CARE OF PATIENTS

WITH CHRONIC HEART

FAILURE
Arteries carry blood away from the
heart, and veins carry blood
towards the heart.

Blood vessels, arteries carry

oxygenated blood and veins carry
deoxygenated blood
HEART FAILURE

 characterized by signs and symptoms of fluid overload or of inadequate

tissue perfusion.
 the inability of the heart to pump sufficient blood to meet the needs of
the tissues for oxygen and nutrients.
 is most often a progressive, life-long condition that is managed with
lifestyle changes and medications to prevent episodes of acute
decompensated heart failure.
TYPES OF HEART FAILURE

Left sided heart failure

Right sided heart failure
HEART FAILURE

The American College of Cardiology and American Heart Association have classifications of heart
failure.
 Stage A. Patients at high risk for developing left ventricular dysfunction but without structural heart
disease or symptoms of heart failure.
 Stage B. Patients with left ventricular dysfunction or structural heart disease that has not developed
symptoms of heart failure.
 Stage C. Patients with left ventricular dysfunction or structural heart disease with current or prior
symptoms of heart failure.
 Stage D. Patients with refractory end-stage heart failure requiring specialized interventions.
CAUSES HEART FAILURE

Coronary artery disease.-Atherosclerosis

Ischemia
Cardiomyopathy
Systemic or pulmonary hypertension
Valvular heart disease
CLINICAL MANIFESTATIONS OF HEART FAILURE

Left-sided HF
Dyspnea
Cough
Pulmonary crackles.
Low oxygen saturation levels.
CLINICAL MANIFESTATIONS OF HEART FAILURE

Right-sided HF
Enlargement of the liver
Accumulation of fluid in the peritoneal cavity
Loss of appetite
LEFT SIDED VS RIGHT SIDED

 HALLMARK SYPTOMS
LEFT SIDED HEART FAILURE RIGHT SIDED HEART FAILURE

TENDS TO CAUSE LUNG CONGESTION AND OFTEN CAUSES FLUID RETENTION IN YOUR
SYMPTOMS THAT AFFECT YOUR BREATHING LEGS OR OTHER PARTS OF THE BODY
HEART FAILURE

Assessment and Diagnostic Finding:

 ECG  PET Scan

 Chest x-ray  Cardiac Catheterization

 Sonograms
 Heart scan
 Exercise or pharmacologic stress
myocardial perfusion
HEART FAILURE

Pharmacologic Therapy
 ACE inhibitors
 Angiotensin II Receptor Blockers
 Beta Blockers
 Diuretics
HEART FAILURE

Nutritional Therapy
 Sodium restriction
 Patient compliance
HEART FAILURE

Nursing Management:
 Lungs- crackles and wheezes
 Heart- presence of s3 sound
 JVD for presence of distention
HEART FAILURE

Nursing Management:
 Sensorium and level of consciousness
 Perfusion or edema
 Hepatojugular reflux
 Measure urinary output
 Weigh the patient daily
HEART FAILURE

Nursing Interventions:
 Promoting Activity Tolerance
 Managing Fluid Volume
 Controlling Anxiety
 Minimizing Powerlessness
NURSING CARE PLANS

Ineffective tissue perfusion

Excess fluid volume

Activity intolerance
INEFFECTIVE TISSUE PERFUSION

OBJECTIVES OF CARE:

a. O2 saturation at 99%;
b. capillary refill time of 2 seconds from 4; and
c. absence of cyanosis.
 NURSING INTERVENTIONS:
1. Administer oxygen therapy per nasal cannula at
2-6 LPM as ordered.
2. Semi-Fowler’s or High-Fowler’s position
3. Evaluate ABG analysis results
4. Auscultate lung fields at least every 4 hours for
crackles and wheezes in dependent lung fields
5. Observe for increased rate of respirations.
® Oxygen corrects hypoxemia and alleviates client’s
need for air.
® To promote greater lung expansion.
® Any alteration in the ABG components may
indicate signs of respiratory failure.
® Respiratory distress and presence of adventitious
breath sounds are indicative of pulmonary congestion.
® It could be indicative of falling arterial pH.
EXCESS FLUID VOLUME
OBJECTIVES OF CARE:

a. balance intake and output;

b. stable weight;
c. free from signs of edema; and
d. demonstration of behaviors to monitor fluid status.
 NURSING INTERVENTIONS:
1. Administer diuretics as ordered. ® Helps rid body fluids and sodium.

