Download Congestive Heart Failure

Congestive
Heart Failure
PATIENT INFORMATION
B Y: L A S H O N D A M A R T I N
What is it?
Certain conditions can gradually weaken the heart and leave it stiff and thickened
Heart cannot fill and pump blood as well as it should
Fluid builds up in heart, body, and other organs
Congestive heart failure
Causes/Risk factors
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Narrowed arteries in the heart (Coronary Artery Disease)
High blood pressure (hypertension)
Heart attack
Cardiomyopathy
Diabetes
Obesity
Emphysema
Severe anemia
Valve disease
Thyroid disease
Kidney Disease
Family history of heart disease
Symptoms
• Shortness of breath (upon exertion or lying down)
• Chest pain (if it is caused by a heart attack)
• Fatigue & weakness
• Swelling (edema) in legs, ankles, feet
• Swelling in abdomen (ascites)
• Sudden weight gain from fluid retention
• Decreased appetite & nausea
• Rapid or irregular heartbeat
• Increased need to urinate at need
Treatment
• Lifestyle changes:
o Exercise
o Healthy diet & decreasing salt
o Managing & reducing stress
o Weight loss
o Not smoking
•Medications
• Surgery
• Medical devices
Coping & support
• Although heart failure is irreversible, treatment can help improve symptoms and prolong live
• Know when to contact your doctor
• Regular appointments
• Keep track of your medications & avoid certain over-the-counter drugs and supplements.
• Keep track of weight & blood pressure
Questions?
Congestive
Heart Failure
NURSING IMPLICATIONS
What is it?
• A clinical syndrome resulting from structural or functional cardiac disorders that impair the
ability of the ventricles to fill or eject blood
• Impaired contraction or filling of the heart may cause pulmonary or systemic congestion
• Most often chronic and progressive
• Managed with lifestyle changes and medications
Nursing assessment
• Health history and family history
• Life style
• Patient’s emotional response to the diagnosis
• Signs and symptoms of increasing CHF
• Physical examination:
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LOC, unexplained confusion or weakness
Crackles, increased/fast RR, dyspnea, cough
Tachycardia, abnormal or uneven heart sounds
Extremities for edema, color, swelling, circulation, temperature, peripheral pulses
BP, dizziness, lightheadedness, syncope
JVD
Anorexia or nausea
Rapid weight gain
Weakness/fatigue, restlessness, sleep disturbances, anxiety (suggest hypoxia from pulmonary congestion)
Abdomen tenderness and hepatomegaly
Tests and diagnosis
• Diagnosis:
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Medical history
Review of symptoms
Physical exam
Blood tests & lab work
• Tests:
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Chest x-ray
ECG
Labs – electrolytes, BUN, CBC, BNP
Echocardiogram
Stress test
Cardiac computerized tomography scan (CT)
MRI
Coronary angiogram
Myocardial biopsy
Potential Complications
• Hypotension, poor perfusion, and cardiogenic shock
• Dysrhythmias
• Thromboemolism
• Pericardial effusion and cardiac tamponade
• Kidney or liver damage and/or failure
Medical management
• Objectives:
o Improvement of cardiac function by ↓preload and after load
o Reduction of symptoms and improvement of functional status
o Stabilization of patient condition and ↓risk of hospitalization
o Delaying the progression of HR and extension of life
expectancy
o Promotion of a lifestyle conductive to cardiac health
Treatment: drugs
• Angiotensin-converting enzymes (ACE inhibitors) – Lisinopril (Prinivil)
• Beta blockers – carvedilol (Coreg)
• Diuretics – furosemide (Lasix)
o Thiazide - Hydrochlorothiazide (HCTZ)
o Aldosterone antagonists – spironolocatone (Aldactone)
• Angiotensin II receptor blockers – losartan (Cozaar)
• Digoxin (Lanoxin)
Treatment: surgery & medical devices
• Coronary bypass surgery
• Heart valve repair or replacement
• Implantable cardioverter-defibrillators (ICDs)
• Cardiac resynchronization therapy (CRT) or biventricular pacing
• Heart pumps
• Heart transplant
Nursing Diagnoses
• Activity intolerance R/T decreased cardiac output
• Excess fluid volume R/T to systemic fluid overload
• Risk for impaired skin integrity R/T edema and decreased tissue perfusion
• Powerlessness R/T chronic illness and hospitalizations
• Risk for ineffective therapeutic regimen management R/T lack of knowledge of diet, drug
therapy, activity program, and signs/symptoms of complications
Nursing Interventions
• Promote activity tolerance
• Managing fluid volume
• Controlling anxiety and minimize powerlessness
• Assist patients and family to effectively manage the
therapeutic regimen
• Monitor and manage potential complications
• Educate: self-care, medication compliance, lifestyle changes,
signs and symptoms of worsening condition
Evaluation
• Expected patient outcomes may include:
o Demonstrates tolerance for desired activity
o Maintains fluid balance
o Decreased anxiety
o Makes sound decisions regarding care and treatment
o Patients and family members adhere to therapeutic regimen
Nursing considerations: drugs
• Many potential complications are associated with the excessive/repeated use of diuretics.
• Ongoing nursing assessments and collaborative interventions:
o Hypokalemia which can lead to digitalis toxicity
o Hyperkalemia
o Low magnesium levels
o Hyponatremia
o Volume depletion from excessive fluid loss can cause dehydration and hypotension
o Other: ↑serum creatinine and hyperuricemia
Nursing considerations: patient education
• Take/administer medications exactly as prescribed
• Monitor effects of medication such as changes in breathing and edema
• Know signs and symptoms of orthostatic hypotension and how to prevent it
• Weigh self daily at same time with same clothing
• Restrict sodium intake to no more than 2g/day
• Participate in prescribed activity program
• Develop methods to manage and prevent stress
• Keep regular appointments with physician
• Be alert for symptoms that may indicate recurring heart failure, and report these symptoms
immediately to your physician
Questions?