Congestive Heart Failure/CCF

GNS II
UNIT 2
V.Maliti
 GLOSSARY

Some common terms: Brunner& Suddarth

(2010:823)
 Systolic heart failure: inability of the heart to
pump sufficiently because of an alteration in the
ability of the heart to contract
 Preload: The amount of myocardial stretch before
systole caused by the volume of blood presented
to the ventricles
 Afterload: The resistance to eject blood from a
ventricle
 GLOSSARY

Right-sided heart failure ( right ventricular failure):

inability of the right ventricle to fill/pump (empty)
sufficient blood to the pulmonary circulation
 Left-sided heart failure (left ventricle failure):
inability of left ventricle to fill/pump (empty)
sufficient blood to meet the
oxygenation/nutritional needs of the tissues
 GLOSSARY

 Paroxysmal nocturnal dyspnea (PND):

shortness of breath that occurs suddenly
during sleep
Pulsus paradoxus: systolic blood pressure
that is more than 10mm Hg higher during
exhalation than during inspiration;
difference normally is less than 10mm Hg
 GLOSSARY

 Stenosis: Narrowing
 Anuria: Urine output of less than 50ml/24hrs
 Ascites: An accumulation of serous fluids in
peritoneal cavity
 Pulseless electrical activity (PEA): Condition
in which electrical activity is present but there
is not adequate pulse/Blood Pressure
 GLOSSARY

 Orthopnea: shortness of breath when

laying down
 Stroke volume (SV): amount of blood
pumped out of the ventricle with each
contraction
 Cardiac output: volume of blood pumped
into arteries by the heart with each
ventricular contraction
 GLOSSARY

 Myocardial infarction: Permanent damage to the heart tissue

and muscle due to the interruption of blood supply to the area.
Commonly referred to as a heart attack.
 Coronary artery disease (CAD): Disease affecting the
coronary arteries that surround the heart and supply blood to
the heart muscle. CAD occurs when the lumen of the coronary
arteries becomes narrowed with plaque deposits (a buildup of
cholesterol and other fats, calcium and elements carried in the
blood).
Electrocardiogram (ECG or EKG): A test that records
changes in the electrical activity of the heart. May show whether
parts of the heart muscle have been damaged due to
insufficient oxygen flow to the heart.
 Congestive Heart Failure/CCF
 Congestive Cardiac Failure…adult 412, Paed
(Nettina 2014:1538)
Refers to a condition when cardiac output cannot
meet the metabolic demands of the body

Pathophysiology & Etiology

May results from:
 Acquired heart disease i.e myocarditis,
cardiomyopathy & rheumatic fever
 Chronic pulmonary disease: i.e bronchopulmonary
dysplasia (abnormality)
 Congestive heart diseases overload
 Pathophysiology…cont

 Arrhythmias: prolonged Supraventricular

Tachycardia (SVT), complete heart block
 Anemia
 Lactogenic fluid overload
 In an attempt to meet the metabolic needs of
the body, the heart rate increase to increase
Cardiac Output
 Pathophysiology…cont

 Reload (CVP) increases as the failing heart contracts poorly

 With ↓ CO, the systemic vascular resistances ↑ to maintain
Bp. This increases the afterload limits CO
 With ↓ blood flow to the kidneys, the glomerular filtration
rate ↓ as tubular reabsorption increases sodium & water
retention, resulting in decreases urine output
 Long term, these compensatory mechanisms are
detrimental to the failing myocardium. ↑ in preload &
afterload leads to dilatation & myocardial hypertrophy
resulting to progressive Congestive Heart Failure.
 Clinical Manifestations common to
children:
 Impaired myocardial function: Tachycardia, poor
peripheral perfusion, pallor, activity intolerance,
confusion
 Pulmonary Congestion: Tachypnea, cyanosis,
retractions, nasal flaring, coughing, shortness of
breath
 Systemic venous congestion: Hepatomegaly,
peripheral edema (scrotal & orbital), Water weight
gain, Decreased urine output, distended jugular veins,
ankle-edema, renal impairment
 Clinical manifestation common to
adults
 Left-side heart failure: S&S- Dyspnea,
Tachycardia, Crackles, Dry cough, paroxysmal
nocturnal dyspnea, hypertension).
 Right-sided heart failure: S&S -Jugular venous
distension, Abdominal distension/ascites,
splenomegaly, hepatomegaly/liver congestion,
Nocturia, Anasarca(edema).
 Diagnostic Evaluation
Characteristic physical examination
Chest x-ray – cardiomegaly & pulmonary congestion
Management
Diuretics
Digitalis: Digoxin increase myocardial contractility
Angiotensin-converting enzymes inhibitors Afterload
reduction to ↓ the workload of myocardium
Beta-adrenergic blockers
Inotropic support (agents that changes the force of heart
contraction)
 Complications
 Pulmonary edema-
 Put the patient in semi-fowler, IV diuretics, bronchodilators, ordered
afterload medication Mechanical ventilation?
 Metabolic acidosis-Management?
 Failure to thrive
 Myocardial failure
 Arrhythmia
 Take vital signs,
 Oxygen,
 Give ordered medications
 Death
 Nursing Assessment

 Obtain history of symptoms, onset, duration,

limits of activities,
 Assess heart sounds
 Assess jugular vein dissention
 Document vital signs & SPO2
 Observe for diaphoresis (profusely sweating)
 Assess for Ascites and edema
 Nursing Diagnose

 Decrease cardiac output related to

myocardial dysfunction
 Excessive fluid volume related to decrease
cardiac contractility and decreased excretion
from the kidney
 Nursing Dx cont…

 Impaired Gas exchange related to pulmonary

venous congestion
 Activity intolerance related to myocardial
dysfunction and pulmonary congestion
 Risk for infection related to pulmonary congestion
 Anxiety related to diagnosis and prognosis
 Nursing interventions
 Improving Myocardial efficiency:
 Measure heart rate
 Check potassium level
 Run lead II ECG,
 Administer afterload reduction medications as
prescribed
 Measure BP before & after giving medication
 Observe for the signs of hypotension (dizziness, light-
headache, syncope)
 Nursing interventions cont…

 Maintaining fluid & electrolyte balance:

 Administer diuretics as prescribed, monitor serum
electrolytes, keep intake and output
 Relieving Respiratory Distress
 Administer oxygen therapy as prescribed
 Elevated head of bed
 Interventions cont…

 Promoting activity tolerance

 Organize nursing care to provide periods of uninterrupted
sleep/rest
 Avoid unnecessary activities
 Respond efficiently to patients needs; Rx source of distress
 Encourage activities that require less energy
- Encourage small, frequent feeds
 Interventions cont…
 Decrease Risk of infection
 Ensure good hand washing practice
 Avoid exposure to ill patient
 Monitor signs of infection: fever, cough, diarrhoea,
vomiting etc
 Provide adequate nutrition
 Provide food that the patient likes, Supplement c high
calories snacks
 Provide small meals,
 Ensure clean environment before meals
 Interventions cont…

 Reduce anxiety & fear

 Communicate the care plan to the pt & family
 Educate the family about Congestive Heart
Failure (CHF) & provide home care nursing
referral after D/C
 Encourage questions & answer questions, refer
another member of health care team
 Health Education
 Teach the signs & symptoms of CHF
 Medications effects, adverse effects
 Demonstrate medication administration
 With the family, design a med administration time
schedule
 Teach patient & family cardiopulmonary resuscitation (
CPR)
 Reinforce dietary guidelines; provide recipe
 Encourage ways to prevent infection
 Encourage return for follow up visit
 Provide written materials on CHF