CONGESTIVE CARDIAC

FAILURE (CCF)

• PRESENTED BY: Ms B. M Paulus

• WALVIS BAY CAMPUS 2022
 LEARNING OBJECTIVES
By the end of the unit students should be able to ;
 Define CCF and related concepts
 Discuss the etiology and contributing factors of CCF
 Explain the pathophysiology of CCF
 Outline the clinical manifestations of CCF
 LEARNING OBJECTIVES CONT…..
 Discuss the nursing management of CCF
 Design nursing care plan of patients suffering from CCF
 Plan health education of patients suffering from CCF
 CONGESTIVE CARDIAC FAILURE
A condition in which the heart ‘s function as a pump is
inadequate to deliver oxygen rich blood to the body.
OR

Refers to the condition when the cardiac output can not meet the
metabolic demands of the body.
 Related concepts
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
 stroke volume (sv) : amount of blood pumped out of the
ventricle with each contraction
 Related concepts cont…
Cardiac output- the volume of blood being pumped by the
ventricles in one minute.
Shock – circulatory failure characterized by a very low cardiac
output and severe hypotension.
Systolic blood pressure- blood pressure during contraction of
the heart
Diastolic blood pressure – blood pressure when the ventricles
are relaxing and refilling.
 Classifications of CCF
Systolic heart failure: inability of the heart to pump
sufficiently because of an alteration in the ability of the heart to
contract
Diastolic heart failure: heart cannot relax properly due to
stiffening of the hearts muscle, leading to improper filling of the
heart with blood.
 Classifications of CCF Cont…
Forward heart failure: inability of the heart to pump
sufficient blood to meet the oxygen needs of the body
during an exercise or rest leads to forward heart failure.
backward heart failure Inability of the heart to meet
the oxygen needs when the heart pressures are very high
is backward heart failure.
 Classifications of CCF Cont…
Right sided heart failure/ left sided heart failure: the
failure of the pumping action of the right side of the heart
causes swelling in the legs and abdomen while that of the
left side causes congestion in the lungs.
 contributing factors
 Coronary artery disease
 Valvular disorders
 Hypertension
 Infections e.g. myocarditis
 Arrhythmias
 cardiomyopathies
 Contributing factors
 Causes of increased oxygen demand includes obesity,
pregnancy , severe anemia, hyperthyroidism
 Patients with underlying heart disease taking certain
medications that cause sodium retention or affects the
contraction of the heart muscles.
 Pathophysiology cont….
 preload 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 decreased
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

1. Impaired myocardial function: Tachycardia, poor peripheral perfusion,

pallor, difficulty in breathing,
2. Pulmonary Congestion: Tachypnea, cyanosis, ,nasal flaring, coughing,
edema
3. Systemic venous congestion: Hepatomegaly, splenomegaly, peripheral
edema , Water weight gain, Decreased urine output
 Diagnostic studies
 CXR
 ECG
 FBC
 LFT
 U+ E
 MEDICAL MANAGEMENT
Digitalis: Digoxin
Angiotensin-converting enzymes inhibitors e.g perindopril
Beta-adrenagic blockers e,g propanolol
Inotropic support e.g dopamine
Diuretics e.g furosemide
 NURSING MANAGEMENT
Bed rest with limited activities
Sodium restricted diet
Oxygen therapy as prescribed
Care for edematous areas
Allow expression of feelings
Give health education
 Complications
Pulmonary edema
Metabolic acidosis
Failure to thrive
Arrhythmia
Death
Nursing interventions

1. Improving Myocardial efficiency

-Measure heart rate
2. 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…
3. Maintaining fluid & electrolyte balance
-Administer diuretics as prescribed
- monitor serum electrolytes
-keep intake and output
4. Relieving Respiratory Distress
-Administer oxygen therapy as prescribed
-Elevated head of bed;
 NURSING INTERVENTIONS CONT…

4. 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
 NURSING INTERVENTIONS CONT…
5. Decrease Risk of infection
-Ensure good hand washing practice
-Avoid exposure to ill patient
-Monitor signs of infection
6. Provide adequate nutrition
-provide food that the pt likes,
- Supplement c high calories snacks
-Provide small meals,
 NURSING INTERVENTIONS CONT…
7. Reduce anxiety & fear
- Communicate the care plan to the pt & family
-Educate the family about Congestive Heart Failure & provide
home care nursing referral after D/C
-Encourage questions & answer questions
- refer another member of health care team
Health Education

 Teach importance of controlling blood

pressure
 If signs and symptoms occur, seek help
from nearest medical facility.
Demonstrate medication administration
Reinforce dietary guidelines;
Encourage ways to prevent infection
Encourage return for follow up visit
Instruct patient to rest frequently to reduce the
workload of the heart
 REFERENCES
1. Smeltzer, S.C., Bare, B.G., Hinkle, J.L.& Cheever, K. H. (2010) 12 th Ed. Brunner
& Suddarth’s Textbook of Medical-Surgical Nursing. Tokyo: Wolters Kluwer Health.

2. Vlok, M. E. 1998. Manual of Nursing, 9th Ed. Volume 1. Basic Nursing, Cape Town:
Juta & Co
3. Viljoen, M. J. 2000. Nursing Assessment: History Taking and physical Assessment.
Cape Town. Kasigo.
4. Mogotlane, S., Chauke, M, C., Matlaka, m., Mokoena, J., Young, A. Tuta’s Complete
Textbook of Medical and Surgical Nursing. (2013) Juta and Company LTD. Lansdowne.
Cape Town.