1. Heart failure

2. Definition Heart failure, also called "congestive heart failure," is a disorder where the heart loses its ability to pump blood efficiently. Heart failure is almost always a chronic, long-term condition that is managed with medications and lifestyle changes.

3. Introduction Heart failure occurs when the heart is unable to pump enough blood through the body. This condition usually occurs over time and is the result of some form of heart disease. The condition is slightly more common among men than women.

4. Pathophysiology Heart failure is a clinical syndrome that occurs when the heart does not function adequately as a pump and fails to pump enough blood to meet the body's metabolic needs. Congestion (the buildup of fluid). intravascular and interstitial volume overload and decreased tissue perfusion.

5. Pathophysiology Systolic heart failure occurs when the heart's ability to contract decreases. Left ventricular systolic heart failure cause fluid congestion in the lungs, a condition known as pulmonary edema. Right ventricular heart failure causes hepatomegaly and peripheral edema.

6. Pathophysiology Diastolic heart failure occurs when the heart has a problem relaxing. This form of heart failure may lead to fluid accumulation in the pulmonary and peripheral vasculature Heart failure almost never occurs at the same time as an acute myocardial infarction

8. The Onset of Heart Failure Is an Indicator of One or More of the Following Problems  Acute myocardial infarction  Hypertension  Fluid overload  Intracranial injury  Dysrhythmias

9. The Onset of Heart Failure Is an Indicator of One or More of the Following Problems  Valvular heart disease  Hyperthyroidism  Cardiomyopathy  Fever  Adult respiratory distress syndrome

10. Heart Failure Can Also Occur in Conjunction With  Pneumothorax  Oxygen toxicity syndrome  Intracranial tumors  Uremic pneumonia  Drugs (methotrexate, busulfan, hexamethonium, nitrofurantoin)

11. Nursing Assessment Symptoms  Severe dyspnea (especially on exertion)  Orthopnea  Weakness & fatigue  Paroxysmal nocturnal dyspnea  Weight gain

12. Nursing Assessment  Swelling of extremities  Palpitations  Reduced exercise capacity  Nocturia  Gastrointestinal symptoms (nausea, bloating, constipation, anorexia)

13. Nursing Assessment Record the patient's medical history Diabetes Thyroid disease Cardiomyopathy Collagen vascular disease

14. Nursing Assessment Assessed for a history of  Previously compromised heart (chronic heart failure)  Hypertension  Myocardial infarction  Medications  Allergies

15. Nursing Assessment Perform a physical examination  Decreased pulse pressure  Diaphoresis  Tachycardia  Edema (extremities, anasarca, ascites)  Tachypnea

16. Nursing Assessment  Pulmonary rales or wheezes  Hepatomegaly  Distended neck veins  Increased venous pressure  Third heart sound (gallop)  Pulsus alternans  Hepatojugular reflux  Pleural effusion (hydrothorax)

17. Diagnostic Procedures

18. Chest x-ray  Elevated BUN and creatinine levels  Hypokalemia (may be present if the patient is taking thiazides or loop diuretics)  Abnormal liver function test values

19. Diagnostic Procedures  Proteinuria and high urine specific gravity  Hyponatremia (evident in cases of severe heart failure)  Anemia  Impaired gas exchange (anxiety and fear)

20. Nursing Interventions Airway, breathing, and circulation  Provide supplemental oxygen  Anticipate the need for endotracheal intubation  Suction as needed  Provide humidified oxygen  Elevate the head of the bed into a semi- to high fowler's position

21. Nursing Interventions Cardiac rhythm and vital signs, including heart rate, pulse oximetry, blood pressure, lung sounds, and respiratory rate. Monitor the patient's level of consciousness, intake and output, and skin perfusion. Establish IV access. Laboratory and ABG. Chest x-ray.

22. Pharmacologic Agent Diuretics (furosemide) decreases preload secondary to reduction in blood volume =hypokalemia, hyponatremia, need for Foley catheterization

23. Pharmacologic Agent Morphine venous and arterial vasodilation by decreasing preload and afterload, reducing anxiety and resulting heart stimulation, and myocardial workload. Avoid for patients: dyspnea, decreased level consciousness, hypercarbia, or inadequate ventilation.

24. Pharmacologic Agent Vasodilators  Vasodilators (nitroglycerin, isosorbide)  Arteriolar dilators (hydralazine, minoxidil)  Combined dilators (nitroprusside)  ACE inhibitors (captopril, enalapril)

25. Pharmacologic Agent Positive Inotropic agents  Sympathomimetics (dopamine, dobutamine)  Digitalis glycosides  Phosphodiesterase inhibitors (amrinone, milrinone) Decrease myocardial workload, improve oxygen delivery to tissues, and increase contractility and cardiac output

26. Pharmacologic Agent Bronchodilators Monitor the patient for pulmonary wheezing, as well as side effects such as nausea, vomiting, and tachyarrhythmias Prepared to initiate advanced cardiac life

27. Patient Education A patient who is experiencing heart failure, with or without pulmonary edema, will be fearful and filled with anxiety. Therefore, it is critical to maintain a calm and efficient manner throughout the assessment, diagnosis, and treatment of the patient.

28. Patient Education Once the patient is out of immediate danger, always provide a thorough explanation of what is happening in clear, straightforward terms. And whenever possible, educate family members and significant others who are present.

29. Conclusion The proper identification and management of heart failure requires a thorough understanding of the pathophysiology of the disease and in-depth knowledge of appropriate diagnostics, interventions, and patient management techniques.

30. Conclusion When an understanding of all these elements is achieved, better care can be given to the patient experiencing heart failure, and mortality and morbidity can be reduced.