Minante I, Cauayan City, Isabela

 4. DIET

Nursing
TYPE OF DIET Date Indication/s
Responsibility

Fluid Restriction Diet September 2, 2023 Fluid restriction is often Monitor the patient's
necessary for patients fluid intake and educate
with heart failure and them about their
edema to prevent fluid prescribed fluid
overload and further restriction. They can
exacerbation of provide guidance on
symptoms. measuring and tracking
fluid intake, including
both beverages and
foods with high water
content. The nurse
should also closely
monitor the patient's
weight and assess for
signs of dehydration or
fluid overload.
Low Sodium Diet September 4, 2023 A low sodium diet is Educate the patient
crucial for patients with about the importance of
Food recommendation heart failure and edema limiting sodium intake.
for a low sodium diet: as it helps reduce fluid They can collaborate
Fresh fruit and retention and manage with the hospital's
vegetables blood pressure. nutritionist to provide a
meal plan with low
sodium options.

5. ACTIVITY/ EXERCISE

General
Type of exercise Indication/Purpose Client’s Response
description
Walking Encourage the patient Walking is a low-impact The patient may
to engage in regular cardiovascular exercise experience increased
walking, starting with that improves stamina, improved
shorter distances and circulation, strengthens breathing, and a
gradually increasing as the heart, and helps reduction in swelling
tolerated. reduce fluid retention. It over time.
also promotes overall
well-being.
Seated Leg Exercises These exercises can be Seated leg exercises The patient may
performed while sitting help improve experience improved
on the edge of the bed circulation, prevent blood flow, reduced leg
or in a chair. They blood clots, and swelling, and increased
include movements like maintain muscle tone in mobility.
leg lifts, ankle pumps, the lower extremities.
and heel slides. They also aid in
reducing swelling and

Minante I, Cauayan City, Isabela

 edema.

Deep Breathing and These exercises involve Deep breathing and The patient may feel
Relaxation slow and deep relaxation exercises help more relaxed,
breathing, combined reduce stress, anxiety, experience reduced
with relaxation and promote overall anxiety and stress
techniques such as well-being. They can levels, and find it easier
visualization or also aid in managing to control breathing.
progressive muscle shortness of breath and These exercises can
relaxation. improving lung provide a sense of
function. calmness and help the
patient cope with their
hospital stay.

6. NURSING MANAGEMENT ( AT LEAST 3 DAYS)

Time Focus DAR

September 3, 2023 Orthopnea Data:
Patient states that she has
difficulty breathing when lying
flat

Action:
Administer supplemental
oxygen at 2 liters per minute
via nasal cannula

Response:
Patient reports feeling more
comfortable and able to breathe
easier

September 5, 2023 Bipedal edema Data:

Patients presents with bipedal
edema
BP: 110/80
Heart rate: 22

Action:
Administered furosemide 40mg

Response:
Patient noticed improved
mobility.

Minante I, Cauayan City, Isabela

September 6, 2023 Difficulty of breathing Data:
BP: 110/80
Heart Rate: 28
Oxygen saturation: 95

Action:
Positioned in high back rest and
continued administered Oxygen

Response:
Patient reports relieved after
the intervention

Minante I, Cauayan City, Isabela