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Congestive

Heart Failure


CHF or Heart Failure is defined as the inability of the
heart to maintain adequate circulation to meet the tissues
need for oxygen and nutrients.
There are two types of heart failure: diastolic heart
failure and systolic heart failure.


Diastolic results from impaired ventricular filling.

Systolic results from pump failure that is characterized
by impaired contractility.





Heart Failure
Chronic Heart Failure
Acute Heart Failure
(Pulmonary Edema)
Diastolic HF
(Alteration in ventricular filling)
Systolic HF
(Alteration in ventricular contraction)
Left Side HF Right Side HF

Causes from
Atherosclerosis
Left sided heart failure
COPD
Valvular stenosis
Valvular insufficiency
Pulmonary Hypertension








Causes from:
Atherosclerosis
Fluid over load
IM
Valvular stenosis
Valvular insufficiency
Hypertension
Cardiac conduction defects
Cardio myopathy
Infection
Immune and connective disorder
Endocrine imbalance


Left Side HF

Assessment Findings:

Dyspnea, orthopnea,
nocturnal dyspnea, tachypnea
Crackles, wheezes, rhonchi,
cough
Hemoptysis
Gallop rhythm: S3, S4
Palpitations, arrhythmias,
disrhythmias, tachycardia
Fatigue
Anxiety
Diaphoresis
Forthy sputum (blood-tinged)
Anorexia
Right Side HF
Assessment Findings:

Jugular vein distention
Anorexia, nausea, vomiting
Abdominal distention, ascites
Hepatomegaly
Liver and spleen enlargement
Dependent edema, peripheral
edema
Weight gain
Signs of left-sided heart failure
Tachycardia, fatigue, nocturia
Elevated CVP
nocturia




Diagnostic Tests:
History and physical examination
BNP (a test to determine an increase in cardiac hormone
production
indicating heart failure)
Chest x-ray will show left ventricular hypertrophy & increase
pulmonary congestion.
ABG, CBC, serum electrolytes (decreased potassium)
ECG
Echocardiogram will show increased
size of cardiac chambers and decreased wall motion.
Hemodynamic monitoring


Left Side HF
Right Side HF
Pharmacologic Therapy:

ACE inhibitors (angiotension converting enzyme inhibitors
are prescribed 1
st
for heart failure.) They are used for:
Management of heart failure due to systolic disfunction.
Promotion of vasodilation & diuresis by decreasing afterload &
preload.
Prototype (Capoten) Captopril
(Vasotec) Enalapril


Alternatives for pt. who can not take ACE inhibitors:
ARBS (Angiotensin II receptor blockers)
Hydralazin & Isosorbide Dinitrate
Pharmacologic Therapy cont. :
Beta Blockers can be used with ACE inhibitors to reduce
mortality & morbidity. They are contraindicated with pt. with
severe or uncontrolled asthma.
Medications:
Carvedilol, Metoprolol, Bisoprolol
Diuretics (for treatment of edema)
Loop diuretics for pt. with renal insufficiency
Potassium-sparing diuretic to inhibit sodium reabsorption
Thiazides for mild treatment
Side effects can cause electrolyte imbalance
Medications:
Furosemide (Lasix)

Pharmacologic Therapy cont. :



Digitalis
myocardial contraction and left ventricular output
increased CO
conduction through the AV node
Caution: check for apical pulses before administration,
watch out for toxicity that can cause dangerous
dysrhymias
Medications:
Digoxin (Lanoxin)


Pharmacologic Therapy cont. :
Calcium Channel Blockers
Interfere with the ability of muscles to contract, leading to
vasodilation & reducing systemic vascular resistance
Medications:
Amlodipine (Norvasc)
Nifedipine (Procardia)
Diltiazem (Cardizem)

Additional Medical Management:
Avoid NSAIDs, decongestants, excessive amounts of fluids
Keep low sodium diet (2-3 g / day)
Oxygen therapy
Administer analgesics (Morphine IV) & assess RR & keep Narcan
antidote available
Nursing Diagnoses
Decreased cardiac output r/t altered
myocardial contractility
Activity intolerance r/t imbalance between
oxygen supply and demand
Excess fluid volume r/t excess fluid intake
or sodium intake
Anxiety r/t breathlessness and
restlessness from inadequate oxygenation



Assess:

I. For s/s of pulmonary & systemic fluid over
load (crackles, wheezes & peripheral edema)
II. Heart sounds
III. Daily weight and I&O
IV. O2 saturation & ABGs
V. Review diagnostic tests (EKG, Chest x-ray,
EEG)
VI. Review labs (BNP, BUN & creatinine, serum
electrolytes, CBC)



Assist:


I. Keep pt. in semi-fowler position
II. Administer IV fluids, meds, O2 per MD order
III. Encourage bed rest until stable
IV. Take VS before, during & after activity &
medication administration
V. Help maintain diet & reduce oral fluids (no
caffeine, low sodium, low cholesterol)


Teach:

I. Elevate legs when seated - to reduce/prevent edema
II. Recognize s/s of fluid overload
III. Anxiety controlling techniques when short of breath
IV. Add potassium to diet (if on non-potassium sparing
diuretics)
V. Limit sodium & cholesterol intake
VI. Adverse effects of smoking
VII. Once stable, pt. should exercise for 30 min. 2-3 times
weekly.
VIII. Medications side effects