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Congestive Heart Failure II
Transcript of Congestive Heart Failure II
Signs & Symptoms
What is Congestive Heart Failure?
is shortness of breath (dyspnea) which occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.
Systemic hypoxia affects the entire system
Normal Heart Function
Normal heart function
Pulmonary and systemic circulation
Increase with exercise
Frank Starling law of heart
Left ventricular failure
Fluid accumulates in lungs
Right ventricular failure
Fluid accumulates in system (liver, spleen, abdomen, legs)
Right-sided heart failure
Left-sided heart failure
Systolic dysfunction – inability of the heart to contract due to weakness
Diastolic dysfunction – inability of the heart to relax after it pumps out blood
Types of CHF
Shortness of breath
Persistent coughing or wheezing
Tiredness and fatigue
Heart valve repair/replacement
Normal Feelings and Emotions Experienced
Numbness, Helplessness, Fear, Sadness, Guilt, Shame, Anger, Need for Privacy
Auscultate apical pulse; assess heart rate & rhythm
Inspect skin for pallor, cyanosis.
Monitor I & O and urine output, noting decreasing output and dark or concentrated urine.
Elevate lower extremities
Wear support stockings
Note changes in sensorium.
Provide quiet environment.
Administer supplemental oxygen as indicated.
Administer diuretics as prescribed.
An abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling)
Pathophysiological categories of edema
Increased hydrostatic pressure
Reduced plasma osmotic pressure (Hypoproteinemia)
Types of Edema
Heredity & race
High blood pressure
Daily weight checks
Maintaining healthy weight
Restricting salt the diet
Limiting of fats and cholesterol
Limiting alcohol consumption
Drugs commonly used in management of HF:
1. Angiotensin-Converting Enzyme (ACE) Inhibitors: Captopril
2. Angiotensin II receptor blockers: Losartan, candesartan, irbesartan
3. Diuretics: Thiazides (eg, hydrochlorothiazide) and furosemide
4. Inotropic-cardiotonic drugs: Digoxin, Inamrinone and Nesiritide
5. Aldosterone Antagonist: Spironolactone
6. Vasodialators: Nitrates, hzdralayine and isosorbide dinitrate
7. Beta adrenergic blocking agents: Propranolol, atenolol, metoprolol
8. Adrenergics : Dopamine or dobutamine
How do the heart & body compensate?
Hypertrophy of ventricle
Blood vessels narrow
Hormonal response to CHF
Release of renin in response to decreased perfusion and sympathetic activity
Release of Aldosterone
Causes of CHF
Past myocardial infraction
especially aortic and mitral valves
Congenital heart defects
Coronary artery disease
Lack of appetite & nausea
Fluid accumulation in the right lung
The ventricle pumps out as much blood as it receives during diastole.