Right Sided Congestive Heart

Failure

Carino, Shonnia
Hassan, Huda
Manipon, Shannon
Regacho, Richard
Somera, Maria Monica
Congestive Heart Failure
The state in which the heart can no longer
pump an adequate supply of blood to meet
the demands of the body.
can be classified as acute or chronic

Acute heart failure develops quickly and

often without warning
Chronic heart failure develops gradually
and the patient is seen initially with milder
symptoms COMPARE. PICS.
Classification:

Heart failure is classified into two types:

 Statistics
PHILIPPINES
Just likecoronary arterydisease, the

incidence of HF increases with age.

More than5 millionpeople in the United
States have HF.
There are550, 000 casesof HF diagnosed
each year according to the American Heart
Association.
HF is most common among people older
than75 years of age.
HF is now consideredepidemicin the
United States.
Incidences
Heart failure can affect both women and
men, although the mortality is higher
among women. WHY?
There are also racial differences; at all ages
death rates are higher in African American
than in non-Hispanic whites.
Heart failure is primarily a disease of older
adults, affecting 6% to 10% of those older
than 65.
It is also the leading cause of
hospitalization in older people.
Congestive heart failure -
right-sided
Causes
Right-sided
heart failure
occurs in
Diagnosis
Based on the assessment data, major
nursing diagnoses for the patient with HF
include the following:
Activity intolerancerelated to decrease CO.

Excess fluid volumerelated to the HF

syndrome.
Anxietyrelated to breathlessness from
inadequate oxygenation.
Powerlessnessrelated to chronic illness
and hospitalizations.
Ineffective therapeutic regimen
Assessment and Diagnostic
Findings
HF may go undetected until the patient
presents with signs and symptoms of
pulmonary and peripheral edema.
ECG:Ventricular or atrial hypertrophy, axis
deviation, ischemia, and damage patterns
may be present. Dysrhythmias, e.g.,
tachycardia, atrial fibrillation, conduction
delays, especially left bundle branch block,
frequent premature ventricular contractions
(PVCs) may be present. Persistent ST-T
segment abnormalities and decreased QRS
amplitude may be present.
 Heart scan (multigated acquisition
[MUGA]):Measures cardiac volume during
bothsystoleanddiastole, measures
ejection fraction, and estimates wall
motion.
Exercise or pharmacologicalstress
myocardial perfusion (e.g., Persantine
or Thallium scan):Determines presence
of myocardial ischemia and wall motion
abnormalities.
Positron emission tomography (PET)
scan:Sensitive test for evaluation of
 Arterial blood gases (ABGs):Left
ventricular failure is characterized by mild
respiratory alkalosis (early) or hypoxemia
with an increased Pco2(late).
BUN/creatinine:Elevated BUN suggests
decreased renal perfusion. Elevation of
both BUN and creatinine is indicative of
renal failure.
Serum albumin/transferrin:May be
decreased as a result of reduced protein
intake or reduced protein synthesis in
congestedliver.
Management

Nursing Interventions
for Congestive Heart
Failure (Right side)
Patient care management
goal: to treat the underlying
or precipitating factors and
Medical Management
-Beta Blockers (carvedilol, metoprolol)
These medicines lower heart rate and blood pressure, and
protect your heart from certain substances that can damage your
heart

-ACE Inhibitors (lisinopril, captopril)

Angiotensin converting enzyme (ACE) inhibitors reduce the
amount of heart-damaging hormones your body produces. They
also open blood vessels and lower blood pressure to lessen the
workload of your heart.

-Hydralazine and Nitrates (Apresoline,

Nitrobid, Imdur, Isordil)
Hydralazine and nitrates are often used together to treat
heart failure. They open blood vessels so it's easier for your heart
to receive and pump blood.
Surgical Management
Coronary artery bypass grafting (CABG) is a
type of surgery that improves blood flow to
the heart. Surgeons use CABG to treat
people who have severe coronary heart
disease (CHD).

CABG will have an incision in the chest and

temporarily stops the heart. To open the
chest, your doctor cuts the breastbone
(sternum) in half lengthwise and spreads it
apart. Once the heart is exposed, your
doctor inserts tubes into the heart so that
the blood can be pumped through the body
Pharmacologic Therapy
ACE Inhibitors.ACE inhibitorsslow the
progression of HF, improve exercise
tolerance, decrease the number of
hospitalizations for HF, and
promotevasodilationand diuresis by
decreasing afterload and preload.
Angiotensin II Receptor Blockers.
ARBsblockthe conversion of angiotensin I
at the angiotensin II receptor and cause
decreasedblood pressure, decreased
systemic vascular resistance, and improved
cardiac output.
Nutritional Therapy
Sodiumrestriction. A lowsodiumdiet
of2 to 3g/dayreduces fluid retention and
the symptoms of peripheral and pulmonary
congestion, and decrease the amount of
circulating blood volume, which decreases
myocardial work.
Patient compliance. Patient compliance is
important because dietary indiscretions
may result in severe exacerbations of HF
requiring hospitalizations.
Additional Therapy

Supplemental Oxygen. The need for

Surgical Management PICS
Implantable Cardioverter-Defibrillator
(ICD)
Some people who have severe heart failure
or serious arrhythmias (irregular
heartbeats) 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.
They have saved millions of lives, but may
not be for everyone. This is a shared
decision by the patient and physician.
Learn more about implantable devices.
 Heart transplantation
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
closely matches the tissues of the person
 Percutaneous coronary intervention
(PCI) (also referred to as angioplasty)
Heart failure can develop when blockages
in the coronary arteries restrict the blood
supply to the heart muscle. Removing
these blockages can improve overall heart
function, which may improve or resolve
heart failure symptoms. PCI is one type of
procedure to reopen blocked vessels.
The procedure is usually performed in the
cardiac catheterization lab. A small tube a
catheter with a tiny deflated balloon on
the end is inserted through an incision in