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Subtitle
Congestive heart

ffailure
Pre test
DEFINITION
• https://www.youtube.com/watch?v=NZ14XjO
QoFY
It is a clinical syndrome resulting from the
inability of heart to pump enough blood at
rest or during exercise even though the
filling pressures are adequate
Causes of congestive heart failure
• Coronary heart disease
• Heart attack
• High blood pressure
• Heart valve disorders
• Inflammation of Heart muscle (myocarditis,
cardiomyopathy
 CONT…..
• Severe lung disease (pulmonary hypertension)
• Severe anemia
• Overactive thyroid gland (hyperthyroidism)
• Underactive thyroid gland (hypothyroidism)
• Atrial fibrillation
• Kidney failure
Types of Congestive heart failure

1. Left-sided heart failure

2. Right-sided heart failure
 CONT…
1. Left-sided heart failure
Due to left ventricular dysfunction
normal blood does not flow that cause
blood to back up into left atrium and into
pulmonary veins that increase pulmonary
pressure that causes fluid
CONT…..
which is manifested as pulmonary
congestion and edema.
 CONT…
2. Right-sided heart failure:-
Right sided heart failure causes due to
back up of blood into right atrium
venous circulation .The primary cause
of right side failure is due to left sided
heart failure.
 Due to any of the above causes

Increased systemic vascular resistance

Increased force of left ventricular contraction

Increased left ventricle oxygen demand

 Left ventricular hypoxia

Decreased left ventricular contraction

Increased left ventricular preload (amount of blood in

the chamber during diastole)

Left ventricular failure

 Increased left atrial preload

Pulmonary edema

Increased pulmonary vascular resistance

Right ventricular failure

SYMPTOMS
• Weight gain
• Dyspnea
• Orthopnea
 CONT…..
• Reduced exercise tolerance, lethargy,
fatigue
• Dizziness
• Increased swelling on feet's ,legs and
abdomen
 CONT…..
• Cough
• Ankle swelling
• Anorexia
SIGNS
•Muscle wasting
•Tachycardia
•Pulse alteration
•Elevated jugular venous
pressure
 DIAGNOSTIC EVALUATION

• Patient history
• Physical examination
Diagnostic studies
• Electrocardiography
CONT….
• Magnetic resonance
• Computed tomography imaging
• Cardiac catheterization with
angiography
• A biopsy of heart muscle is needed
TREATMENT
• lifestyle change
• Salt restriction
• Exercises
• Smoking and alcoholism
• Body weight (daily weight)
• Supportive stockings
 CONT…..
• Drug management
• Angiotensin - converting enzyme
(ACE) inhibitors
• Angiotensin II receptor blockers
• Beta-blockers
 CONT…
• Potassium-sparing diuretics
• Thiazide and thiazide-like diuretics
• Anticoagulants (heparine)
• morphine to relieve anxiety
CONT….
• Positive inotropic drugs (drugs that
make muscle contract more forcefully)
(dopamine)
• Oxygen for pulmonary edema is
required
 CONT….
• Non pharmacological management of heart
failure (surgical intervention)
• Coronary artery bypass grafting (
revascularization)
• Percutaneous coronary intervention
(Angioplasty)
 CONT….
• Valve replacement
• Biventricular pacemaker
• Heart transplantation
• Left ventricular assist device
(LVAD)
Nursing care of patients with congestive heart
failure :
• Maintain the patient in high fowler's position
• Elevate extremities except when the patient is
in acute distress
• Frequently monitor vital signs
• Change position frequently
 CONT…..
• Monitor intake and output and daily weight
• Restrict fluids as ordered
• Teach the patient and family and provide
emotional support (life style change
 CONT…
• Explain the side effect of diuretic medications
for additional actions ( side effects of
diuretics include electrolyte imbalance,
symptomatic hypotension.
• Use aseptic procedures when caring for
invasive lines
 COMPLICATIONS:

• Intractable or refractory heart failure

• Cardiac dysrhythmias
• Myocardial failure and cardiac arrest
CONT….
• Digoxin toxicity
• Pulmonary infarction
• Pneumonia
• Emboli
 NURSING DIAGNOSIS
• Decreased cardiac out put related to myocardial
dysfunction.
• Excess fluid volume related to decrease cardiac
contractility and decreased excretion from the kidney .
• Impaired gas exchange related to pulmonary venous
congestion.
• Risk for infection related to pulmonary congestion.
 SUMMARIZATION OF THE TOPIC

• Introduction of congestive heart

failure
• Definition of congestive heart failure
• Causes of congestive heart failure
• Types of congestive heart failure
 CONT….
• Pathophysiology of congestive heart
failure
• Compensatory mechanism of congestive
heart failure
• Clinical manifestation of congestive heart
failure
 CONT…..
• Diagnostic evaluation of congestive heart
failure
• Treatment of congestive heart failure
• Nursing care of congestive heart failure
CONT….
• Complications of congestive heart
failure
• Nursing diagnosis of congestive heart
failure
 BIBLIOGRAPHY

• "Lippincott Manual of Nursing Practice";

Sandra M. Nettina ANP-BC.; 2009.
• "Nursing care Plans: Nursing Diagnosis and
Intervention"; Meg Gulanick, PhD, APRN,
FAAN., et. al.; 2007.
 CONT…
Iseman MD. In: Goldman L, Ausiello
D, eds. Cecil Medicine. 23rd ed.
Philadelphia, Pa: Saunders Elsevier;
2007:chap 345.
POST TEST