Introduction

Congestive Heart Failure

Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping
power of your heart muscles. While often referred to simply as “heart failure,” CHF specifically
refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently.

You have four heart chambers. The upper half of your heart has two atria, and the lower half
of your heart has two ventricles. The ventricles pump blood to your body’s organs and tissues,
and the atria receive blood from you body as it circulates back from the rest of your body.

CHF develops when your ventricles can’t pump enough blood volume to the body. Eventually,
blood and other fluids can back up inside you:

 Lungs
 Abdomen
 Liver
 Lower body

Types of Heart Failure

Types of heart failure Description

1. Left-sided heart failure Fluid may back up in your lungs, causing

shortness of breath.

2. Right-sided heart failure Fluid may back up into your abdomen, legs
and feet, causing swelling.

3. Systolic heart failure The left ventricle can't contract vigorously,

indicating a pumping problem.

4. Diastolic heart failure The left ventricle can't relax or fill fully,
(also called heart failure with indicating a filling problem.
preserved ejection fraction)
 Signs and symptoms
Symptoms that indicate Symptoms that indicate
Symptoms you may your condition has a severe heart condition:
notice first: worsened:
 Fatigue  Irregular heartbeat  Chest pain that radiates
through the upper body
 Swelling in your ankles,  A cough that develops from  Rapid breathing
feet, and legs congested lungs
 Weight gain  Wheezing  Skin that appears blue, which
is due to lack of oxygen in
your lungs
 Increased need to  Shortness of breath, which may  Fainting
urinate, especially at indicate pulmonary edema
night

Congestive heart failure stages

Stage Main symptoms Outlook

Class I You don’t experience any symptoms
during typical physical activity.
Class II You’re likely comfortable at rest, but
normal physical activity may cause
fatigue, palpitations, and shortness of
breath.
Class III You’re likely comfortable at rest, but
there’s a noticeable limitation of
physical activity. Even mild exercise
may cause fatigue, palpitations, or
shortness of breath.
Class IV You’re likely unable to carry on any
amount of physical activity without
symptoms, which are present even at
rest.
CHF at this stage can be managed through
lifestyle changes, heart medications, and
monitoring.
CHF at this stage can be managed through
lifestyle changes, heart medications, and
careful monitoring.
Treatment can be complicated. Talk with your
doctor about what heart failure at this stage
may mean for you.
There’s no cure for CHF at this stage, but
there are still quality-of-life and palliative care
options. You’ll want to discuss the potential
benefits and risks of each with your doctor.

Causes
The most common causes of congestive heart failure are:

 Coronary artery disease and heart attack.

 High blood pressure (hypertension)
 Damage to the heart muscle (cardiomyopathy)
 Myocarditis
 Valve Conditions

Less common causes of Congestive Heart Failure:

 Viral infections of the stiffening of the heart muscle
 Heart rhythm abnormalities
 Risk Factors

 High blood pressure.

 Heart attack
 Diabetes
 Alcohol use
 Tobacco use
 Obesity
 Lifestyle/Diet

Diagnostic Examination

 Electrocardiogram (ECG).
 Echocardiogram
 Stress test
 Cardiac computerized tomography (CT) scan
 Magnetic resonance imaging (MRI)
 Coronary angiogram
 Myocardial biopsy
 Chest X-ray
 Blood tests

Treatment
Doctors usually treat heart failure with a combination of medications. Depending on your
symptoms, you might take one or more medications, including:
Medications:

 Angiotensin-converting enzyme (ACE) inhibitors

 Angiotensin II receptor blockers
 Beta blockers
 Diuretics
 Aldosterone antagonists
 Inotropes
 Digoxin (Lanoxin)

Surgery & Medical devices:

 Coronary bypass surgery
 Heart valve repair or replacement
 Implantable cardioverter-defibrillators (ICDs)
 Cardiac resynchronization therapy (CRT), or biventricular pacing
 Heart Transplant

Prevention

 Avoid or Stop smoking

 Weight monitoring and Maintain a healthy weight.
 Eat a healthy diet and,
 Restrict sodium in your diet
  Reduce stress
 Avoid certain over-the-counter medications
 Exercise Daily.

