CHF Flashcards
Heart Failure
Heart pumps blood inadequately, leading to reduced blood flow to tissue, back-up of blood in veins and lungs, and changes that may further weaken the heart
there is a problem with the contraction of the heart (systolic failure) and/or filling of the heart (diastolic failure).
Can occur at any age - mostly elders
Some cases are reversible
Most HF is a progressive, lifelong disorder managed with lifestyle changes and medications.
Failure can be in the Right Ventricle, the Left Ventricle or both.
ETIOLOGY OF HEART FAILURE
PRIMARY CARDIAC ORIGIN ***HTN ***CAD MI Valvular dysfunction Dysrhythmias ***Cardiomyopathy Rheumatic Heart Congenital Heart Pulmonary Hypertension
NON-CARDIAC ORIGIN Diabetes Age Tobacco Obesity Increased Cholesterol Thyroid dysfunction ETOH Chemo Chronic anemia Infectious disease Inflammatory disorders Sleep apnea
Forms
Systolic
Heart contracts less forcibly so not all blood is pumped out
More blood must remain in the veins
Most common
Causes
- CAD, myocarditis, heart valves, Conduction problems
Diastolic
Heart is stiff and does not allow for proper filling
More blood remains in the veins
Causes
- Inadequately treated HTN, advanced age, parasites, constrictive pericarditis
Pathophysiology of CHF
heart damage–> Ventricular overload–>Decreased ventricular Contraction–> Tachycardia, ventricular dilation, myocardial hypertrophy–> Decreased cardiac output–> Decreased Renal perfusion–> Increased sodium retention–> Increased osmotic pressure–> Increased ADH–> Increased water reabsorption–> Fluid overload edema
New York Heart Association:
Class I – Patients without physical limitations.
Class II – Patients who are comfortable at rest but become symptomatic with activity.
Class III – Patients who are comfortable at rest, but have marked limitations with any type of physical activity.
Class IV – Patients who are symptomatic with rest or activity.
American College of Cardiology & AHA
Class A – Has several risk factors but no S/S
Class B – Has heart disease but no S/S
Class C – Has heart disease and experiences S/S
Class D – Advanced heart disease requiring specialized treatment
Pathophysiology of CHF
Right-sided failure
- RV cannot eject sufficient amounts of blood, and blood backs up in the venous system. This results in peripheral edema, hepatomegaly, ascites, anorexia, nausea, weakness, and weight gain.
Left-sided failure
LV cannot pump blood effectively to the systemic circulation. Pulmonary venous pressures increase, resulting in pulmonary congestion with dyspnea, cough, crackles, and impaired oxygen exchange.
Chronic HF is frequently biventricular.
Clinical Manifestations
Right: Tired and weak after physical activity Tachycardia Murmurs Jugular distention Fluid accumulation/weight gain Liver enlarged/R upper quadrant pain Anorexia, nausea, bloating
Left: Weakness/fatigue Alternating pulses S3 S4 sounds Fluid accumulation in lungs SOB Orthropnea Dry cough Feeling of suffication Clots Confusion/disorientation
Significant Subjective Data
Patient may state: I’m having trouble breathing My ankles and fingers are swelled up I have to sleep with two pillows Sometimes I have chest pain I am always tired Sometimes my left arm gets numb My brain feels kind of foggy sometimes
Medical Management of HF
Eliminate or reduce etiologic or contributory factors.
Reduce the workload of the heart by reducing afterload and preload.
Optimize all therapeutic regimens.
Prevent exacerbations of HF.
?Pacer
Medications: Vasodilators Diuretics Morphine Angiotensin-converting enzyme inhibitors Angiotensin II receptor blockers Beta-blockers Digitalis Anticoags Other dysrythmics
Assessment
Health history Sleep and activity Diet Knowledge and coping Physical exam - Mental status - Lung sounds: crackles and wheezes - Heart sounds: S3 S4 - Fluid status/signs of fluid overload Daily weight and I&O
Assess responses to medications
Nursing Management
I&O Weigh daily Auscultate lung sounds Determine degree of JVD Assess dependent edema Monitor VS Examine skin turgor and mucous membranes Assess for symptoms of fluid overload
Nursing Diagnosis: Impaired Gas Exchange Decreased cardiac Output Excess fluid volume Activity intolerance and fatigue Anxiety Powerlessness Noncompliance
Patient Teaching: Medications -Action, side effects and signs of toxcity Diet: low-sodium diet (DASH/TLC) Fluid restriction for severe BP and O2 monitoring Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, Daily weight Exercise and activity program Stress management Prevention of infection Know how and when to contact health care provider Include family in teaching
Collaborative Problems/PC
Pleural Effusion Dysrhythmias Thromboembolism Pericardial effusion and cardiac tamponade Enlarged liver Renal Failure Cardiogenic shock
Pulmonary Edema
Acute event in which the LV cannot handle an overload of blood volume.
Pressure increases in the pulmonary vasculature, causing fluid to move out of the pulmonary capillaries and into the interstitial space of the lungs and alveoli.
Results in hypoxemia
Clinical manifestations: Restlessness, Anxiety, Dyspnea, Cool and clammy skin, Cyanosis, Weak and rapid pulse, cough, Lung congestion (moist, noisy respirations), Increased sputum production (sputum may be frothy and blood-tinged), Decreased level of consciousness
Management: Prevention Early recognition: - monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention Place patient upright and dangle legs. Minimize exertion and stress. Oxygen Medications - Morphine - Diuretic (furosemide)
Treating Congestive Heart Failure
UNLOAD FAST: Upright position Nitrates Lasix Oxygen ACE inhibitors Digoxin
Fluids (decreased)
Afterload (decreased)
Sodium Restriction
Test (Digoxin level, ABGs, Potassium Level)
