Living With Congestive Heart Failure CHF 4

7/31/2019 Living With Congestive Heart Failure CHF 4

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A Case Study by

Jasmine Hunter, Rose Larsen, and Amy

Sauls-Crenshaw


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Heart Failure may develop after a Heart Attack due to long term

hypertension, diabetes, valvular, or inflammatory heart disease. It is the

most common diagnosis for hospitalized patients over 65 years old. It

usually starts in the left ventricle and if left untreated it progresses to right

sided failure. Even though the right side can fail without left side failure.

Mr. Evans is a 72 year old

man who was admitted to the

cardiac unit with a diagnosis

of heart failure.


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It is when the body is no longer able to

pump the blood it needs to maintain its

metabolic needs. It is caused when there

is a over release of hormones in the body.

(epinephrine and norepinephrine) The

release causes a negative effect on the

failing heart and the circulatory system.


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Decreased Cardiac Output

Fatigue

Anginal Pain

Anxiety

Oliguria

Decreased Gastrointestinal Motility

Pale, Cool Skin

Weight Gain

Restlessness


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Left Ventricular Failure

Dyspnea

Cough

Frothy, blood-tinged sputum

Orthopnea

Paroxysmal nocturnal dyspnea

Pulmonary CracklesRadiographic evidence of pulmonary

vascular congestion with pleuraleffusion.


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Right Ventricular Failure

Distended Jugular VeinsAscites

AnorexiaNauseaAbdominal DistentionLiver enlargement with right upper

quadrant pain.Edema: feet, ankles, and sacrum. May

progress up legs into thighs andexternal genitalia and lower trunk


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Respiratory DistressNumber of pillows needed to breathecomfortably when resting.Edema (site, degree of pitting)Abdominal distention secondary toascites.Weight gainAdventitious breath soundsAbnormal heart soundsActivity intoleranceJugular vein distentionBlood flow to the kidneys is diminished,resulting in oliguria.Oxygen deficit in tissues results incyanosis and general debilitation.


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Shortness of breath (dyspnea)Fatigue or weakness

Swelling in legs, ankle, & feetPersistent coughSudden weight gain

** Women are more likely than men to have swollenankles and shortness of breath**


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Kidney Damage - The kidneys are not functioning in the

correct way and the body is retaining fluidinstead of eliminating it from the body

PVD (tissue damage) - The heart is not functioning properly and

the heart is not pumping the blood

everywhere it needs to goPneumonia - Fluid could get into the lungs and cause

aspiration


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BNP- is a neurohormone secreted by the heart in response to expansion

of ventricular and pressure overload

< 100 normal

> 100 is suggestive of HF

Blood chemistry

- will reveal elevated BUN and creatinine resulting from a decreased

glomerular filtration
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Chest radiographReveals pulmonary vascular congestion and pleural effusionECGReveals cardiac dysthymiasEchocardiogramDone to determine presence of pericardial fluid, heart failure andejection fractionPulmonary artery Catheterization

Asses right and left ventricular function
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Action

Digoxin Increases the force of the heart's contractions, which can be beneficial in heart failure and for irregular heart

beats. Used to relieve heart failure symptoms, especially when the patient isn't responding to ACE inhibitorsand diuretics. Also slows certain types of irregular heartbeat (arrhythmias), particularly atrial fibrillation.

Lasix Used to help lower blood pressure. Used to help reduce swelling (edema) from excess buildup of fluid in the

body. Causes the body to rid itself of excess fluids and sodium through urination. Helps to relieve the heart's

workload. Also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles andlegs. Different diuretics remove fluid at varied rates and through different methods.

K-Lyte Potassium supplement. Restores electrolyte loss.

Cardabid Nitroglycerin (nitrates). Used to ease chest pain (angina). Relaxes blood vessels and increases the supply of

blood and oxygen to the heart while reducing its workload.

Toprol - XL Decreases the heart rate and cardiac output, which lowers blood pressure and makes the heart beat more

slowly and with less force. Used to lower blood pressure. Used with therapy for cardiac arrhythmias (abnormalheart rhythms) and in treating chest pain (angina). Used to prevent future heart attacks in patients who have

had a heart attack.

Aspirin Keeps blood clots from forming by preventing blood platelets from sticking together. Helps prevent clotting in

patients who have had a heart attack, unstable angina, ischemic strokes, TIA (transient ischemic attacks, or"little strokes") and other forms of cardiovascular disease. Usually prescribed preventively when plaque

buildup is evident but there is not yet a large obstruction in the artery.

Lotensin Used to treat or improve symptoms of cardiovascular conditions including high blood pressure and heart

failure. Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood toflow more easily and makes the heart's work easier or more efficient.

Coumadin Helps to prevent harmful clots from forming in the blood vessels. May prevent the clots from becoming larger

and causing more serious problems. Helps to prevent harmful clots from forming in the blood vessels. May

prevent the clots from becoming larger and causing more serious problems. Often prescribed to prevent firstor recurrent stroke.


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Percutaneous coronary intervention

(PCI) (formerly referred to as

angioplasty)

Coronary artery bypass

Heart transplant

Valve replacementDefibrillator implantation

Left ventricular assist device (LVAD)


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PCI is one type of procedure to reopen blocked vessels. The

procedure is usually performed in the cardiac catherizationlab. A small tube a catheter with a tiny deflated balloon

on the end is inserted through an incision in the groin area

and pushed through to the diseased artery. Then the

balloon is inflated to push open the artery. The balloon is

removed once the artery has been fully opened. A stentmay be placed during the procedure to keep the blood

vessel open. Although there's a slight risk of damage to the

artery during this procedure, PCI usually improves the

patient's condition.