Client’s data

Name: Mrs. M
Age: 64 years old
Sex: Female
Occupation: LGU
Employee
Address: Mobo, Masbate City
Ward/Department: Medical Ward
(ICU )
Admitting Diagnosis: Congestive Heart Failure r/o Acute
Coronary Syndrome
Date of Admission: January 11, 2020
Time Admitted: 2:51 am
Admitting Physician: Dr. B
Final Diagnosis: CHF, Pleural Effusion Bilateral, CKD secondary
to Diabetes Type 2

Date of Discharge: January 28, 2020

Chief Complaint: Shortness of Breath (SOB)
Length of stays: 18 days
 Theoretical framework

14 Basic Needs
Virginia Henderson
Henderson Theory of Nursing was developed by Virginia Henderson. She
did not believe that she was setting out a theory, and preferred it to be thought of as a
definition whether it is considered a definition or a theory, it has a wide influence on
concept and practice of nursing. She conceptualized the fundamental needs of human.

14 Basic Needs

1. Breathing normally
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining a desirable position
5. Sleeping and resting
6. Selecting and suitable clothes
7. Maintaining normal body temperature by adjusting clothing and modifying the
environment.
8. Keeping the body clean and well-groomed to promote integument(skin)
9. Avoiding dangers in the environment and avoiding injuring others
10. Communicating with others in expressing emotions, needs, fears, or opinions
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of accomplishment.
13. Playing or participating in various form of recreation.
14. Learning, discovering or satisfying the curiosity that leads to normal development
and health, and using available health facilities.

“The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful
death) that he would perform unaided if he had the necessary strength, will or
knowledge. And to do this in such way as to help him/her gain independence as rapidly
as possible” (Henderson, 1996)
Henderson’s theory emphasizes on the basic human needs and how e or as a nursing
student can assist in meeting those needs.
Based on our patient, Mrs. M, she has Congestive Heart Failure, Chronic Kidney
Disease Secondary to Diabetes. We enlightened her all the things that we learned
about the Health Teaching. We applied the 14 components for our patient; especially
the proper or correct meal a person who suffering from heart failure must take. that is
our priority as a nursing student, we taught her the proper diet, and how to limit the food
she consumes to avoid the worsening of the symptoms she is enduring. Example:
Sodium Restriction and Appropriate fluid restriction. And other Nutritious food needed
by our body requirements.
We imparted to her that in case she undergoes difficulty in breathing she just needs to
is Pursed lip breathing and if the discomfort continues, she must report it to the health
provider, she also needs to sleep on a proper time and maintain normal body
temperature.
We informed her the advantages and disadvantages if she will not follow the
instructions of the Doctor.
The most important thing is that no matter the hardship she’s undergoing right now she
must not forget to worship God because he is always there with her.
We believe that for the faster Recovery the patient is the only person who can and will
help herself to recuperate from her illness.
 Developmental task

Psychosocial Development
Erik Erikson

Erik Erikson (1902–1994) was a stage theorist who took Freud’s controversial theory of
psychosexual development and modified it as a psychosocial theory. Erikson
emphasized that the ego makes positive contributions to development by
mastering attitudes, ideas, and skills at each stage of development.
This mastery helps children grow into successful, contributing members of society.
During each of Erikson’s eight stages, there is a psychological conflict that must be
successfully overcome in order for a child to develop into a healthy, well-adjusted adult.

 Generativity vs. Stagnation (40-65 years)

Generativity refers to "making your mark" on the world by caring for others as well as
creating and accomplishing things that make the world a better place.
Stagnation refers to the failure to find a way to contribute. These individuals may feel
disconnected or uninvolved with their community and with society as a whole.
A 64-year-old humorous Mus.M. belongs to Developmental Stage of Generativity.

“I am so fund conversing amicably with different bunch of people. You know how they say I is in my Age”
Mrs. M enunciating these words.

