BRIEF DESCRIPTION

HEART FAILURE(congestive heart failure)

 the inability of the heart to pump sufficient blood to meet the needs of the tissues for
oxygen and nutrients.
 The term heart failure indicates myocardial disease in which there is a problem with
contraction of the heart (systolic dysfunction) or filling of the heart (diastolic
dysfunction) that may or may not cause pulmonary or systemic congestion.
 Heart failure is most often a progressive, life-long condition that is managed with lifestyle
changes and medications to prevent episodes of acute decompensated heart failure.

CLASSIFICATIONS:
 Left-Sided Heart Failure
 Right-Sided Heart Failure
 Systolic heart failure
 Diastolic heart failure

DEFINITION:
Left-Sided Heart Failure
 the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the
systemic circulation.
 Pulmonary venous blood volume and pressure increase, forcing fluid from the pulmonary
capillaries into the pulmonary tissues and alveoli, causing pulmonary interstitial
edema and impaired gas exchange.
Right-Sided Heart Failure
 When the right ventricle fails, congestion in the peripheral tissues and the viscera
predominates.
 The right side of the heart cannot eject blood and cannot accommodate all the blood that
normally returns to it from the venous circulation.
 Increased venous pressure leads to JVD and increased capillary hydrostatic pressure
throughout the venous system.
Systolic heart failure
 The left ventricle can't contract vigorously, indicating a pumping problem
Diastolic heart failure(also called heart failure with preserved ejection fraction)
 The left ventricle can't relax or fill fully, indicating a filling problem.

*The American College of Cardiology and American Heart Association have

classifications of heart failure.

Stage A Patients at high risk for developing left ventricular dysfunction but without structural
heart disease or symptoms of heart failure.
Stage B Patients with left ventricular dysfunction or structural heart disease that has not
developed symptoms of heart failure.
Stage C Patients with left ventricular dysfunction or structural heart disease with current or prior
symptoms of heart failure.
Stage D Patients with refractory end-stage heart failure requiring specialized interventions.

CLINICAL MANIFESTATIONS:
 Shortness of breath (dyspnea)
 Fatigue and weakness
 Swelling (edema) in your legs, ankles
and feet
 Rapid or irregular heartbeat
 Reduced ability to exercise
 Persistent cough or wheezing
 Increased need to urinate at night
 Very rapid weight gain from fluid
retention
 Lack of appetite and nausea
 Difficulty concentrating or decreased
alertness
 Sudden, severe shortness of breath
and coughing up pink, foamy mucus
 Chest pain
 Swelling of your abdomen (ascites)
 BRIEF DESCRIPTION
LEFT-SIDED HEART FAILURE:
 DYSPNEA OR SHORTNESS OF BREATH
 May be precipitated by minimal to moderate activity.
 COUGH
 The cough associated with left ventricular failure is initially dry and nonproductive.
 PULMONARY CRACKLES
 Bibasilar crackles are detected earlier and as it worsens, crackles can be auscultated
across all lung fields.
 LOW OXYGEN SATURATION LEVELS
 Oxygen saturation may decrease because of increased pulmonary pressures.
RIGHT-SIDED HEART FAILURE
 Enlargement of the liver result from venous engorgement of the liver.
 Accumulation of fluid in the peritoneal cavity may increase pressure on the stomach and
intestines and cause gastrointestinal distress.
 Loss of appetite results from venous engorgement and venous stasis within the
abdominal organs.

