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Congestive heart failure Dr. Walaa Nasr Lecturer of Adult Nursing Second year Second year.

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Presentation on theme: "Congestive heart failure Dr. Walaa Nasr Lecturer of Adult Nursing Second year Second year."— Presentation transcript:

1 Congestive heart failure Dr. Walaa Nasr Lecturer of Adult Nursing Second year Second year

2 Congestive heart failure outlines Definition Definition Causes and pathophysiology Causes and pathophysiology Types of heart failure Types of heart failure Compensatory mechanism of heart failure Compensatory mechanism of heart failure Clinical manifestations Clinical manifestations Classification of heart failure Classification of heart failure Diagnostic evaluation Diagnostic evaluation Medical management Medical management Nursing management Nursing management

3 Congestive heart failure Definition Heart failure describes the clinical syndrome that develops when the heart cannot maintain an adequate cardiac output. The heart pumps blood inadequately, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and other changes that may further weaken the heart.

4 Causes of congestive heart failure Coronary artery disease Coronary artery disease Heart attack Heart attack High blood pressure High blood pressure Heart valves disorders Heart valves disorders Inflammation of Heart muscle (myocarditis, cardiomyopathy) Inflammation of Heart muscle (myocarditis, cardiomyopathy)

5 Causes of congestive heart failure (cont … ) Severe lung disease ( pulmonary hypertension) Severe lung disease ( pulmonary hypertension) Severe anemia Severe anemia Overactive thyroid gland (hyperthyroidism) Overactive thyroid gland (hyperthyroidism) Underactive thyroid gland (hypothyroidism) Underactive thyroid gland (hypothyroidism) Abnormal heart rhythms ( atrial fibrillation) Abnormal heart rhythms ( atrial fibrillation) Kidney failure Kidney failure

6 Congestive heart failure Types Left-sided heart failure Left-sided heart failure There are two types of left- sided heart failure There are two types of left- sided heart failure Systolic dysfunction Systolic dysfunction Diastolic dysfunction Diastolic dysfunction Right-sided heart failure Right-sided heart failure

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8 Congestive heart failure Compensatory Mechanisms of heart failure Renin-angiotensin-aldosterone system Renin-angiotensin-aldosterone system Sympathetic nervous system Sympathetic nervous system Enlargement of the muscular walls of the ventricles (ventricular hypertrophy). Enlargement of the muscular walls of the ventricles (ventricular hypertrophy).

9 Congestive heart failure Clinical manifestations Symptoms (back up of blood and fluid) Symptoms (back up of blood and fluid) Dyspnea Dyspnea Orthopnea Orthopnea Reduced exercise tolerance, lethargy, fatigue Reduced exercise tolerance, lethargy, fatigue Nocturnal cough Nocturnal cough Wheeze Wheeze Ankle swelling Ankle swelling Anorexia Anorexia

10 Congestive heart failure Clinical manifestations ( cont … ) Signs Signs Cachexia and muscle wasting Cachexia and muscle wasting Tachycardia Tachycardia Pulsus alternans Pulsus alternans Elevated jugular venous pressure Elevated jugular venous pressure Crepitations or wheeze Crepitations or wheeze Third heart sound Third heart sound Oedema Oedema Hepatomegaly (tender) Hepatomegaly (tender) Ascites Ascites

11 Congestive heart failure Classification of heart failure New York Heart Association (NYHA) Functional Classification Symptoms % of patients Class No symptoms or limitations in ordinary physical activity 35%I Mild symptoms and slight limitation during ordinary activity 35%II Marked limitation in activity even during minimal activity. Comfortable only at rest 25%III Severe limitation. Experiences symptoms even at rest 5%IV

12 Congestive heart failure Diagnostic evaluation Patient history Patient history Physical examination Physical examination Diagnostic studies Diagnostic studies 1. Electrocardiography (ejection fraction) 2. Radionuclide 3. magnetic resonance 4. computed tomography imaging 5. cardiac catheterization with angiography 6. a biopsy of heart muscle is needed

13 Congestive heart failure Treatment lifestyle change lifestyle change 1. Salt restriction 2. Exercises 3. Smoking and alcoholism 4. Body weight (daily weight) 5. Supportive stockings

14 Congestive heart failure Treatment (cont … ) Drug management Drug management Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers Angiotensin II receptor blockers Beta-blockers Beta-blockers Other vasodilators ( nitroglycerin) Other vasodilators ( nitroglycerin) Cardiac glycosides (digoxin) Cardiac glycosides (digoxin) Aldosterone receptor blockers (spironolactone) Aldosterone receptor blockers (spironolactone) Loop diuretics Loop diuretics

15 Congestive heart failure Treatment (cont … ) Potassium-sparing diuretics Potassium-sparing diuretics Thiazide and thiazide-like diuretics Thiazide and thiazide-like diuretics Anticoagulants (heparine) Anticoagulants (heparine) Opioids (morphine) to relieve anxiety Opioids (morphine) to relieve anxiety Positive inotropic drugs (drugs that make muscle contract more forcefully) (dopamine) Positive inotropic drugs (drugs that make muscle contract more forcefully) (dopamine) Oxygen for pulmonary edema is required Oxygen for pulmonary edema is required

16 Non pharmacological management of heart failure (surgical intervention) Non pharmacological management of heart failure (surgical intervention) Coronary artery bypass grafting ( revascularization) Coronary artery bypass grafting ( revascularization) Percutaneous coronary intervention (Angioplasty) Percutaneous coronary intervention (Angioplasty) Valve replacement Valve replacement Biventricular pacemaker Biventricular pacemaker Heart transplantation Heart transplantation Left ventricular assist device (LVAD) Left ventricular assist device (LVAD) Congestive heart failure Treatment (cont … )

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18 Maintain the patient in high fowler's position Maintain the patient in high fowler's position Elevate extremities except when the patient is in acute distress Elevate extremities except when the patient is in acute distress Frequently monitor vital signs Frequently monitor vital signs Change position frequently Change position frequently Monitor intake and output and daily weight Monitor intake and output and daily weight Nursing care of patients with congestive heart failure

19 Nursing care of patients with congestive heart failure (cont … ) Restrict fluids as ordered Restrict fluids as ordered Teach the patient and family and provide emotional support (life style change) Teach the patient and family and provide emotional support (life style change) Explain the side effect of diuretic medications for additional actions ( side effects of diuretics include electrolyte imbalance, symptomatic hypotension Explain the side effect of diuretic medications for additional actions ( side effects of diuretics include electrolyte imbalance, symptomatic hypotension Use aseptic procedures when caring for invasive lines Use aseptic procedures when caring for invasive lines

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