She even blabbed “ I couldn’t help feeling as if I alone, bore the weight of this planet on my back and
struggle as if it’s the last day of me on earth, Then, added “My child told me to resign at LGU due to my
sickness, but I have strongly opposed. Every time there are community activities, I voluntarily take part
in it. whatever these people need, I couldn’t be any happier because we are able to do so, how
delightful it is to give help considerably more that. These people know me, significantly with my age.
This is just so pleasant notion. “

To my dear only child who I believed I have supported well enough with education and is able to have
her own family already. To my grandchildren who visits me frequently, I am beyond lucky for the reason
that even though I am already this old, my family never deserted me at all. At the same time being
cognizant that I have brought them up so well.

If I may pass away, I will have no regrets because I have satisfying helped my community and my child is
already stable.

I don’t really know if I can still get a work if ill be able to participate in community activities because my
body is already weak.
 Physiologic measurement

DURING ADMISSION DURING ASSESSMENT

Temperature 35.9 C 37’C

Blood pressure 190/110 mmHg 190/90 mmHg
Respiratory rate 20 cpm 27 cpm
Pulse rate 88 bpm 51 bpm
Weight 62kls 65 kls.

o PRESENT HISTORY

A case of Mrs. M,64 years old, a resident of Mobo, Masbate, admitted at

Masbate Provincial Hospital last January 11, 2020 at 2:51am due to Shortness
of Breath (SOB), an Admitting diagnosis of Congestive Heart Failure r/o
Acute Coronary Syndrome.

o PAST HISTORY

Patient Verbalized “ Ka upat na ako na admit didi sa provincial Diabetes tpus

Highblood lng an aram ko idtun 2017 & 2018 , peru last year (2019) didtu kona
naaraman na may igwa daw akon Heart Enlargement , gin explain san doktor
na may igwa daw akon sakit sa puso “ .
.

o LIFESTYLE

Our client doesn’t have any vices.

o FAMILY HISTORY

Father
Mother Diabetes
Heart
Failure

Mrs. M
Diabetes and
Heart Failure

- Mother

- Father

- Mrs. M

13 areas of assessment
I. Social Status
Mrs. M, 64 years old, female client, born on October 8, 1955, an LGU
employee residing at Mobo, Masbate. She was with her husband. She only
has one (1) children (daughter).

During assessment her daughter and granddaughter accompanied/the

one who took care of her from the time she was admitted until she was
discharge. They are approachable and kind.

II. Mental Status

Our patient can state correctly where she was “Oo, aram ko man kung
hain ako kay pabalik balik naman ako didi”, as verbalized by the client.
Upon assessment, Mrs. M is oriented to tome and place and able to deliver
concrete messages and was able to respond in questions asked to her. The
patient is still cooperating even though she’s feeling weak.

III. Emotional Status

During our assessment, we asked her if she is aware about her ailment “
Oo aram kona man na magkakaigwa ako kay an ginpatayan san akon papa
diabetes tapos sa akon iloy sakit sa puso” as verbalized by the client. We
asked her also if shes’s feeling different or discomfort with her body “
Nagasakit an akon an akon dughan, nalilisudan ako maghinga bisan waran
ginahimu nagasakit gayud”.

Upon our assessment, Mrs. M is aware of her condition.

IV. Sensory Perception

Sense of Sight

Our patient is asked to read a printed letter at distance of 1 meter the

same with another eye. The clients can read on the left eye but blurry on right
eye.

Upon our assessment with the given data, she can read, extraocular
movement and papillary response is normal.

Sense of Taste

We didn’t test her sense of taste because according to the Doctor’s order
the patient should NPO (Nothing per Orem).

Sense of Hearing

For the auditory assessment, every word that we whispered/ delivered the
patient was able to repeat.
 The patient’s auditory is normal.

Sense of Smell
We did not conduct an assessment to her because we feared that the
disturbing smell would cause her difficulty in breathing.

Tactile Sensitivity

During our assessment of the sensation of the patient she was instructed
to tell what she feels when she was going to be pricked on her arm, she
stated that the pricking was felt.

Upon our assessment, Mrs. M sensory transmission, functions well as

manifested by the presented.