CAUSES:
 Coronary artery disease and heart attack
 High blood pressure (hypertension
 Faulty heart valves
 Damage to the heart muscle (cardiomyopathy)
 Myocarditis
 Heart defects you're born with (congenital heart defects)
 Abnormal heart rhythms (heart arrhythmias
RISK FACTORS:
 Coronary artery disease  Valvular heart disease.
 Heart attack  Viruses
 Diabetes  Alcohol use
 Some diabetes medications  Tobacco use
 Certain medications  Obesity
 Sleep apnea  Irregular heartbeats
 High blood pressure

DIAGNOSTIC TESTS:
 Blood tests
 Chest X-ray
 Electrocardiogram (ECG)
 Cardiac computerized tomography (CT) scan
 Magnetic resonance imaging (MRI
MANAGEMENT:

SURGERY:
 Coronary bypass surgery
 Heart valve repair or replacement
 Implantable cardioverter-defibrillators (ICDs)
 Cardiac resynchronization therapy (CRT), or biventricular pacing
 Ventricular assist devices (VADs
 Heart transplant
MEDICAL:
 PHARMACOLOGIC THERAPY
 ACE Inhibitors
 Angiotensin II Receptor Blockers
 Beta Blockers
 Diuretics
 Calcium Channel Blockers
 NUTRITIONAL THERAPY
 Sodium restriction
 Patient compliance
 BRIEF DESCRIPTION

NURSING MANAGEMENT:

NURSING ASSESSMENT
 HEALTH HISTORY
 Assess the signs and symptoms such as dyspnea, shortness of breath, fatigue,
and edema.
 Assess for sleep disturbances, especially sleep suddenly interrupted by
shortness of breath.
 Explore the patient’s understanding of HF, self management strategies, and the
ability and willingness to adhere to those strategies.
 PHYSICAL EXAMINATION
 Auscultate the lungs for presence of crackles and wheezes.
 Auscultate the heart for the presence of an S3 heart sound.
 Assess JVD for presence of distention.
 Evaluate the sensorium and level of consciousness.
 Assess the dependent parts of the patient’s body for perfusion and edema.
 Assess the liver for hepatojugular reflux.
 Measure the urinary output carefully to establish a baseline against which to
assess the effectiveness of diuretic therapy.
 Weigh the patient daily in the hospital or at home.

NURSING INTERVENTIONS:
 Promoting activity tolerance
 Managing fluid volume
 Controlling anxiety
 Minimizing powerlessness
NURSING PRIORITIES
 Improve myocardial contractility/systemic perfusion.
 Reduce fluid volume overload.
 Prevent complications.
 Provide information about disease/prognosis, therapy needs, and prevention of
recurrences.

DISCHARGE AND HOME CARE GUIDELINES:

 Patient education
 Encourage the patient and their families to ask questions so that information can be
clarified and understanding enhanced.

COMPLICATIONS:
 Kidney damage or failure
 Heart valve problems
 Heart rhythm problems
 Liver damage

PREVENTION:
 Healthy Diet
 Engaging In Cardiovascular Exercises
 Smoking Cessation

HYPERTENSION
 Is one of the most common lifestyle diseases to date. It affects people from all walks of
life. Let us get to know hypertension more by its definitions.
 Hypertension is defined as a systolic blood pressure greater than 140 mmhg and
a diastolic pressure of more than 90 mmhg.
 This is based on the average of two or more accurate blood pressure
measurements during two or more consultations with the healthcare provider.
 BRIEF DESCRIPTION

