Congestive Heart Failure By Dr. Hanan Said Ali
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Transcript of Congestive Heart Failure By Dr. Hanan Said Ali
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Congestive Heart Failure
ByDr. Hanan Said Ali
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ObjectivesObjectives
Define congestive heart failure. Enumerate causes of congestive
heart failure.Explain how to assess patients
physically and physiologically. Identify principles of care. Identify nursing care for patients
with congestive heart failure.
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Congestive Heart Congestive Heart Failure Failure Definition Acute heart failure is pump failure due to
ischemia or infarction.
CausesMyocardial infarctionDrugs as Beta blockerDysrhythmiasValve dysfunctionVentricular septal defect
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Causes Cont.Causes Cont.
Pericardial tamponade
Constrictive pericarditis
Haemorrhage and anaemia
Pulmonary embolusCardiomyopathy
HypertensionThyrotoxic crisisWet beri – beri( vitamin B
deficiency)myocaditis
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Assessment ( Signs & Assessment ( Signs & Symptoms.)Symptoms.)Physical assessmentSkinCyanosis, pallor, and sweating. Organ hypoperfusion produces cold.Peripheral oedema.
RespirationThe patient may be tachypnoeic.Blood- stained frothy sputum as a
result of pulmonary oedema.Wheeze
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Physical assessment Cont.Physical assessment Cont.
GeneralThe patient may show signs of
generalized weakness and fatigue.
Auscultation Fourth heart sound may be heard.Crepitation may be heard at the
lung bases in left heart failure.
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Physiological AssessmentPhysiological AssessmentCVP will be high with right- sided heart
failure.
Blood pressure may be low, normal, or high.
Heart rate tachycardia will usually be evident unless bradycardia is the main cause of failure.
Renal function urine output may be reduced and renal dysfunction evident from blood urea and creatinine levels
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Neurological/Psychological Neurological/Psychological assessmentassessmentThe patient may exhibit anxiety and distress,
drowsiness, confusion as a result of poor cardiac output and cerebral hypoperfusion.
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InvestigationsInvestigations
12- lead ECG
Chest x- ray
Blood investigation ( urea, electrolytes, haemoglobin, glucose, cardiac enzymes, and brain type natriuretic peptide, this released into bloodstream from the ventricle when it is excessively stretched.
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Priorities of carePriorities of careBasic resuscitation measures are
aimed at restoring an adequate circulation as quickly.
Administration of high – flow, high- concentration oxygen.
vasodilators, and diuretics
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Priorities of carePriorities of care
Diamorphine 2.5mg IV, reassurance, information and comfort.
Mechanical ventilation.
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Principles of carePrinciples of careMonitoringContinuous ECG monitoring.Pulse oximetry and frequent BP
monitoring.Invasive arterial pressure and CVP
monitoring.
RestThe heart can be rested by reducing
the work of breathing through mechanical ventilation.
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Principles of carePrinciples of careOptimizing intravascular fluid volume
The circulating volume should be optimized before introducing other drugs.
Supporting the cardiac output.In low- output states the tissues
compensate for the decrease in oxygen delivery by extracting more oxygen .
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Principles of carePrinciples of careTherapiesDiureticCause an initial vasodilatation followed,
20- 30 min later, by a diuresis.
NitratesCan be given rapidly either by oral or
sublingual while an infusion is being prepared.
( A drop in blood pressure on a low- dose infusion is suggestive of hypovolaemia)
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Principles of carePrinciples of care
Calcium sensitizer agent Improves ventricular contractility
and vasodilates peripherally without having a major impact on cardiac work.
Mechanical ventilation
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Nursing care planNursing care planActivity intolerance related to
fatigue secondary to cardiac insufficiency.Expected outcome Nursing intervention
Tolerate activity, have needs met to satisfaction
Have the patient rest in bed (high fowler's position) or chair when tiredProvide emotional and physical rest to reduce oxygen consumption and relieve dyspnea and fatigue.If in bed teach leg exercise to prevent DVTAssess patient daily for dyspnea fatigue, pulse rate to determine level of activity
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Nursing care planNursing care planImpaired gas exchange related to
increased preload mechanical failure or immobility.Expected outcome Nursing intervention
Have respiratory rate of 12-18/ min Elevate head of bead to high fowlers position to improve ventilation.Support patients arms on pillows to move arm off and away from chest to facilitate breathing.
Administer oxygen by nasal cannula to improve O2 saturation.
Auscultate for lung and heart sounds& use pulse oximetry.
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Nursing care planNursing care planFluid volume excess related to
pump failure.Expected outcome Nursing intervention
Have reduced or absence of oedema Evaluate degree of peripheral oedema and measure abdominal girth dailyAdminister digitalis ( Digoxin)to improve cardiac output and contractility & diuretics to mobilize oedematous fluid.Assess intake and output & and weight patient daily.
Provide salt restricted diet.Observe for hypokalemia.
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Nursing care planNursing care planSleep pattern disturbance related
to nocturnal dyspnea.Expected outcome Nursing intervention
Feel rested after sleep Explain etiology of nocturnal dyspnea to reduce fear .
Explore with patient alternative position of comfort such as sleeping with two or more pillow to relieve dyspnea.
Have patient take diuretics early in the day to decrease urination during night.
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Nursing care planNursing care planPotential impaired skin integrity
related to oedema or immobilityExpected outcome Nursing intervention
Have no break down of skin at oedematous areas
Identify location and severity of oedema.
Handle oedematous skin gently.
Pad bony prominences to reduce pressure and skin breakdown.
Perform passive ROM exercise to extremities to facilitate venous return of fluid.
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Nursing care planNursing care planAnxiety related to dyspnea or
perceived threat to deathExpected outcome Nursing intervention
Express feeling less apprehensive about condition and prognosis.
Asses facial expression and behaviour for feeling of apprehensionAllow patient to ask questions to relieve anxiety.Demonstrate calm behaviour to improve confidence..Use measures to decrease dyspnea.
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Nursing care planNursing care planSelf care deficit related to dyspnea
and fatigueExpected outcome Nursing intervention
Achieve ADL with assistance as necessary
Assist patient with all ADL to meet patient needs and to relieve anxiety.Give small, easy digested food.Advise family of patients fluctuating abilities regarding self care activities.
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Thank You