V. Motor Stability and Gait

During our assessment Mrs. M gait was assessed, We asked her if she
can stand on her own balance by herself. “ Dili ako ka tindog na ako lng sige
lang akon higda kay an akon tiil sakit sakit sigen manas, pag matindog ako
dali lng ako pagkapoyon nalilisodan ako maghangos “ as verbalized by the
client.

Assessment of the range of motion of the patient was done through

instruction in which include the ability of the patient to bend her shoulder
apart. She can also move her shoulder laterally and medially. She can bend
her elbow and can lift her both arms very slowly because of edema on her
both arms.

The patient has difficulty in flexing and extending her left knee of her ankle
and foot caused by edema, pitting edema (2+ or 4mm).

Mrs. M gait is hindered due to her physical position. Muscle weakened

and Edema is present on both extremities which results in gait difficulty.

VI. Body Temperature

Date assessed Time Temperature

January 23, 2020 2:30 p.m. 37°C

January 24,2020 4:10 p.m. 36.5°C
January 25, 2020 8:40 a.m. 37.5°C
January 26, 2020 3:20 p.m. 37.0°C
January 27,2020 10:30 a.m. 37.1°C

Upon assessing Mrs. M temperature, the given above indicates that she
had a normal body temperature during our assessment.
VII. Respiratory Status

Date assessed Time Respiratory Rate

 January 23, 2020 2:30 p.m. 27 cpm
January 24,2020 4:10 p.m. 29 cpm
January 25, 2020 8:40 a.m. 25 cpm
January 26, 2020 3:20 p.m. 23 cpm
January 27,2020 10:30 a.m. 24 cpm

All the given data above, shows that our patient had above normal range
which indicates Tachypnea.

VIII. Circulatory Status

Date assessed Time Pulse Rate Blood Pressure

January 23, 2020 2:30 p.m. 51 bpm 190/90 mmHg
January 24,2020 4:10 p.m. 84 bpm 120/80 mmHg
January 25, 2020 8:40 a.m. 70 bpm 130/80 mmHg
January 26, 2020 3:20 p.m. 60 bpm 100/90 mmHg
January 27,2020 10:30 a.m. 67 bpm 150/80 mmHg

During our assessment of her capillary refill, her nail beds returned longer
than 3 seconds.
Upon the data given above shows that Mrs. M pulse rate results on
January 23,2020 is 51 bpm indicates, Bradycardia, While the blood pressure on
January 23, and 27 is above normal range that indicates, Hypertension.

IX. Nutritional Status

Before hospitalization, Mrs. M usually eats plenty of vegetables, fish,
meat, and sometimes junk foods when snacks.

During admission, her diet,”lugaw kag sabaw, tapos minsan masbi an

doctor dili daw ako pwedi magkaon tapos mag inom”, as verbalized by the
client.

X. Elimination Status
Before hospitalization, Mrs. M defecate three times (3x) a week and she
said “ dati naka udo akon itom an kulay”. During admission and during our
assessment she did not defecate since she was admitted.
 The color of the urine is dark yellow, 500 cc per 24hr base on the catheter
that the nurse measured the urine output.

XI. Reproductive Status

Mrs. M verbalized “atab ako nagmenopause mga 40 or 41 an edad ko sadto”.

XII. Sleep Rest Pattern

Before hospitalization, Mrs. M stated that she sleeps at 8:30 to 9:00 pm,
almost six to seven (6-7) hours of sleep a day. But during hospitalization her
sleeping pattern has been changed because of chest discomfort/dyspnea
early in the morning.

XIII. State of Skin and Appendages

As we assessed the client, the IV site is at her both hands, her skin is cool,
ashen skin, clammy and pale skin, she stated that “ grabi an balhas ko pag
maaga bisan malamig na” called Diaphoresis. There is an absence of
infiltration but presence of edema .Her nail is pale (pallor).
 Doctor’s order

DATE/TIME PROGRESS NOTES DOCTOR’S ORDER

 Admit patient under wheelchair
 Secure consent to care
January 11, 2020  Vital sign every 4 hours
 Diet NPO temporarily
 IVF PNSS 1L to Keep Vein Open rate
2:51 am  Labs:
 CBC/BT
 Creatinine
 ECG
 Chest x-ray APL
 RBS
 Troponin Test