CLASSIFICATION:
CATEGORY SYSTOLIC DIASTOLIC

Normal <120 <80

Elevated 120-139 80-89

Stage 1 hypertension 140-159 90-99

Stage 2 hypertension >160 >100

Hypertensive >180 >120

Emergency

EPIDEMIOLOGY:
 About 31% of the adults in the United States have hypertension.
 African-Americans have the highest prevalence rate of 37%.
 In the total US population of persons with hypertension, 90% to 95% have primary
hypertension or high blood pressure from an unidentified cause.
 The remaining 5% to 10% of this group have secondary hypertension or high blood
pressure related to identified causes.
 Hypertension is also termed as the “silent killer” because 24% of people who had
pressures exceeding 140/90 mmHg were unaware that their blood pressures were
elevated.
CAUSES:
Primary (essential) hypertension
 For most adults, there's no identifiable cause of high blood pressure.
 This type of high blood pressure, called primary (essential) hypertension, tends to
develop gradually over many years.
Secondary hypertension
 Some people have high blood pressure caused by an underlying condition.
 This type of high blood pressure, called secondary hypertension, tends to appear
suddenly and cause higher blood pressure than does primary hypertension. Various
conditions and medications can lead to secondary hypertension, including:
 Obstructive sleep apnea
 Kidney problems
 Adrenal gland tumors
 Thyroid problems
 Certain defects you're born with (congenital) in blood vessels
 Certain medications, such as birth control pills, cold remedies, decongestants,
over-the-counter pain relievers and some prescription drugs
 Illegal drugs, such as cocaine and amphetamines
RISK FACTORS:
 Age
 Race
 Family history.
 Being overweight or obese
 Not being physically active.
 Using tobacco
 Too much salt (sodium) in your diet.
 Too little potassium in your diet
 Drinking too much alcohol
 BRIEF DESCRIPTION
 Certain chronic conditions

CLINICAL MANIFESTATIONS:
 Headache.
 Dizziness
 Chest pain
 Blurred vision

DIAGNOSTIC TESTS:
 URINALYSIS
 BLOOD CHEMISTRY
 ECHOCARDIOGRAPHY
 CHEST X-RAY
 COMPUTED TOMOGRAPHY (CT) SCAN
 ELECTROCARDIOGRAM (ECG)

MANAGEMENT:

MEDICAL:
 PHARMACOLOGIC THERAPY
 Stage 1 Hypertension
 Thiazide diuretic is recommended for most and angiotensin-converting
enzyme-1,aldosterone receptor blocker, beta blocker, or calcium channel
blocker is considered.
 Stage 2 Hypertension
 Two-drug combination is followed, usually including thiazide diuretic and
angiotensin-converting enzyme-1, or beta-blocker, or calcium channel
blocker

NURSING MANAGEMENT:

NURSING ASSESSMENT
 If patient is on antihypertensive medications, blood pressure is assessed to determine
the effectiveness and detect changes in the blood pressure.
 Complete history should be obtained to assess for signs and symptoms that indicate
target organ damage.
 Pay attention to the rate, rhythm, and character of the apical and peripheral pulses.

NURSING INTERVENTIONS:
 Encourage the patient to consult a dietitian to help develop a plan for improving nutrient
intake or for weight loss.
 Encourage restriction of sodium and fat
 Emphasize increase intake of fruits and vegetables.
 Implement regular physical activity.
 Advise patient to limit alcohol consumption and avoidance of tobacco.
 Assist the patient to develop and adhere to an appropriate exercise regimen.
NURSING PRIORITIES
 Maintain/enhance cardiovascular functioning.
 Prevent complications.
 Provide information about disease process/prognosis and treatment regimen.
 Support active patient control of condition.
DISCHARGE AND HOME CARE GUIDELINES:
 The nurse can help the patient achieve blood pressure control
through education about managing blood pressure.
 Assist the patient in setting goal blood pressures.
 Provide assistance with social support.
 Encourage the involvement of family members in the education program to support the
patient’s efforts to control hypertension.
 Provide written information about expected effects and side effects.
 Encourage and teach patients to measure their blood pressures at home.
 BRIEF DESCRIPTION
 Emphasize strict compliance of follow-up check up.

COMPLICATIONS:
 Heart failure
 Myocardial infarction
 Impaired vision.
 Ineffective peripheral perfusion
 Renal failure
PREVENTION:
 Weight reduction
 Adopt DASH
 Dietary sodium retention
 Physical activity
 Moderation of alcohol consumption

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).
 CHD is a disease in which a waxy substance called plaque (plak) builds up inside the
coronary arteries.
PURPOSE OF THE SURGERY:
 Severe chest pain caused by narrowing of several of the arteries that supply your heart
muscle, leaving the muscle short of blood during even light exercise or at rest.
 More than one diseased coronary artery, and the heart's main pumping chamber at the
left ventricle isn't functioning well.
 Left main coronary artery is severely narrowed or blocked
 Artery blockage

GOAL OF THE SURGERY:

