Congestive Heart FailurePATIENT INFORMATION

BY: L A S H O N DA M A RT I N

What is it? Certain conditions can gradually weaken the heart and leave it stiff and thickened

Heart cannot fill and pump blood as well as it should

Fluid builds up in heart, body, and other organs

Congestive heart failure

Causes/Risk factors• Narrowed arteries in the heart (Coronary Artery Disease)• High blood pressure (hypertension) • Heart attack• Cardiomyopathy• Diabetes• Obesity• Emphysema• Severe anemia• Valve disease• Thyroid disease • Kidney Disease • Family history of heart disease

Symptoms• Shortness of breath (upon exertion or lying down)

• Chest pain (if it is caused by a heart attack)

• Fatigue & weakness

• Swelling (edema) in legs, ankles, feet

• Swelling in abdomen (ascites)

• Sudden weight gain from fluid retention

• Decreased appetite & nausea

• Rapid or irregular heartbeat

• Increased need to urinate at need

Treatment• Lifestyle changes:o Exerciseo Healthy diet & decreasing salt oManaging & reducing stressoWeight losso Not smoking

•Medications

• Surgery

• Medical devices

Coping & support• Although heart failure is irreversible, treatment can help improve symptoms and prolong live

• Know when to contact your doctor

• Regular appointments

• Keep track of your medications & avoid certain over-the-counter drugs and supplements.

• Keep track of weight & blood pressure

Questions?

Congestive Heart FailureNURSING IMPLICATIONS

What is it?

• A clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to fill or eject blood

• Impaired contraction or filling of the heart may cause pulmonary or systemic congestion

• Most often chronic and progressive

• Managed with lifestyle changes and medications

Nursing assessment• Health history and family history

• Life style

• Patient’s emotional response to the diagnosis

• Signs and symptoms of increasing CHF

• Physical examination:o LOC, unexplained confusion or weaknesso Crackles, increased/fast RR, dyspnea, cougho Tachycardia, abnormal or uneven heart soundso Extremities for edema, color, swelling, circulation, temperature, peripheral pulses o BP, dizziness, lightheadedness, syncope o JVD o Anorexia or nauseao Rapid weight gain o Weakness/fatigue, restlessness, sleep disturbances, anxiety (suggest hypoxia from pulmonary congestion)o Abdomen tenderness and hepatomegaly

Tests and diagnosis• Diagnosis:• Medical history• Review of symptoms• Physical exam • Blood tests & lab work

• Tests:• Chest x-ray• ECG • Labs – electrolytes, BUN, CBC, BNP• Echocardiogram• Stress test• Cardiac computerized tomography scan (CT) • MRI• Coronary angiogram• Myocardial biopsy

Potential Complications• Hypotension, poor perfusion, and cardiogenic shock

• Dysrhythmias

• Thromboemolism

• Pericardial effusion and cardiac tamponade

• Kidney or liver damage and/or failure

Medical management • Objectives:o Improvement of cardiac function by ↓preload and after loadoReduction of symptoms and improvement of functional statusoStabilization of patient condition and ↓risk of hospitalizationoDelaying the progression of HR and extension of life

expectancyoPromotion of a lifestyle conductive to cardiac health

Treatment: drugs • Angiotensin-converting enzymes (ACE inhibitors) – Lisinopril (Prinivil)• Beta blockers – carvedilol (Coreg)• Diuretics – furosemide (Lasix)oThiazide - Hydrochlorothiazide (HCTZ)oAldosterone antagonists – spironolocatone (Aldactone) • Angiotensin II receptor blockers – losartan (Cozaar)• Digoxin (Lanoxin)

Treatment: surgery & medical devices• Coronary bypass surgery

• Heart valve repair or replacement

• Implantable cardioverter-defibrillators (ICDs)

• Cardiac resynchronization therapy (CRT) or biventricular pacing

• Heart pumps

• Heart transplant

Nursing Diagnoses • Activity intolerance R/T decreased cardiac output

• Excess fluid volume R/T to systemic fluid overload

• Risk for impaired skin integrity R/T edema and decreased tissue perfusion

• Powerlessness R/T chronic illness and hospitalizations

• Risk for ineffective therapeutic regimen management R/T lack of knowledge of diet, drug therapy, activity program, and signs/symptoms of complications

Nursing Interventions• Promote activity tolerance

• Managing fluid volume

• Controlling anxiety and minimize powerlessness

• Assist patients and family to effectively manage the therapeutic regimen

• Monitor and manage potential complications

• Educate: self-care, medication compliance, lifestyle changes, signs and symptoms of worsening condition

Evaluation• Expected patient outcomes may include: oDemonstrates tolerance for desired activityoMaintains fluid balance o Decreased anxietyoMakes sound decisions regarding care and treatmentoPatients and family members adhere to therapeutic regimen

Nursing considerations: drugs • Many potential complications are associated with the excessive/repeated use of diuretics.

• Ongoing nursing assessments and collaborative interventions:o Hypokalemia which can lead to digitalis toxicity o Hyperkalemiao Low magnesium levels o Hyponatremia o Volume depletion from excessive fluid loss can cause dehydration and hypotensiono Other: ↑serum creatinine and hyperuricemia

Nursing considerations: patient education • Take/administer medications exactly as prescribed

• Monitor effects of medication such as changes in breathing and edema

• Know signs and symptoms of orthostatic hypotension and how to prevent it

• Weigh self daily at same time with same clothing

• Restrict sodium intake to no more than 2g/day

• Participate in prescribed activity program

• Develop methods to manage and prevent stress

• Keep regular appointments with physician

• Be alert for symptoms that may indicate recurring heart failure, and report these symptoms immediately to your physician

Questions?