 Meds:
 Furosemide 40mg IVT now
 Nicardipine drip as Side Drip 90cc
D5W + 10mg nicardipine at
10cc/hr
 Lanoxin 0.5mg IVT q 24hr
 Soludexide 1-amp slow IVT OD
 Insert Foley catheter
 Oxygen at 10LPM via face mask
 Refer accordingly

January 12, 2020 (+) Cough  For salbutamol nebulization q 12hr

 continue all meds
7:15am

January 13, 2020  Minimal dyspnea  Soft diet

 (+) crackles  for chest x-ray
6:16am  Elevated creatinine  Ceftriaxone 1.5mg IV q 8hrs
 Start dopamine + furosemide drip D5W
1L + 1-amp dopamine + 40mg furosemide
at 15cc/hr

 Metolazone 50mg 1 tab OD

January 14, 2020  Calcium Carbonate 1tab BID
 Ceftriaxone every 12hrs
10:00am  Carvedilol 25mg/tab 1 tab before meal
January 15, 2020  (--) dyspnea  Continue all meds

January 17, 2020  Continue Sulodexide 1-tab OD

 furosemide 20mg IVTT OD
7:45am

January 18, 2020  Continue all meds

 Trimetazidine 35mg 1tab BID
7:10am

January 20, 2020  (--) dyspnea  Please continue dopamine + furosemide

drip as RTC in order for creatinine to
6:15am decrease
 Sodium bicarbonate 65mg 1-tab TID
 for repeat creatinine and BUN today
please
 For SGOT
D5W 0.3% sodium chloride at 30gtt

January 21, 2020  decrease creatinine  Continue dopamine + furosemide RTC

7:20am compared to previous  Continue other meds

January 22, 2020 (+) anasarca  Please refer to surgeon on call

 pleural effusion (L)
11:15am low breath sound left lung
field

(+) crackles

BP: 140/90 mmHg

- Was previously advised by

Dr. Dela Pena for
hemodialysis

12:20pm  Thank you for this referral

 Patient seen and examine
 Please remove foley catheter
 History and Pleural effusion reviewed
 Pleural Effusion bilateral, CKD secondary
to diabetes nephropathy, cardiomegaly
 As of now no surgical intervention needed
at this time
 Suggest medical management
 Chest x-ray monitoring
 Pleural effusion progress
 Patient was advised

January 25, 2020  (+) dyspnea  Continue all meds

7:30am
January 27, 2020  Continue all meds

10:00am

January 28, 2020  (-) shortness of  May go home (MGH)

breath  follow-up check-up after 1 week
9:45 am
 Laboratory results

HEMATOLOGY

Parameter Normal Result Interpretation

Range
WBC 5.0 – 10.0 10.5 10^9/L Leukocytosis
Lymph % 20.0 – 40.0 8.3 % Lymphocytopenia

Mid % 3.0 – 9.0 6.6% Normal

Gran % 50.0 – 70.0 85.1 % Granulocytosis

RBC 4.50 – 5.50 3.39 10^12/L Anemia

HGB 140 – 160 93 g/L Anemia

HCT 40.0 – 50.0 29.8 % Anemia

MCV 82.0 – 95.0 88.0 fL Normal
MCH 27.0 – 31.0 27.4 pg Normal
MCHC 320 – 360 312 g/L Anemia
PLT 150 – 450 371 10^9/L Normal
MPV 7.0 – 11.0 7.7 f/L Normal
PDW 15.0 -17.0 15.6 Normal
PCT 0.108 – 0.282 0.285 % Elevated procalcitonin

Analysis Normal Result Interpretation

Values

BUN 1.66 – 8.3 mmol/L 12.34 mmol/L Elevated BUN

Creatinine 62 – 106 umol/L 216. 25 umol/L High Creatinine

SGOT/AST Up to 32 u/L 30.70 u/L Decrease

URINALYSIS
 Test Normal Result Interpretation
Values

Troponin I 0 to 0.3 ng/mL 0.84 ng/mL Elevated

(cTn I)

Test Range Result Interpretation

RBS 70-180 mg/dL 157 mg/dL Normal

(Random Blood
Sugar)
 Anatomy

The cardiovascular system

The cardiovascular (from Latin words meaning "heart" and "vessel") system comprises the
blood, heart, and blood vessels.

