WHAT IS CHF?

- General term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues with vital blood-borne nutrients.

1. SYSTOLIC DYSFUNCTION

2. DIASTOLIC DYSFUNCTION

2 TYPES OF CHF?

Also known as “Pulomnary Congestion”

Heart is unable to pump the total volume of blood it receives from the right side of the heart.

LEFT SIDED HEART FAILURE

Also known as “Venous Congestion”

Impairs the ability to move deoxygenated blood from the systemic circulation into the pulmonary circulation

RIGHT SIDED HEART FAILURE

R – enal disease

A – nemia

P – ulmonary embolism

I – nfection (myocarditis, pericarditis)

D – elivery after pregnancy

F – orget to take the meds

A – rrythmias

I – schemia/infarction

L – ipid aggregation

U – ncontrolled hypertension

R – HD

E – ndocarditits

RISK FACTORS:

GENERAL:

2%- 40 to 59 years old

5%- 60 to 69 years old

25% greater among black than white population.

PHILIPPINES:

1,521,912 filipinos have CHF

6th leading cause of death

affects male more than male

INCIDENCE:

A. LEFT SIDED HEART FAILURE

Drinking too much alcohol

Heart attack

Heart muscle infections

High blood pressure

Hypothyroidism

Leaking or narrow heart valves

Any other disease that damages the heart muscle

Poor left-side heart function due to prior heart attacks

ETIOLOGY:

B. RIGHT SIDED HEART FAILURE

Persistent left sided heart failure

Stenosis/Regurgitation of tricuspid or pulmonic valves

Right ventricular infarction

Acute/chronic pulmonary disease: COPD, severe pneumonia, pulmonary embolus

Pulmonary hypertension (Cor Pulmonale)

PATHOPHYSIOLOGY OF CONGESTIVE HEART FAILURE

FUNCTIONAL CLASSIFICATION

Left:

• Dyspnea in the early stages

• Decreases O2 saturation

• Increase RR

• Easy fatigability, weakness and dizziness

• Orthopnea

• Auscultation reveals S3 gallop

• Pulsusalternans

• Paroxysmal Nocturnal Dyspnea

• Cardiac asthma

• Acute pulmonary edema= life-threatening since it may progress to shock & death

CLINICAL MANIFESTATIONS:

RIGHT:

• Chest x-ray

• Echocardiography

• Elevated SGPT

• Decrease CVP

DIAGNOSTICS:

ACE inhibitors Diuretics Digitalis glycosides Angiotensin Receptor BlockersOxygen Therapy

MEDICAL/ PHARMACOLOGIC MANAGEMENT:

SURGICAL MANAGEMENTS

LEFT VENTRICULAR ASSIST DEVICE

HEART TRANSPLANTATION

CORONARY ARTERY BYPASS GRAFT

 CORONARY ANGIOPLASTY

CARDIAC RESYNCHRONIZATION THERAPY

• Ineffective tissue perfusion

• Excess fluid volume

• Activity intolerance

NURSING CARE PLANS

a. O2 saturation at 99%;

b. capillary refill time of 2 seconds from 4; and

c. absence of cyanosis.

OBJECTIVES OF CARE:

® Oxygen corrects hypoxemia and alleviates

client’s need for air.

® To promote greater lung expansion.

® Any alteration in the ABG components may

inidicate sogns of respiratory failure.

® Respiratory distress and presence of

adventitious breath sounds are indicative of

pulmonary congestion.

® It could be indicative of falling arterial pH.

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.

NURSING INTERVENTIONS:

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.

® Helps rid body fluids and sodium.

® To prevent peaks/ valleys in fluid level and thirst.

® Provides a comparative baseline and evaluates the effectiveness of diuretic therapy when used.

® To determine fluid balance.

® To facilitate movement of diaphragm, thus improving respiratory effort.

1. Administer diuretics as ordered.

2. Set an appropriate rate of fluid intake/ infusion throughout 24 hour period.

3. Weigh daily or on a regular schedule, as indicated.

4. Record intake and output accurately.

5. Place in semi- Fowler’s position, as appropriate.

NURSING INTERVENTIONS:

a. verbalize relief from fatigue;

b. vital signs within normal range; and

c. able to turn to sides without experiencing dyspnea

OBJECTIVES OF CARE:

®To conserve energy and protect the client from injury

® Articles within reach minimizes client’s effort

® Restores energy needed for activity and cellular regeneration

® A simple exercise can enhance circulation thus improving clients wellness

® to promote tolerance to certain activities

® To sustain motivation

1. Assist client with self-care activities as needed

2. Keep supplies and personal articles within easy reach

3. Provide a quiet environment and uninterrupted rest periods

4. Encourage range of motion exercise such as Moving client’s arms and legs as far as they can comfortably go in any direction

5. Gradually increase clients level of activity if tolerated well

6. Give client information that provides daily/weekly progress

NURSING INTERVENTIONS: