(relates to Chapter 34, Nursing Management: Heart Failure and Cardiomyopathy, in the textbook)
Congestive Heart Failure
Definition An abnormal condition involving impaired cardiac pumping CHF is not a disease but a syndrome Associated with long-standing hypertension and coronary artery disease (CAD)
Congestive Heart Failure
Definition Heart is unable to pump adequate amount of blood to meet metabolic needs Affects about 5 million people in the United States The most common reason for hospitalization in adults older than 65
Congestive Heart Failure
Etiology and Pathophysiology Risk factors CAD Age Hypertension Obesity
Congestive Heart Failure
Etiology and Pathophysiology Risk factors Cigarette smoking Diabetes mellitus High cholesterol African American descent
Congestive Heart Failure
Etiology and Pathophysiology May be caused by any interference with normal mechanisms regulating cardiac output (CO)
Congestive Heart Failure
Etiology and Pathophysiology CO depends on: Preload Afterload Myocardial contractility Heart rate Metabolic state
Congestive Heart Failure
Etiology and Pathophysiology Pathology of ventricular failure Systolic failure Most common cause of CHF Left ventricle (LV) loses ability to generate enough pressure to eject blood forward
Congestive Heart Failure
Etiology and Pathophysiology Pathology of ventricular failure Systolic failure Hallmark is a in LV ejection fraction
Congestive Heart Failure
Etiology and Pathophysiology Pathology of ventricular failure Diastolic failure Impaired ability of the ventricles to fill during diastole Usually the result of LV hypertrophy
Congestive Heart Failure
Etiology and Pathophysiology Pathology of ventricular failure Diastolic failure Pulmonary congestion Normal ejection fraction
Congestive Heart Failure
Etiology and Pathophysiology Pathology of ventricular failure Mixed systolic and diastolic failure Seen in dilated cardiomyopathy Biventricular failure Patient has extremely poor ejection fractions
Types of Congestive Heart Failure One-sided failure eventually leads to biventricular failure
Congestive Heart Failure
Types of Congestive Heart Failure Left-sided failure Most common form Blood backs up through the left atrium into the pulmonary veins Pulmonary congestion and edema
Congestive Heart Failure
Types of Congestive Heart Failure Left-sided failure Most common cause: HTN Cardiomyopathy Rheumatic heart disease CAD
Left-Sided Heart Failure
Fig. 34-1
Congestive Heart Failure
Types of Congestive Heart Failure Right-sided failure Backward flow to the right atrium and venous circulation Results from diseased right ventricle
Types of Congestive Heart Failure Right-sided failure Primary cause is left-sided failure Cor pulmonale RV dilation and hypertrophy caused by pulmonary pathology
Acute Congestive Heart Failure
Clinical Manifestations Pulmonary edema Agitation Pale or cyanotic Cold, clammy skin Severe dyspnea Tachypnea
Complications Pleural effusion Arrhythmias Left ventricular thrombus Hepatomegaly
Congestive Heart Failure
Classification Based on the persons tolerance to physical activity Class 1: No limitation of physical activity Class 2: Slight limitation
Congestive Heart Failure
Classification Based on the persons tolerance to physical activity Class 3: Marked limitation Class 4: Inability to carry on any physical activity without discomfort
Congestive Heart Failure
Diagnostic Studies Primary goal is to determine underlying cause Physical exam Chest x-ray ECG Hemodynamic assessment
Congestive Heart Failure
Diagnostic Studies Primary goal is to determine underlying cause Echocardiogram Stress testing Cardiac catheterization Ejection fraction (EF)
Acute Congestive Heart Failure
Nursing and Collaborative Management Primary goal is to improve LV function by: Decreasing intravascular volume Decreasing venous return Decreasing afterload
Acute Congestive Heart Failure
Nursing and Collaborative Management Primary goal is to improve LV function by: Improving gas exchange and oxygenation Improving cardiac function Reducing anxiety
Acute Congestive Heart Failure
Nursing and Collaborative Management Decreasing intravascular volume Improves LV function by reducing venous return Loop diuretic: drug of choice
Acute Congestive Heart Failure
Nursing and Collaborative Management Decreasing venous return (preload) Reduces the amount of volume returned to the LV during diastole High Fowlers position
Acute Congestive Heart Failure
Nursing and Collaborative Management Decreasing afterload Decreases pulmonary congestion IV nitroprusside (Nipride) nesiritide (Natrecor)
Acute Congestive Heart Failure
Nursing and Collaborative Management Improving gas exchange and oxygenation Decreases pulmonary congestion IV nitroprusside (Nipride) nesiritide (Natrecor)
Acute Congestive Heart Failure
Nursing and Collaborative Management Improving cardiac function Digitalis Newer inotropics Dobutamine Hemodynamic monitoring
Acute Congestive Heart Failure
Nursing and Collaborative Management Reducing anxiety Morphine IV inotropic drugs Vasodilators ACE inhibitors
Chronic Congestive Heart Failure
Collaborative Care Treat underlying cause Maximize CO Alleviate symptoms
Chronic Congestive Heart Failure
Collaborative Care Oxygen treatment Rest Biventricular pacing Cardiac transplantation
Chronic Congestive Heart Failure
Drug Therapy ACE inhibitors Diuretics Inotropic drugs Vasodilators -Adrenergic blockers
Chronic Congestive Heart Failure
Nutritional Therapy Fluid restrictions not commonly prescribed Sodium restriction 2 g sodium diet Daily weights Same time each day Wearing same type of clothing
Chronic Congestive Heart Failure
Nursing Management Nursing Assessment Past health history Medications Functional health problems Cold, diaphoretic skin
Nursing Management Planning Overall goals: Peripheral edema Shortness of breath Exercise tolerance Drug compliance No complications
Chronic Congestive Heart Failure
Nursing Management Nursing Implementation Acute intervention Establishment of quality of life goals Symptom management Conservation of physical/emotional energy Support systems
Chronic Congestive Heart Failure
Nursing Management Nursing Implementation Ambulatory and home care Teaching Psychologic changes Exercise-saving behaviors Medications
Chronic Congestive Heart Failure
Nursing Management Nursing Implementation Evaluation Respiratory status Sleep Fluid balance
Chronic Congestive Heart Failure
Nursing Management Nursing Implementation Evaluation Activity tolerance Anxiety control Knowledge: disease process