The Heart is cone-shaped, with the broad base directed upward and to the right and the apex
pointing downward and to the left. It is located in the chest (thoracic) cavity behind the
breastbone (sternum), in front of the windpipe (trachea), the esophagus, and the
descending aorta, between the lungs, and above the diaphragm (the muscular partition between
the chest and abdominal cavities). About two-thirds of the heart lies to the left of the midline.

Human cardiovascular system, organ system that conveys blood through vessels to and from
all parts of the body, carrying nutrients and oxygen to tissues and removing carbon dioxide and
other wastes. It is a closed tubular system in which the blood is propelled by a muscular heart.
Two circuits, the pulmonary and the systemic, consist of:

 Arteries - (red) carry oxygenated rich blood and nutrients away from your
heart, to your body’s tissues.
 Veins - (blue) veins are blood vessels that carry blood towards the heart, Most
veins carry deoxygenated blood.
  Capillaries – the smallest blood vessels in the body: they convey blood between
the arterioles and venules

Normal Cardiac Output

The Fist-sized powerhouse beats (expands and contracts) about 100,000 times per day,
pumping five or six quarts of blood each minute, or about 2,000 gallons per day. Cardiac Output
is the volume of blood the heart pumps per minute. The normal range for cardiac output is about
4 to 8 L/min, but it can vary depending on the body’s metabolic needs.

Functions of the Cardiovascular System

 Transportation
- The cardiovascular system transport blood almost all of the body’s
tissues. The blood delivers essential nutrients and oxygen and removes
wastes and carbon dioxide to be processed or removes from the body.

 Protection
- The cardiovascular system protects the body through its white blood
cells. WBC clean up cellular debris and fight pathogens that have
entered the body.

 Regulation
- The cardiovascular system is instrumental in the body’s ability to
maintain homeostatic control of several internal conditions. Blood
vessels help maintain a stable body temperature by controlling the blood
flow to the surface of the skin.

Circulation of the Heart

Blood flows through your heart and lungs in four steps:

Step 1:
- The right atrium receives oxygen poor blood from the body and pumps it
to the right ventricle through the tricuspid valve.
Step 2:
- The right Ventricle pumps the oxygen poor blood to the lungs through
the pulmonary valve.

Step 3:
- The left atrium receives oxygen rich blood from the lungs and pumpd it to
the left ventricle through the mitral valve.

Step 4:
- The left ventricle pumps the oxygen rich blood through the aortic valve
out to the rest of the body.

Heart Wall
The heart wall consists of three layers:

 Epicardium: The outer layer of the wall of the heart.

 Myocardium: The muscular middle layer of the wall of the heart.
 Endocardium: The inner layer of the heart.
 Cardiac Conduction
Cardiac Conduction is the rate at which the heart conducts electrical impulses. Heart nodes and
nerve fibers play an important role in causing the heart to contract.

 Atrioventricular Bundle: A bundle of fibers that carry cardiac impulses.

 Atrioventricular Node: A section of nodal tissue that delays and relays cardiac
impulses.
 Purkinje Fibers: Fiber branches that extend from the atrioventricular bundle.
 Sinoatrial Node: A section of nodal tissue that sets the rate of contraction for the heart.

Cardiac Cycle
The Cardiac Cycle is the sequence of events that occurs when the heart beats. Below are the
two phases of the cardiac cycle:

 Diastole phase: the heart ventricles are relaxed and the heart fills with blood.
 Systole phase: the ventricles contract and pump blood to the arteries.

Valves of the Heart

Heart valves are flap-like structures that allow blood to flow in one direction. Below are the
four valves of the heart:

 Aortic valve: prevents the backflow of blood as it is pumped from the left ventricle to
the aorta.
 Mitral valve: prevents the backflow of blood as it is pumped from the left atrium to
the left ventricle.
 Pulmonary valve: prevents the backflow of blood as it is pumped from the right
ventricle to the pulmonary artery.
 Tricuspid valve: prevents the backflow of blood as it is pumped from the right atrium
to the right ventricle.

