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Heart failure Definition Heart failure, also called "congestive heart failure," is a disorder where the heart loses its ability to pump blood efficiently. Heart failure is almost always a chronic, long-term condition that is managed with medications and lifestyle changes. Introduction Heart failure occurs when the heart is unable to pump enough blood through the body. This condition usually occurs over time and is the result of some form of heart disease. The condition is slightly more common among men than women. Pathophysiology Heart failure is a clinical syndrome that occurs when the heart does not function adequately as a pump and fails to pump enough blood to meet the body's metabolic needs. Congestion (the buildup of fluid). intravascular and interstitial volume overload and decreased tissue perfusion. Pathophysiology Systolic heart failure occurs when the heart's ability to contract decreases. Left ventricular systolic heart failure cause fluid congestion in the lungs, a condition known as pulmonary edema. Right ventricular heart failure causes hepatomegaly and peripheral edema. Pathophysiology Diastolic heart failure occurs when the heart has a problem relaxing. This form of heart failure may lead to fluid accumulation in the pulmonary and peripheral vasculature Heart failure almost never occurs at the same time as an acute myocardial infarction The Onset of Heart Failure Is an Indicator of One or More of the Following Problems Acute myocardial infarction Hypertension Fluid overload Intracranial injury Dysrhythmias The Onset of Heart Failure Is an Indicator of One or More of the Following Problems Valvular heart disease Hyperthyroidism Cardiomyopathy Fever Adult respiratory distress syndrome Heart Failure Can Also Occur in Conjunction With Pneumothorax Oxygen toxicity syndrome Intracranial tumors Uremic pneumonia Drugs (methotrexate, busulfan, hexamethonium, nitrofurantoin) Nursing Assessment Symptoms Severe dyspnea (especially on exertion) Orthopnea Weakness & fatigue Paroxysmal nocturnal dyspnea Weight gain Nursing Assessment Swelling of extremities Palpitations Reduced exercise capacity Nocturia Gastrointestinal symptoms (nausea, bloating, constipation, anorexia) Nursing Assessment Record the patient's medical history Diabetes Thyroid disease Cardiomyopathy Collagen vascular disease Nursing Assessment Assessed for a history of Previously compromised heart (chronic heart failure) Hypertension Myocardial infarction Medications Allergies Nursing Assessment Perform a physical examination Decreased pulse pressure Diaphoresis Tachycardia Edema (extremities, anasarca, ascites) Tachypnea Nursing Assessment Pulmonary rales or wheezes Hepatomegaly Distended neck veins Increased venous pressure Third heart sound (gallop) Pulsus alternans Hepatojugular reflux Pleural effusion (hydrothorax) Diagnostic Procedures Diagnostic Procedures Chest x-ray Elevated BUN and creatinine levels Hypokalemia (may be present if the patient is taking thiazides or loop diuretics) Abnormal liver function test values Diagnostic Procedures Proteinuria and high urine specific gravity Hyponatremia (evident in cases of severe heart failure) Anemia Impaired gas exchange (anxiety and fear) Nursing Interventions Airway, breathing, and circulation Provide supplemental oxygen Anticipate the need for endotracheal intubation Suction as needed Provide humidified oxygen Elevate the head of the bed into a semi- to high fowler's position Nursing Interventions Cardiac rhythm and vital signs, including heart rate, pulse oximetry, blood pressure, lung sounds, and respiratory rate. Monitor the patient's level of consciousness, intake and output, and skin perfusion. Establish IV access. Laboratory and ABG. Chest x-ray. Pharmacologic Agent Diuretics (furosemide) decreases preload secondary to reduction in blood volume =hypokalemia, hyponatremia, need for Foley catheterization Pharmacologic Agent Morphine venous and arterial vasodilation by decreasing preload and afterload, reducing anxiety and resulting heart stimulation, and myocardial workload. Avoid for patients: dyspnea, decreased level consciousness, hypercarbia, or inadequate ventilation. Pharmacologic Agent Vasodilators Vasodilators (nitroglycerin, isosorbide) Arteriolar dilators (hydralazine, minoxidil) Combined dilators (nitroprusside) ACE inhibitors (captopril, enalapril) Pharmacologic Agent Positive Inotropic agents Sympathomimetics (dopamine, dobutamine) Digitalis glycosides Phosphodiesterase inhibitors (amrinone, milrinone) Decrease myocardial workload, improve oxygen delivery to tissues, and increase contractility and cardiac output Pharmacologic Agent Bronchodilators Monitor the patient for pulmonary wheezing, as well as side effects such as nausea, vomiting, and tachyarrhythmias Prepared to initiate advanced cardiac life Patient Education A patient who is experiencing heart failure, with or without pulmonary edema, will be fearful and filled with anxiety. Therefore, it is critical to maintain a calm and efficient manner throughout the assessment, diagnosis, and treatment of the patient. Patient Education Once the patient is out of immediate danger, always provide a thorough explanation of what is happening in clear, straightforward terms. And whenever possible, educate family members and significant others who are present. Conclusion The proper identification and management of heart failure requires a thorough understanding of the pathophysiology of the disease and in-depth knowledge of appropriate diagnostics, interventions, and patient management techniques. Conclusion When an understanding of all these elements is achieved, better care can be given to the patient experiencing heart failure, and mortality and morbidity can be reduced.