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Coronary artery bypass surgery reroutes the blood

supply around a blocked section of the artery. During

this procedure, surgeons remove healthy blood

vessels from another part of the body, such as a leg or

the chest wall. They then surgically attach the vessels

to the diseased artery in such a way that the blood

can flow around the blocked section.

After a bypass operation, it's especially important foryou to watch your diet and reduce the amount of fat

and cholesterol you eat, since these substances cause

the arteries to clog. Doctors also recommend

following a routine of increased physical activity to

strengthen the heart muscles.


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Some people have severe, progressive heart failure that

can't be helped by medications and dietary and lifestyle

changes. In such cases a heart transplant may be the only

effective treatment option.

Surgeons replace the damaged heart with a healthy one

taken from a donor who has been declared brain dead. It

can take several months to find a donor heart that closelymatches the tissues of the person receiving the transplant.

But this matching process increases the likelihood that the

recipient's body will accept the heart.

During a transplant procedure, the surgeon connects thepatient to a heart-lung machine, which takes over the

functions of the heart and lungs. The surgeon then

removes the diseased heart and replaces it with the donor

heart. Finally, the major blood vessels are reconnected and

the new heart is ready to work.


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Heart failure is sometimes caused by a defective or

diseased heart valve. Heart valves regulate the flow ofblood inside the heart. When they don't work

properly, this puts extra strain on the heart and can

lead to heart failure. Correcting the problem surgically

can often improve or resolve the condition.

A variety of different replacement valves can be used:

a mechanical valve made from metal and plastic, one

made from human or animal tissue. During the

surgery, the patient is connected to a heart-lung

machine that supplies blood to the brain and body.

The bad valve is removed and replaced.


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Some people who have severe heart

failure or serious arrhythmias (irregularheartbeats) are candidates for implantable

defibrillators. These devices are surgically

placed and deliver pacing, or an electric

countershock, to the heart when a life-

threatening abnormal rhythm is detected.


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A left ventricular assist device (LVAD) is a battery-operated,

mechanical pump-type device that's surgically implanted. It helps

maintain the pumping ability of a heart that can't effectively work

on its own.

This device is sometimes called a "bridge to transplant," but is

now used in long-term therapy. People awaiting a heart transplantoften must wait a long time before a suitable heart becomes

available.

A common type of LVAD has a tube that pulls blood from the left

ventricle into a pump. The pump then sends blood into the aorta

(the large blood vessel leaving the left ventricle). This effectivelyhelps the weakened ventricle. The pump is placed in the upper

part of the abdomen. Another tube attached to the pump is

brought out of the abdominal wall to the outside of the body and

attached to the pump's battery and control system.


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Decreased Cardiac Output related to impaired

contractility and increased preload and afterload

Impaired Gas Exchange related to alveolar edema

due to elevated ventricular pressures

Excess Fluid Volume related to sodium and water

retention

Activity Intolerance related to oxygen supply and

demand imbalance


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Place patient at physical and emotional rest

Rationale: to reduce work of heart.

Auscultate heart sounds frequently and monitor cardiac rhythm. Take frequent

BP readings

Rationale: to detect further complications and attacks

Administer pharmacotherapy as directed

Rationale: administer medications as ordered to control the signs and symptoms

of CHF

Observe for signs and symptoms of reduced peripheral tissue perfusion: cool

temperature of skin, facial pallor, poor capillary refill of nail beds

Rationale: to monitor for signs and symptoms of CHF leading to further

complications


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Raise head of bed 8 to 10 inches (20 to 30 cm)

Rationale: reduces venous return to heart and lungs; alleviates pulmonary

congestion.

Auscultate lung fields at least every 4 hours for crackles and wheezes in

dependent lung fields

Rationale: to detect fluid accumulates in areas affected by gravity

Encourage deep-breathing exercises every 1 to 2 hours

Rationale: to avoid atelectasis

Offer small, frequent feedings

Rationale: to avoid excessive gastric filling and abdominal distention with

subsequent elevation of diaphragm that causes decrease in lung capacity


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Administer prescribed diuretic as ordered

Rationale: to eliminate the excess water retained in body tissues

Give diuretic early in the morning nighttime

Rationale: diuresis disturbs sleep

Keep input and output record

Rationale: patient may lose large volume of fluid after a single

dose of diuretic

Be alert for signs of hypokalemia

Rationale: may cause weakening of cardiac contractions and may

precipitate digoxin toxicity


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Increase patients activities gradually and stay within patients limits of his

cardiac reserve

Rationale: avoid exhaustion but encourage and maintain increases in activity

tolerance

Assist patient with self-care activities early in the day

Rationale: fatigue sets in as day progresses

Monitor the pulse, symptoms, and behavioral response

to increased activity

Rationale: to detect signs of exhaustion or complications

Relieve nighttime anxiety and provide for rest and sleep

Rationale: patients with heart failure have a tendency to be restless at night

because of cerebral hypoxia with superimposed nitrogen retention


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The overall goal of therapy for Mr. Evans is toreduce the signs and symptoms associated with

CHF. Therefore this goal would include the

following:

Decreasing dyspnea

Decreasing adventitious lung sounds

Maintain vital signs within acceptable levels

Decreasing edema

Consistent lab readings within acceptable ranges

Adherence to an established nutritional diet

Adherence to established medication therapy

Avoid alcohol and exercise regularly


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Living With Congestive Heart Failure CHF 4

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