 Improving your quality of life and reducing angina and other CHD symptoms
 Allowing you to resume a more active lifestyle
 Improving the pumping action of your heart if it has been damaged by a heart attack
 Lowering the risk of a heart attack (in some patients, such as those who have diabetes)
 Improving your chance of survival

TYPES:
Traditional Coronary Artery Bypass Grafting
 Traditional CABG is used when at least one major artery needs to be bypassed. During
the surgery, the chest bone is opened to access the heart.
 Medicines are given to stop the heart; a heart-lung bypass machine keeps blood and
oxygen moving throughout the body during surgery. This allows the surgeon to operate
on a still heart.
 After surgery, blood flow to the heart is restored. Usually, the heart starts beating again
on its own. Sometimes mild electric shocks are used to restart the heart.
Off-Pump Coronary Artery Bypass Grafting
 This type of CABG is similar to traditional CABG because the chest bone is opened to
access the heart. However, the heart isn't stopped, and a heart-lung bypass machine
isn't used. Off-pump CABG sometimes is called beating heart bypass grafting.
Minimally Invasive Direct Coronary Artery Bypass Grafting
 This type of surgery differs from traditional CABG because the chest bone isn't opened
to reach the heart. Instead, several small cuts are made on the left side of the chest
between the ribs. This type of surgery mainly is used to bypass blood vessels at the front
of the heart.
 Minimally invasive bypass grafting is a fairly new procedure. It isn't right for everyone,
especially if more than one or two coronary arteries need to be bypassed.
 BRIEF DESCRIPTION
WHO NEEDS CORONARY ARTERY BYPASS GRAFTING?
 Coronary artery bypass grafting (CABG) is used to treat people who have
severe coronary heart disease (CHD) that could lead to a heart attack. CABG also might
be used during or after a heart attack to treat blocked arteries.
Your doctor will decide whether you're a candidate for CABG based on factors such as:
 The presence and severity of CHD symptoms
 The severity and location of blockages in your coronary arteries
 Your response to other treatments
 Your quality of life
 Any other medical problems you have

RISK FACTORS:
 Blood clots that can increase your chances of having a stroke, heart attack, or lung
problems
 Infection
 Abnormal heart rhythms (arrhythmias)
 Problems breathing
 Fever and pain
 Kidney failure
 Memory loss and trouble thinking clearly

LABORATORY TESTS:
 EKG (Electrocardiogram)
 Echocardiography
 Stress Test
 Coronary Angiography and Cardiac Catheterization

PREPARATION:
 Blood tests, chest X-rays, and an electrocardiogram (EKG). Your doctor may also do an
X-ray procedure called a coronary angiogram. It uses a special dye to show how the
blood moves through your arteries.
 Your doctor will give you specific instructions about activity restrictions and changes in
your diet or medications you should make before surgery.
 Make arrangements for after your surgery. It will take about four to six weeks for you to
recover to the point where you can resume driving, return to work and perform daily
chores.

DURING THE PROCEDURE:

Coronary bypass surgery generally takes between three and six hours and requires general
anesthesia. The number of bypasses you need depends on where in your heart and how severe
your blockages are.

For general anesthesia, a breathing tube is inserted through your mouth. This tube attaches to a
ventilator, which breathes for you during and immediately after the surgery.

Most coronary bypass surgeries are done through a long incision in the chest while a heart-lung
machine keeps blood and oxygen flowing through your body. This is called on-pump coronary
bypass surgery.

The surgeon cuts down the center of the chest, along the breastbone. He or she then spreads
open the rib cage to expose the heart. After the chest is opened, the heart is temporarily
stopped with medication and a heart-lung machine takes over to circulate blood to the body.

