Patho-congestive Heart Failure

Con ges tiv e Hea rt Fa il ur e  Right

Sided Heart Failure  Left Sided Heart Failure

By: Andrew D. Beluso, RN

CHF Inability of the heart to pump sufficiently  The heart is unable to maintain adequate circulation to meet the metabolic needs of the body  Classified according to the major ventricular dysfunction- Left or Right 

CHF Etiology of CHF 1. CAD  2. Valvular heart diseases  3. Hypertension  4. MI  5. Cardiomyopathy  6. Lung diseases  7. Post-partum  8. Pericarditis and cardiac tamponade 

New York Heart Association Class 1  Ordinary physical activity does NOT cause chest pain and fatigue  No pulmonary congestion  Asymptomatic  NO limitation of ADLs

New York Heart Association Class 2  SLIGHT limitation of ADLs  NO symptom at rest  Symptom with INCREASED activity  Basilar crackles and S3

New York Heart Association Class 3  Markedly limitation on ADLs  Comfortable at rest BUT symptoms present in LESS than ordinary activity

New York Heart Association Class 4  SYMPTOMS are present at rest

CHF

PATHOPHYSIOLOGY  LEFT Ventricular pump failure back up of blood into the pulmonary veins increased pulmonary capillary pressure pulmonary congestion

CHF

PATHOPHYSIOLOGY  LEFT ventricular failure  decreased cardiac output decreased perfusion to the brain, kidney and other tissues  oliguria, dizziness

CHF

PATHOPHYSIOLOGY  RIGHT ventricular failure  blood pooling in the venous circulation  increased hydrostatic pressure peripheral edema

CHF

PATHOPHYSIOLOGY RIGHT ventricular failure blood pooling venous congestion in the kidney, liver and GIT

LEFT SIDED CHF ASSESSMENT FINDINGS  1.

Dyspnea on exertion  2. PND  3. Orthopnea  4. Pulmonary crackles/rales  5. cough with Pinkish, frothy sputum

LEFT SIDED CHF ASSESSMENT FINDINGS  7.

Cool extremities  8. Cyanosis  9. decreased peripheral pulses  10. Fatigue  11. Oliguria  12. signs of cerebral

RIGHT SIDED CHF ASSESSMENT FINDINGS  1.

Peripheral dependent, pitting edema  2. Weight gain  3. Distended neck vein  4. hepatomegaly  5. Ascites

RIGHT SIDED CHF ASSESSMENT FINDINGS 6.

Body weakness 7. Anorexia, nausea 8. Pulsus alternans

CHF

LABORATORY FINDINGS  1. CXR may reveal cardiomegaly  2. ECG may identify Cardiac hypertrophy  3. Echocardiogram may

CHF LABORATORY FINDINGS  4. ABG and Pulse oximetry may show decreased O2 saturation  5. PCWP is increased in LEFT sided CHF and CVP is increased in RIGHT

CHF NURSING INTERVENTIONS  1. Assess patient's cardio-pulmonary status  2. Assess VS, CVP and PCWP. Weigh patient daily to monitor fluid

CHF

NURSING INTERVENTIONS  3.

Administer medications- usually cardiac glycosides are given- DIGOXIN or DIGITOXIN, Diuretics, vasodilators and hypolipidemics are

CHF

NURSING INTERVENTIONS  4. Provide a LOW sodium diet. Limit fluid intake as necessary  5. Provide adequate rest periods to prevent fatigue

CHF

NURSING INTERVENTIONS  6. Position on semifowler’s to fowler’s for adequate chest expansion  7. Prevent complications of

CHF NURSING INTERVENTION AFTER THE ACUTE STAGE  1. Provide opportunities for verbalization of feelings  2. Instruct the patient about the medication regimendigitalis, vasodilators and diuretics  3. Instruct to avoid OTC drugs, Stimulants, smoking

CHF NURSING INTERVENTION AFTER THE ACUTE STAGE  4. Provide a LOW fat and LOW sodium diet  5. Provide potassium supplements  6. Instruct about fluid restriction

CHF NURSING INTERVENTION AFTER THE ACUTE STAGE  7. Provide adequate rest periods and schedule activities  8. Monitor daily weight and report signs of fluid retention

Thank You!