1. Nursing Care of Patients with Heart Failure
Chapter 26
Nursing Care of Patients with Heart Failure

2. Heart Failure
Syndrome Occurs from Progressive Inability of Heart to Pump Enough Blood to Meet Body’s Oxygen/Nutrient Needs
Older Term: Congestive Heart Failure

3. Causes Coronary Artery Disease Cardiomyopathy Hypertension
Heart Valve Disorders
Myocardial Infarction

4. Pathophysiology Each Ventricle Pumps Equal Amount of Blood
If More Than Either Ventricle Can Handle, Heart Not Effective Pump
Left Ventricle Typically Weakens First
Failure of One Leads to Failure of Other

5. Left-Sided Heart Failure
Afterload
Force Generated by Left Ventricle to Eject Blood Into Aorta Through Aortic Valve
Peripheral Vascular Resistance (PVR)
Pressure Within Aorta/Arteries
PVR Influences Afterload

6. Left-Sided Heart Failure (cont’d)
Hypertension Major Cause
Blood Backs Up from Left Ventricle
Alveolar Edema Results

7. Left-Sided Heart Failure (cont’d)

8. Right-Sided Heart Failure
Left-sided Heart Failure Major Cause
Must Continually Pump Blood Against Increased Fluid in Pulmonary Artery and Lungs

9. Right-Sided Heart Failure (cont’d)
Cor Pulmonale
Right Ventricle Hypertrophies and Fails Due to Increased Pulmonary Pressures
Backward Buildup of Blood in Systemic Blood Vessels
Peripheral Edema Results

10. Right-Sided Heart Failure (cont’d)

11. Compensatory Mechanisms Maintain Cardiac Output
Designed to Maintain Cardiac Output
Also Contribute to Cycle of Heart Failure

12. Compensatory Mechanisms
Maintain Cardiac Output When Low
Sympathetic Nervous System Raises Heart Rate
Increases Cardiac Oxygen Needs
Renin-Angiotensin-Aldosterone System, Antidiuretic Hormone Save Water
Increases Fluid Volume

13. Compensatory Mechanisms (cont’d)
Chambers Enlarge (Dilation)
Muscle Mass Increases (Hypertrophy)
Increases Cardiac Oxygen Needs

14. Pulmonary Edema Acute Heart Failure
Severe Fluid Congestion in the Alveoli
Life-threatening
Drowning in Own Secretions

15. Signs and Symptoms Classic: Pink, Frothy Sputum
Rapid Respirations with Accessory Muscles
Severe Dyspnea, Orthopnea
Crackles, Wheezes
Anxiety, Restlessness
Clammy, Cold Skin

16. Diagnosis
X-Ray
ABGs
Pulmonary Pressures

17. Therapeutic Interventions
Immediate Treatment
Reduce Workload of Left Ventricle
Treat Underlying Cause
Fowler’s Position
Oxygen/Mechanical Ventilation

18. Therapeutic Interventions (cont’d)
Morphine IV
Diuretics IV
Inotropic Agents IV
Vasodilators IV

19. Nursing Diagnoses Impaired Gas Exchange Decreased Cardiac Output
Excess Fluid Volume
Acute Pain
Anxiety

20. Chronic Heart Failure Progressive
Signs and Symptoms May Worsen Over Time

21. Signs and Symptoms Fatigue and Weakness Exertional Dyspnea Cough
Orthopnea, Paroxysmal Nocturnal Dyspnea
Cough
Crackle and Wheezes
Tachycardia
Chest Pain

22. Signs and Symptoms (cont’d)
Cheyne-Stokes Respiration
Edema
Anemia
Nocturia
Cyanosis
Altered Mental Status
Malnutrition

23. Complications of Heart Failure
Liver and Spleen Enlargement
Pleural Effusion
Thrombosis and Emboli
Cardiogenic Shock

24. Diagnostic Tests Screening Tests BNP Serum BUN, Creatinine
Liver Function Tests
Thyroid Function Test
Ferritin

25. Diagnostic Tests (cont’d)
Chest X-Ray
Echocardiography
ECG
Exercise Stress Testing
Cardiac Magnetic Imaging
Cardiac Catheterization/Angiography
Sleep Studies

26. Therapeutic Intervention Goals
Improve Heart’s Pumping Ability and Decrease Heart’s Oxygen Demands
Identify and Correct Underlying Cause
Increase Strength of Heart’s Contraction
Maintain Optimum Water and Sodium Balance
Decrease Heart’s Workload

27. Drug Therapy Oxygen Therapy ACE Inhibitors or ARBs Beta Blockers
Diuretics
Inotropic Agents
Vasodilators

28. Therapeutic Interventions
Activity
Sodium and Weight Control
Pacemakers, ICD
Cardiac Resynchronization Therapy

29. Therapeutic Interventions (cont’d)
Mechanical Assistive Devices
Intra-aortic Balloon Pump
Ventricular Assist Device
Total Artificial Heart
Implantable Replacement Heart

30. Intra-Aortic Balloon Pump

31. Ventricular Assist Devices and Artifical Heart
Support Failing Heart
Bridge to Transplantation
Destination Therapy
Heart Replacement
Please see figure 26.4, page 491 of the text for different types of ventricular assist devices.

32. Surgical Interventions
CABG
Valve Replacement
Ventricular Reconstruction

33. Nursing Diagnoses Impaired Gas Exchange Decreased Cardiac Output
Acute Pain 
Anxiety 
Excess Fluid Volume

34. Nursing Interventions
Oxygen
Rest and Activity
Positioning
Fluid Management
Reduce Oxygen Consumption

35. Nursing Interventions (cont’d)
Medications/Teaching
Low-sodium Diet
Weight Control
Education
Coping

36. Cardiac Transplantation
End Stage Heart Failure
Strict Selection Criteria

37. Heart Transplant

38. Cardiac Transplantation (cont’d)
Immunosuppressive Therapy Preoperatively
Lifelong Antirejection Therapy

39. Cardiac Transplantation (cont’d)
Complications
Rejection
Infection
Malignancies
Anti-rejection Medicine Side Effects

40. Postoperative Cardiac Surgery Nursing Diagnoses
Pain
Ineffective Airway Clearance
Impaired Gas Exchange
Decreased Cardiac Output
Risk for Infection
Deficient Knowledge