2. Set an appropriate rate of fluid intake/ infusion ® To prevent peaks/ valleys in fluid level and thirst.
throughout 24 hour period.
® Provides a comparative baseline and evaluates the
3. Weigh daily or on a regular schedule, as effectiveness of diuretic therapy when used.
indicated.
® To determine fluid balance.
4. Record intake and output accurately.
® To facilitate movement of diaphragm, thus
improving respiratory effort.
5. Place in semi- Fowler’s position, as
appropriate.
ACTIVITY INTOLERANCE

OBJECTIVES OF CARE:
a. verbalize relief from fatigue;
b. vital signs within normal range; and
c. able to turn to sides without experiencing
dyspnea
 NURSING INTERVENTIONS:
1. Assist client with self-care activities as needed ®To conserve energy and protect the client from injury

2. Keep supplies and personal articles within easy ® Articles within reach minimizes client’s effort
reach
3. Provide a quiet environment and uninterrupted rest ® Restores energy needed for activity and cellular
periods regeneration
4. Encourage range of motion exercise such as ® A simple exercise can enhance circulation thus
Moving client’s arms and legs as far as they can improving clients wellness
comfortably go in any direction
® to promote tolerance to certain activities
5. Gradually increase clients level of activity if
tolerated well
® To sustain motivation
6. Give client information that provides daily/weekly
progress
STROKE

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 STROKE

A stroke is a medical emergency in which the blood supply

to any portion of the brain is interrupted or reduced.
Alternative names: Cerebrovascular accident/ disease
(CVA), Cerebral infarction, Cerebral hemorrhage.

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THE SYMPTOMS OF A STROKE ARE DEPENDANT ON
WHAT PORTION OF THE BRAIN IS DAMAGE.

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STROKE
TYPES OF STROKE
HOW ARE STROKES TREATED?
 A sudden development of one or more of the following symptoms usually indicates a
stroke.

SYMPTOMS
A sudden development of one or more of the following symptoms usually indicates
a stroke.
 Sudden numbness or weakness in the face, arms and/or legs.
 Confusion.
 Personality changes.
 Sudden change in eyesight.
 Decreased motor skills.
 Severe headaches 38
TESTS

 Computed Tomography (CT)

 Magnetic Resonance Imaging (MRI)
 Cerebral Angiography: identify responsible blood vessel
 Electrocardiogram (ECG): underlying heart conditions
 Echocardiogram: blood clot from heart
 Carotid Duplex: carotid artery stenosis
 Heart monitors, blood work and many more tests!!
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ISCHEMIC STROKE:
 A blood vessel becomes
blocked and the blood supply
to that part of your brain is Embolic Stroke: occurs when
blocked. a clot forms in a vessel away
from the brain, but travels
 Types of Ischemic strokes: through the bloodstream and
 Thrombotic Stroke:occurs when a becomes lodged in narrower
clot forms in an artery that supplies brain arteries.
blood to the brain (i.e. carotid
arteries).
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TREATMENTS
 Tissue plasminogen activator (tPA) can be given within three hours from
the onset of symptoms.

In addition to being used to treat strokes, the following can also be used as
preventative measures.
 Anticoagulants/Antiplatelets
 Carotid Endarterectomy
 Angioplasty/Stents

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ISCHEMIC STROKE

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 HEMORRHAGIC STROKE:
 A small blood vessel in the brain
becomes weak and ruptures.
 Types of hemorrhagic stroke:
 Intracerebral hemorrhage (ICH):bleeding directly
into brain tissue forming a pool of blood.
 Subarachnoid hemorrhage:bleeding into the
cerebral spinal fluid of the subarachnoid space
surrounding the brain.

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TREATMENT
 Surgery is often required to remove pooled blood from the brain and
to repair damaged blood vessels.
Prevention:
 An obstruction is introduced to prevent rupture and bleeding of
aneurysms and arteriovenous malformations (AVM).
 Surgical Intervention
 Endovascular Procedures
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HEMORRHAGIC STROKE

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TRANSIENT ISCHEMIC ATTACK (TIA)

 Blood supply to the brain is only briefly interrupted

 Symptoms do not last long
 Warning Stroke- steps should be taken to prevent future stroke.

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RISKS
TIA  Excessive alcohol
High Blood Pressure consumption
 Family History
High Cholesterol
 Age
Smoking
 Sex
Heart Disease
 Race
Diabetes
 Obesity 47
PREVENTION
 Control high Blood Pressure
 Lower cholesterol
 Quit smoking
 Control diabetes
 Maintain healthy weight
 Exercise
 Manage stress
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 Eat a healthy diet
PROGNOSIS

 The results of a stroke vary depending on the size and location, the
presence of any associated medical problems, and the likelihood of
recurring strokes.
 Dysfunctions correspond to the area in the brain that had been
damaged.

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 A quick guide for the general public to remember:
As a way of helping the general public to become more aware of the symptoms of a stroke, a
simple symptom checklist to remember has been devised and publicized. This is to think of the
word FAST. That is:
F - Facial weakness. Can the person smile? Has their mouth or eye
drooped? 
A - Arm weakness. Can the person raise both arms? 
S - Speech disturbance. Can the person speak clearly? Can they
understand what you say? 
T - Time to call the nearest emergency department.