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Cardiovascular

disorders
CONGESTIVE HEART
FAILURE
hope that we could satisfy
you with our presentation,
CONGESTIVE HEART
FAILURE
A. Gen. Info:
- Inability of the heart to pump an adequate
supply of blood to meet the metabolic needs of
the body

B. Types:
1. Left sided heart failure
2. Right sided heart failure
1. LEFT SIDED HEART
FAILURE
a. Left ventricular damage causes blood to back
up through the left atrium and into the
pulmonary veins. Increased pressure causes
transudation into the interstitial tissues of the
lungs with resultant pulmonary congestion

b. Caused by:
- left ventricular damage (MI, CAD)
- hypertension, aortic valve disease (AI, AS)
- mitral stenosis, cardiomyopathy
2. RIGHT SIDED HEART
FAILURE
a. weakened RV is unable to pump blood into the
pulmonary system; systemic venous
congestion occurs as pressure builds up.

b. caused by:
- left sided heart failure
- RV infarction
- atherosclerotic heart disease
- COPD, pulmonic stenosis, pulmonary
embolism
Diagnostic Procedures
LEFT SIDED HEART FAILURE

ECG
chest x-ray (cardiomegaly, pleural
effusion)
echocardiography
cardiac catheterization, dec. PO2, inc.
PCO2
RIGHT SIDED HEART FAILURE
chest x-ray: reveals cardiac
hypertrophy

echocardiography: indicates inc.


size of cardiac chambers

elevated CVP, dec. PO2, inc.


ALT(SGPT)
Anatomy and Physiology
Pathophysiology
Signs and symptoms
Left sided CHF
 
Signs:
 
 easy fatigability, dyspnea on exertion, PND, orthopnea, cough, nocturia,
confusion

Symptoms:

 Shortness of breath, especially with activity such as walking


 Difficulty breathing when lying flat in the bed
 Waking up at night short of breath
 Fatigue
 Weakness
 Pale, blue or cool skin
 Palpitations
 Changes in blood pressure
 Fainting for no apparent reason
Right sided CHF
Signs:
- elevated jugular venous pressure, hepatomegaly, ascites, lower extremity
edema
 
Symptoms:
- easy fatigability, lower extremity swelling, early satiety, RUQ discomfort
 
Other Symptoms of right-sided heart failure include:
 Swollen legs
 Liver and spleen enlargement
 Swollen neck veins
 Fluid buildup in the stomach
 Swollen abdomen
 Slow weight gain
 irregular heart rhythm
 Nausea
 Vomiting
 Appetite loss
 Weakness
 Fatigue
Complications
The cardiac conditions
combined with asthma or
symptoms of chronic
obstructive pulmonary
disease (COPD) are difficult
clinical challenges.
Possible Nursing
Diagnoses
Impaired Gas Exchange due to pulmonary
congestion

Fluid volume excess due to increase capillary


fluid pressure

Decrease cardiac output due to altered


myocardial contractility/ inotropic changes
Prevention
Dietary, Lifestyle and Health Changes

 Restrict salt (sodium) intake. Restricting sodium minimizes


fluid retention.
 Avoid caffeine. Avoiding caffeine lowers the risk of an
increased heart rate or abnormal heart rhythms.
 Limit or stop alcoholic beverage consumption.
 Check your weight everyday. If your weight suddenly
increases, you may be retaining fluid and may need to adjust
your medications.
 Don't smoke or chew tobacco.
 Don't use illegal drugs.
 Exercise regularly, within your doctor's guidelines.
 Rest. Adequate rest helps conserve energy and decreases
demands on the heart.
 Reduce stress.
 Get a flu and pneumonia shot.
Health Teaching
Medical Management:

1. Determination and elimination/control of


underlying cause

2. Drug therapy:
 - Diuretics: Furosemide, Spironolactone
 - Dilators: ACE inhibitors, nitrates
 - Digitalis: digoxin
 
3. Diet: low salt, low cholesterol
 
* If medical therapies unsuccessful, mechanical
assist devices (intra-aortic balloon pump), cardiac
transplantation or mechanical hearts may be
employed.
Electrical Devices:
Defibrillators (ICDs) have been shown to
prevent sudden cardiac death (a fatal
arrhythmia) in certain groups of people with
heart failure. These are small devices that
are placed under the patient’s skin and
monitor the electrical activity of the heart. If
a problem is detected, the device will give
the heart an electrical shock which is
designed reset the heart and restore a
healthy heart rhythm.
Biventricular Pacemakers are advanced
types of pacemakers that can stimulate both
the right and left side of the heart at the
same time if an electrical problem has caused
them to become out of sync. These devices
Treatment
 Continuous positive airway pressure (CPAP) and bilevel
positive airway pressure (BiPAP)—Recent data comparing
nasal CPAP therapy and facemask ventilation therapy have
demonstrated decreased need for intubation rates when these
modalities are used. In patients with severe CHF treated with
CPAP, however, no significant difference was found in short-
term mortality rates and length of hospital stay. Although
BiPAP therapy may improve ventilation and vital signs more
rapidly then CPAP, a higher incidence of MI associated with
BiPAP has been reported. BiPAP and CPAP are contraindicated
in the presence of acute facial trauma, the absence of an
intact airway, and in patients with an altered mental status or
who are uncooperative.
 Alternating tourniquets, formerly a mainstay of therapy,
have been used to decrease preload. Their use has been
supplanted by newer therapies such as intravenous
nitroglycerin and nitroprusside.
 Phlebotomy with removal of 500 mL of blood or via
plasmapheresis is another former mainstay of therapy used to
decrease preload. Its use has been supplanted by newer
Nursing Management
1. Monitor respiratory status and provide
adequate ventilation (when CHF progresses to
pulmonary edema)
 
2. Provide physical and emotional rest

3. Increase cardiac output

4. Reduce/eliminate edema

5. Provide client teaching and discharge


planning
NURSING CARE PLANS
DRUG STUDY
STEM CELL
TREATMENT(update)
Updates
Statistics on Heart Failure
A person aged 40 years or older has a one in five
chance of developing heart failure.
About five million Americans have been diagnosed with
heart failure.
About 550,000 new cases are diagnosed each year.
Heart failure is the most common hospital discharge
diagnosis with more than one million hospital stays each
year.
The costs of treating heart failure in the United States
exceed $27 billion.
The risk of heart failure increase with age: 10% of both
men and women over 75 have been diagnosed with
heart failure.
Statistics derived from the American Heart Association,

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