Chambers of the Heart

 The upper chambers, The atria,

- are separated by a partition known as the interatrial septum.
- The atria receive blood from various parts of the body and pass it into
the ventricles

 The lower chambers, the ventricles,

- are separated by the interventricular septum.
- The ventricles, in turn, pump blood to the lungs and to the remainder of
the body.

Blood Vessels
Arteries

 Aorta: the largest artery in the body, of which most major arteries branch off from.
 Brachiocephalic artery: carries oxygenated blood from the aorta to the head, neck and
arm regions of the body.
 Carotid arteries: supply oxygenated blood to the head and neck regions of the body.
 Common iliac arteries: carry oxygenated blood from the abdominal aorta to the legs
and feet.
 Coronary arteries: carry oxygenated and nutrient filled blood to the heart muscle.
 Pulmonary artery: carries de-oxygenated blood from the right ventricle to the lungs.
 Subclavian arteries: supply oxygenated blood to the arms.

Veins

 Brachiocephalic veins: two large veins that join to form the superior vena cava.
 Common iliac veins: veins that join to form the inferior vena cava.

 Pulmonary veins: transport oxygenated blood from the lungs to the heart.
 Venae cavae: transport de-oxygenated blood from various regions of the body to the
heart.
 pathophysiology

Risk Factors:
 Age Deranged insulin
 Family History release
 Overweight
 Decreased
glucose uptake
Insulin resistance

Increased hepatic Hyperglycemia Type II Diabetes

output

↑RAAS Critical metabolic

↑Endothelin Alteration of the
kidney changes
hemodynamics

↑TGFβ
Glomerular
Glomerular
Hypertrophy
Hyperfiltration

Hypertension

Loss of nephron Decreased

function production
of RBC
Infection

↑ BUN Decreased
↑ Creatinine Glomerular Difficulty
Filtration concentrating
urine

Heart Attack ↑Troponin

Diastolic
Dysfunction

Impaired Gas
Hypoxia
Exchange Pulmonary
Congestion

Orthopnea

Peripheral
Pulmonary Edema
Edema
 Discharge plan

MEDICATIONS
 Patients need to understand the purpose, dosage, route, and possible side effects of all
prescribed medications.
 Take drugs with water. DO NOT take them with grapefruit juice, since it may change how
your body absorbs certain medicines. Ask your provider or pharmacist if this will be a
problem for you.

EXERCISE AND ENVIRONMENT

 Encouraged patient to do the aerobic exercise include walking, swimming to increase
strength.
 Always do 5 minutes of stretching or moving around to warm up your muscles
and heart before exercising. Allow time to cool down after you exercise.

TREATMENT
 Tell Patient to Get vaccines as directed. Get a flu shot every year. You may also need
the pneumonia vaccine. The flu and pneumonia can be severe for a person who has HF.
Vaccines protect you from these infections.
 Explain to the client the Treatment drugs for CHF: ( Ex. Vasodilator drugs, Diuretics,
Digoxin, )

HEALTH TEACHING
 Tell her to use the same scale every day at the time and emphasize the important of
monitoring her weight. Report if Weight gain of 3‐5 pounds over 2‐3 days.
 Teach the patient how to realize her symptoms are worsening and when to call for help.
 Make sure you know the warning signs of heart failure and of a heart attack. Know what to
do when you have chest pain, or angina.

OUT PATIENT
 Consider assisting patient with schedule the first post hospitalization follow-up
appointment.

DIET
 Emphasize the importance of adjusting diet during illness.
 Sodium restriction (initially 4 gm sodium qd) and Instruct to lower the amount of fluid,
you may need to limit fluid to 6 to 9 cups, (1.5 to 2 liters) a day.
 Encourage patient to eat, heart-healthy foods include walnuts, whole-grain breads, low-
fat dairy products, beans, and lean meats. Fatty fish such as salmon and tuna are also
heart healthy.

SPIRITUALITY
 Encourage patient that no matter how hard and difficult the challenges are, never forget
to pray and never lose faith in god.