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Congestive Heart Failure II

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by

Samantha Threats

on 2 May 2012

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Transcript of Congestive Heart Failure II

Congestive heart failure – cardiac output is insufficient to meet the needs of the body and the body becomes congested with fluid.
Risk Factors
Kati
&
Sam

Signs & Symptoms
Nursing Aspects
Edema
What is Congestive Heart Failure?
Orthopnea
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.
Affects:
Kidneys
Lungs
Liver
Extremities
Systemic hypoxia affects the entire system
Normal Heart Function
Normal heart function

Pulmonary and systemic circulation

Cardiac output
Increase with exercise

Frank Starling law of heart
Maintain homeostasis

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
Surgery
Heart valve repair/replacement
Coronary bypass
Implantable cardioverter-defibrillators
Heart transplant
Normal Feelings and Emotions Experienced
Numbness, Helplessness, Fear, Sadness, Guilt, Shame, Anger, Need for Privacy
Interventions
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)
Definiton
Pathophysiological categories of edema
Increased hydrostatic pressure
Reduced plasma osmotic pressure (Hypoproteinemia)
Lymphatic obstruction
Sodium retention
Inflammation
Types of Edema
Subcutaneous edema
Dependant edema
Periorbital edema
Pitting edema
Pulmonary edema
Brain edema
Pulmonary
Edema
Starling’s Law
Increased age
Male gender
Heredity & race
High blood pressure
High cholesterol
Obesity
Physical inactivity
Smoking
Management
Non-Pharmacological
Pharmacological
Smoking cessation
Daily weight checks
Maintaining healthy weight
Restricting salt the diet
Limiting of fats and cholesterol
Limiting alcohol consumption
Exercise
Stress reduction
Adequate rest
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?
Tachycardia
Tachypnea
Hypertrophy of ventricle
Increased afterload
Increased preload
Blood vessels narrow
Hormonal response to CHF
Release of renin in response to decreased perfusion and sympathetic activity

Renin-Angiotensin-Aldosterone System

Angiotensin II

Vasoconstriction

Release of Aldosterone

Catecholamines

Epinephrine, Norepinephrine
Causes of CHF
Chronic hypertension
Past myocardial infraction
Valvular defects
especially aortic and mitral valves
Congenital heart defects
Arrhythmia
Cardiomyopathy
Coronary artery disease
atherosclerosis
Hemochromatosis
Increased
heart rate
Confusion
&
Impaired thinking
Lack of appetite & nausea
A review
Fluid accumulation in the right lung
The ventricle pumps out as much blood as it receives during diastole.
Definition:
Full transcript