Objectives Describe congestive heart failure Explain the pathophysiology of congestive heart failure Describe nursing interventions in caring for clients with congestive heart failure
Heart Failure Definition- Inability of the heart to fill with blood and/or pump blood, sufficiently. Caused by structural or function abnormality (i.e. cardiomyopathy, valve disorders etc.)
Heart Failure No longer termed “congestive heart failure” – Many pts. do not experience pulmonary or systemic congestion Now identified as a “neurohormonal” problem that progresses due to chronic release of catecholamines (epi- and norepi-) which produce negative effects on a failing heart
Heart Failure May results in any or all of the following: – Intravascular fluid volume overload – Intrastitial fluid volume overload – An inability to meet the demands of the body
Types of Heart Failure Right Heart Failure Left Heart Failure Key aspects of heart failure include: – Weakened heart contractions – Increase in blood volume and congestion – Decreased cardiac output
Causes of Heart Failure Age CAD HTN Valve Disease Congenital Heart Disease Cardiomyopathy Endocarditis Myocarditis COPD
NYHeartAsso Classification of Heart Failure Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities. Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion. Class III: marked limitation of any activity; the patient is comfortable only at rest. Class IV: any physical activity brings on discomfort and symptoms occur at rest.
Right-Sided Heart Failure The Right Ventricle is unable to fill with a sufficient amount of venous blood AND/OR The Right Ventricle is unable to effectively pump blood forward to the pulmonary circulation
Right-Sided Heart Failure Causes: – ↑ pressure of blood backing up from a failing Left ventricle – Pulmonary Hypertension Primary (idiopathic) Secondary (caused by another pathology) – If related to COPD: COR Pulmonale – Pulmonary or Tricuspid Valve disease
Right-Sided Heart Failure Signs & Symptoms are related to: Peripheral Congestion Low cardiac output L/R Ventricular Failure See p. 334 Box 8-3
Cor Pulmonale COPD increases pressure in the Pulmonary Arteries. Over time the increased pressure on the Right Ventricle causes it to dilate and/or hypertrophy. The inability of the RV to eject all of its volume forward causes blood to back up into the Right Atrium and the veins peripheral edema – Special note: 1 liter fluid = 1 kg (2.2 lbs) – Wt. gain of 2.2 lbs = 1 liter body fluid gain
Left-Sided Heart Failure The Left Ventricle is unable to fill with a sufficient amount of blood AND/OR The LV is unable to effectively pump blood out to the rest of the body
Digoxin Onset of action 2-6 hours, half-life 2-4 days Action: – Strengthens the force and efficiency of cardiac contraction – Slows heart rate – Increases circulation, effecting diuresis Therapeutic Levels – Normal serum dig level range 0.5- 2 ng/mL
Digoxin Side Effects – Bradycardia – Hypokalemia leads to: Toxicity- N/V, Visual disturbances, confusion, severe bradycardia, tachycardic dysrhythmias Antidote – Digibind (Digoxin immune Fab) Duration 2-6 hours
Nursing Interventions Goals – Prevent disease progression – Prevent complications – Patient & family education including end-of-life decisions
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