Heart Failure Power Point

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Heart Failure

a chronic, progressive condition in which the heart cant pumpenough blood to meet the bodys needs for blood and oxygen. it doesnt mean that your heart has stopped or is aboutto stop working. However, heart failure is a serious conditionthat requires medical care. Basically, the heart cant keep up

with its workload. the cardiac output is reduced and as the condition progresses,the bodys tissues become filled with fluid. This swelling orcongestion of the tissue spaces (fluid overload) is the reasonwhy heart failure is also known as Congestive Heart Failure(CHF). Common to people who are:

65 years old or older African - Americans Overweight


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At first the heart tries to make up for this by:

Enlargement of the heart muscles (hypertrophy) to pump withgreater force.

Enlargement or dilation of the ventricles so that more blood canfill into the heart.

Increased heart rate to increase cardiac output.

The body also tries to compensate in other ways:

Increase in blood pressure by causing vasoconstriction to returnmore blood to the heart.

Decreased urine output so that the blood volume can beincreased.

The body's compensation mechanisms help explain why somepeople may not become aware of their condition until years after their

heart begins its decline.


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Causes:Coronary Heart

Disease (CHD) also called

coronary arterydisease. When


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Heart muscle disease (dilated

cardiomyopathy, hypertrophiccardiomyopathy) or inflammation(myocarditis) - Any damage to theheart muscle whether because of

drug or alcohol use, viral infections orunknown reasons increases the riskof heart failure.

Severe lung disease - When the lungsdon't work properly, the heart has to

work harder to get available oxygen tothe rest of the body.


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TYPES OF CONGESTIVE HEART FAILURE

Left-sided heart failure or left ventricular failure (LVF)is areduction in the output from the left ventricle. The pressure in theleft atrium increases as the oxygen-rich blood from the lungs arebacked up since the left ventricle is not pushing out this blood fastenough or efficiently.

Right-sided heart failure or right ventricular failure (RVF) is areduction in the blood output from the right ventricle. The pressurein the right atrium may be decreased, normal or increaseddepending on the return of blood from the rest of the body.

Forward failure. an inadequate output of the affected ventricle

causes decreased perfusion to vital signs.

Backward failure. Blood backs up behind the affected ventricle,causing increased pressure in the atrium behind the affectedventricle.

Systolic failure. Leads to problems with contraction and ejection of

blood.


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Signs and Symptoms of CHF

Left-sided heartfailure Right-sided heartfailure

Signs of pulmonaryedema (fluid in lungs)Pleural effusion (fluidaround lungs)DyspneaTachypneaCrackles in the lung Dry, hacking cough Paroxysmal nocturnaldyspnea Increased BP (from fluidvolume excess)

Peripheral edema Jugular vein distention Ascites (fluid in theabdomen)Abdominal distentionHepatomegaly Splenomegaly Anorexia and nauseaNocturnal diuresisIncreased BP (from fluidvolume excess)


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Management:

Digitalis therapy

Major therapy for CHF

(+) inotropic (increase pumping action/contractility),

(-) chronotropic effects (decrease CR)

DOC: Lanoxin (Digoxin)

Antidote for toxicity: Digoxin immune fab (Digibind)

Nursing responsibilities: Asses heart rate before administration; if below 60

bpm or 120 bpm above, withhold the drug.

Monitor serum potassium

Assess for signs of digitalis toxicity


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Diuretic therapy

To decrease cardiac workload by reducing circulating volumeand thereby reduce preload

Commonly used diuretics:

Thiazides: Chlorthiazide (Diuril)

Loop diuretics: Furosemide (Lasix)

Pottasium-Sparing: Spironolactone (Aldactone) Aldosteroneantagonist

Nursing responsibilities:

Assess for signs of hypokalemia when administering loop andthiazide diuretics

Give potassium supplemental and potassium-rich foods.

Administer early in the morning or early in the afternoon to

prevent sleep pattern disturbance related to nocturia.


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Vasodilators

Relax the smooth muscle in blood vessels, which causes thevessels to dilate

All hypertensive drugs are vasodilators

Commonly used vasodilators:

Nitroprusside (Nipride) potent vasodilator

Hydralazine (Apresoline)

Metroprolol (Lopressor) Beta blocker

Clonidine (Catapres) Alpha II Agonist

Amlodipine (Norvasc) Calcium channel blocker

Captopril (Capoten) ACE inhibitor

Losartan (Cozaar) ARBs


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Other Drugs

Sympathomimetics

Dopamine

Dobutamine

TREATMENT

Diet: sodium-restricted diet to prevent fluid excess

Activity: balanced program of activity and rest

Oxygen Therapy: to increase oxygen supply


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NURSING MANAGEMENT

Providing Oxygenation

Administer oxygen therapy per nasal cannula at2-6 LPM as ordered

Evaluate ABG analysis results

Semi-Fowlers or High-Fowlers position topromote greater lung expansion

Promoting Rest and Activity

Bed rest or limited activity may be necessaryduring the acute phase

Provide an overbed table close to the patient to

allow resting the head and arms


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Decreasing Anxiety

Allow verbalization of feelings

Identify strengths that can be used for coping Learn what can be done to decrease anxiety

***Anxiety causes increased breathlessness whichmay be perceived by the client as an increase in the

severity of the heart failure and this in turn increasesanxiety.

Facilitating Fluid Balance

Control of sodium intake

Administer diuretics and digitalis as prescribed

Monitor I and O, weight and V/S

Dry phlebotomy (rotating tourniquets)


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Promoting Nutrition

Provide bland, low-calorie, low-residue with vitamin supplementduring acute phase

Frequent small feedings minimize

exertion and reduce gastrointestinalblood requirements

There may be no need to severely

restrict sodium intake of the clientwho receives diuretics.

No added salt diet is prescribed.No processed foods in the diet.

Heart Failure Power Point

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