II.

Anatomy and Physiology

The heart is composed of two independent pumping systems, one on the

right side, and the other on the left. Each has two chambers, an atrium and a
ventricle. The ventricles are the major pumps in the heart.

The external structures of the heart include the ventricles, atria, arteries,
and veins. Arteries carry blood away from the heart while veins carry blood into
the heart. The vessels colored blue indicate the transport of blood with relatively
low content of oxygen and high content of carbon dioxide. The vessels colored
red indicate the transport of blood with relatively high content of oxygen and
low content of carbon dioxide.

The Right Side of the Heart

The right system receives blood from the veins of the whole body. This is
"used" blood, which is poor in oxygen and rich in carbon dioxide.

• The right atrium is the first chamber that receives blood.

• The chamber expands as its muscles relax to fill with blood that has
returned from the body.
 • The blood enters a second muscular chamber called the right ventricle.
• The right ventricle is one of the heart's two major pumps. Its function is to
pump the blood into the lungs.
• The lungs restore oxygen to the blood and exchange it with carbon
dioxide, which is exhaled.

The Left Side of the Heart

The left system receives blood from the lungs. This blood is now oxygen rich.

• The oxygen-rich blood returns through veins coming from the lungs
(pulmonary veins) to the heart.
• It is received from the lungs in the left atrium, the first chamber on the
left side.
• Here, it moves to the left ventricle, a powerful muscular chamber that
pumps the blood back out to the body.
• The left ventricle is the strongest of the heart's pumps. Its thicker muscles
need to perform contractions powerful enough to force the blood to all
parts of the body.
• This strong contraction produces systolic blood pressure (the first and
higher number in blood pressure measurement). The lower number
(diastolic blood pressure) is measured when the left ventricle relaxes to
refill with blood between beats.
• Blood leaves the heart through the ascending aorta, the major artery that
feeds blood to the entire body.

The Valves

Valves are muscular flaps that open and close so blood will flow in the right
direction. There are four valves in the heart:
 • The tricuspid regulates blood flow between the right atrium and the right
ventricle.
• The pulmonary valve opens to allow blood to flow from the right ventricle
to the lungs.
• The mitral valve regulates blood flow between the left atrium and the left
ventricle.
• The aortic valve allows blood to flow from the left ventricle to the
ascending aorta.

The Heart's Electrical System.

The heartbeats are triggered and regulated by the conducting system, a

network of specialized muscle cells that form an independent electrical system
in the heart muscles. These cells are connected by channels that pass
chemically caused electrical impulses.
III. The Patient and his Illness

Left Sided Congestive Heart Failure

Pathophysiology

Causes:
o Myocardial Infarction
o Hypertension
o Aortic stenosis insufficiency
o Mitral stenosis insufficiency
Reduced myocardial contractility
Increases cardiac workload
Decreased diastolic filling
Obstructions of left atrial
emptying

Bloods dams back Left sided CHF Left atrial pressure

into the pulmonary
capillary bed
Stroke volume decreases
Blood flow to the kidneys
Pressure at the
pulmonary capillary Tissue perfusion
bed decreases RAAS stimulation

Pulmonary edema
Cellular hypoxia Vasoconstriction and
reabsorption of Na and water

ECF volume

S/Sx Total blood volume

Systemic BP
 Right Sided Congestive Heart Failure

Pathophysiology

Causes:
o LSCHF
o Pulmonary
Embolism Reduced myocardial Increases cardiac
o Right ventricular contractility workload
infarction
o Congenital septal
defects
Decreased diastolic
Obstruction of right Contraction of right sided filling
atrial emptying atrial filling

Increase right atrial Right sided CHF Blood drains back from
pressure RV to RA

S/Sx Increased pressure in the

veins
b. Synthesis of the Disease

b.1. Definition of the Disease

Congestive heart failure (CHF), or heart failure, is a condition in which the heart
can't pump enough blood to the body's other organs.

b.2. Predisposing / Precipitating Factors

• Infection
• Anemia
• Thyrotoxicosis
• Abnormal heart rhythms
• Rheumatic fever
• Infective Endocarditis
• Myocarditis
• Hypertension
• Heart attack
• Myocardial infarction
• Pulmonary embolism
• Overexercise
• Sudden increase in salt in the diet
• Excessive environmental heat or humidity
• Emotional crises

b.3. Signs and Symptoms

Left-Sided Heart Failure:

• Dyspnea

• Orthopnea
• Cough or wheezing

• Frothy pink sputum

• Crackles can be heart in the lungs

• Paroxysmal Nocturnal Dyspnea

• Cerebral hypoxia

• Anxiety

• Irritability

• Restlessness

• Wheezing

• Dizziness

• Syncope

• Fatigue

• Weakness

• Anorexia

• Hypokalemia

• Increase level of aldosterone

• Clubbing of the fingers

• Polycythemia

• S3, S4 heart sound, Pulsus Alterans

• Increase pulmonary arterial pressure, pulmonary capillary wall pressure

• Confusion

• Impaired memory

• Insomnia Nocturia

• Oliguria
Right-Sided Heart Failure:

• Ankle edema to the legs, sacrum and scrotum

• Patient with severe peripheral edema may develop

• Serous exudates and bulae (bulla)

• Hepatomegaly

• Ascites

• Neck vein engorgement

• Portal hypertension

• Splenomegaly

• Jaundice

• Hemolytic anemia

• Internal hemorrhoids

• Leg varicosities

• Weight gain

• S3 and S4 heart sound

• Elevated CVP reading

IV. Clinical Intervention

Medical Management of Physiologic Outcomes

Medical General Indication(s)/Purpose(

Management/ Description s)
Treatment
Half-normal Has lesser
0.45% NaCl saline concentration of
(0.45% solutes than plasma
NaCl), often therefore
with "D5" treats cellular
(5% dehydration
dextrose), through fluid shifting
contains 77 out of the vascular
mEq/L of Na compartment into
and Cl and cells; promotes
50 g/L elimination by
glucose. kidneys.
Fluid Therapy

NURSING RESPONSIBILITIES
- Read doctor’s order
- Check IV label
 - Check for patency of tubing
- Regulate as ordered
- Check IV infusion and amount
- Monitor Electrolyte
Name of drug/ Route/Adm General Action Indication or Purpose
generic inistration
name/brand Dosage
name and
frequency
of
administra
tion

Metoprolol 50 mg/tab, Antihypertensive It is used for patient’s

(Lopressor) 1 tab OD with hypertension.
Beta 1- selective
adrenergic blocker

Selective inhibitor of
beta1-adrenergic
receptors;
competitively blocks
beta1-receptors thus
lowering BP and
decreasing cardiac
output.

Nursing Responsibilities:

PRIOR TO THE PROCEDURE:

• Check doctor’s order and sensitivity to drug.
• Explain the action and possible side effects of the drug to the
patient/SO.
• Always observe aseptic technique.

DURING THE PROCEDURE:

• Slowly administer the drug.
• Give oral drug in food to facilitate absorption.
 AFTER THE PROCEDURE:
• Observe the patient’s response to the medication.
• Document the time and date it was given with the drug name,
dosage.
Name of drug/ Route/Adm General Action Indication or Purpose
generic inistration
name/brand Dosage
name and
frequency
of
administra
tion

Captopril 25 mg SL
(Capoten) for BP > or ACE inhibitor It is used for treatment
equal to of hypertension.
140/90

Nursing Responsibilities:

PRIOR TO THE PROCEDURE:

• Check doctor’s order and sensitivity to drug.
• Explain the action and possible side effects of the drug to the
patient/SO.
• Always observe aseptic technique.

DURING THE PROCEDURE:

• Slowly administer the drug.

AFTER THE PROCEDURE:

• Observe the patient’s response to the medication.
• Document the time and date it was given with the drug name,
dosage.
• Monitor BP an hour after taking the drug.
Name of drug/ Route/Adm General Action Indication or Purpose
generic inistration
name/brand Dosage
name and
frequency
 of
administra
tion

Mannitol 100 cc q 8 For patients

(Osmitrol) Diuretics experiencing renal
dysfunction, increased
intraocular or
An osmotic diuretic intracranial pressure,
that increases the edema; ascites caused
osmotic pressure of by renal, hepatic or
glomerular filtrate, cardiac failure.
inhibiting tubular
reabsorption of
water and
electrolytes and that
elevates blood
plasma
osmolality, resulting
in enhanced water
flow into
extracellular fluid.

NURSING RESPONSIBILITIES:

- Monitor vital signs, including central venous pressure and fluid intake
and output hourly. Report increasing oliguria.
- Monitor weight, renal function, fluid balance, serum, and urine sodium
and potassium levels daily.
- It can be used in measuring glomerular filtration rate.
Name of drug/ Route/Adm General Action Indication or Purpose
generic inistration
name/brand Dosage
name and
frequency
of
administra
tion

Digoxin 0.5 mg/

(Lanoxin) IVP now
then 0.25 Cardiac glycoside; It is used for heart
mg/tab OD failure and atrial
Cardiotonic fibrillation.

Nursing Responsibilities:

PRIOR TO THE PROCEDURE:

• Check doctor’s order and sensitivity to drug.
• Explain the action and possible side effects of the drug to the
patient/SO.
• Always observe aseptic technique.
• Avoid giving it with meals.
• Check dosage and preparation carefully.

DURING THE PROCEDURE:

• Slowly administer the drug.

AFTER THE PROCEDURE:

• Observe the patient’s response to the medication.
• Document the time and date it was given with the drug name,
dosage.
• Monitor for therapeutic drug levels: 0.5- 2mg/mL.