The surgeon takes a section of healthy blood vessel, often from inside the chest wall or from the
lower leg, and attaches the ends above and below the blocked artery so that blood flow is
redirected around the narrowed part of the diseased artery.
 BRIEF DESCRIPTION

After completing the graft, the surgeon will restore your heartbeat, disconnect you from the
heart-lung machine and use wire to close your chest bone. The wire will remain in your body
after the bone heals.
AFTER THE PROCEDURE:
 Expect to spend a day or two in the intensive care unit. The breathing tube will remain in
your throat until you are awake and able to breathe on your own.
 Cardiac rehabilitation often begins while you're still in the hospital. You'll be given a
program of exercise and education designed to help you recover. You'll continue with
monitored programs in an outpatient setting until you can safely follow a home-based
maintenance program.
 Barring complications, you'll likely be discharged from the hospital within a week. You
still might have difficulty doing everyday tasks or walking a short distance. If, after
returning home, you have any of the following signs or symptoms, call your doctor:
 Fever
 Rapid heart rate
 New or worsened pain around your chest wound
 Reddening around your chest wound or bleeding or other discharge from your
chest wound
 Expect a recovery period of about six to 12 weeks. In most cases, you can return to
work, begin exercising and resume sexual activity after four to six weeks, but make sure
you have your doctor's OK before doing so.

RESULTS
 After surgery, most people feel better and might remain symptom-free for as long as 10
to 15 years. Over time, however, it's possible that other arteries or even the new graft
used in the bypass will become clogged, requiring another bypass or angioplasty.
 Your results and long-term outcome will depend in part on taking your medications to
prevent blood clots, lower blood pressure, lower cholesterol and help control diabetes as
directed, and following healthy lifestyle recommendations, including these:
 Stop smoking.
 Follow a healthy-eating plan, such as the DASH diet.
 Achieve and maintain a healthy weight.
 Exercise regularly.
 Manage stress.

REHABILITATION FOR POST CABG:

WHAT TO EXPECT
 Most patients find that they get tired very easily after the operation. While
everyone heals differently, most people feel back to normal within 6 to 8
weeks after surgery.
 Soreness across your chest, neck, and back may persist for several months.
 Take prescribed painmedication to relieve discomfort.
 It is common to feel slightly winded with activity.
 You may require a couple of pillows to sleep.
 If you have an incision on your leg, it is normal to have swelling. Remember
to elevate your leg while sitting.
 It is normal to have a decreased or sluggish appetite. Eat small, frequent
meals.

CARE OF YOUR INCISIONS

 Gently wash the incision with warm water and mild soap every day. Showers
are okay. Lightly pat the incision dry with a towel.
 Steri-strips (paper strips/tape) will fall off within 3 –10 days, don’t be afraid to
gently pull them off if they don’t fall off by themselves.
 If you have stiches and/or staples, a medical professional should remove
them within 10 days.
 It is normal for your wound to be sore, a little numb or itchy, and to look
slightly red or bruised.
 This will improve within several weeks.
 BRIEF DESCRIPTION
ACTIVITY
• Walking is the best activity after cardiac surgery, feel free to walk outside.
• Pace yourself: Light activity around the house; washing, dressing, walking on level
ground.
• Keep your activity at a level where you can carry on a conversation. If you are too short
of breath to talk, slow down.
Decrease or stop activity if you feel pain, dizziness, difficulty breathing, irregular heartbeats,
heavy sweating, fatigue or if your heart is beating too fast.

RESTRICTIONS
• Do not lift or push more than 10 pounds
• Do not drive for 4-6 weeks after your surgery
• Sexual activity: Wait 3 to 4 weeks. Be well rested and chose a comfortable position that
puts the least amount of stress on your chest.

MEDICATIONS
• You were given a list of medications with your discharge materials. Your medications
may be different than before surgery.
• Follow your medication schedule and only take the medications on your list.
• Do not take any other medications unless you first discuss it with your doctor.
• Do not take pain medication before driving or with alcohol
• If you are on Coumadin Therapy, you will need to be monitored on a regular basis.

DIET
• Eat a sensible, low-fat, low-salt diet.
• Do not add salt to your food. Too much salt will cause swelling.
• Drink 8 glasses of water every day, unless your doctor says otherwise.