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Heart Failure

Heart Failure. Objectives . Describe congestive heart failure Explain the pathophysiology of congestive heart failure Describe nursing interventions in caring for clients with congestive heart failure. Heart Failure.

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Heart Failure

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  1. Heart Failure

  2. Objectives • Describe congestive heart failure • Explain the pathophysiology of congestive heart failure • Describe nursing interventions in caring for clients with congestive heart failure

  3. Heart Failure • Definition- Inability of the heart to fill with blood and/or pump blood, sufficiently. • Caused by structural or function abnormality (i.e. cardiomyopathy, valve disorders etc.)

  4. Heart Failure • No longer termed “congestive heart failure” • Many pts. do not experience pulmonary or systemic congestion Now identified as a “neurohormonal” problem that progresses due to chronic release of catecholamines (epi- and norepi-) which produce negative effects on a failing heart

  5. Heart Failure • May results in any or all of the following: • Intravascular fluid volume overload • Intrastitial fluid volume overload • An inability to meet the demands of the body

  6. Types of Heart Failure • Right Heart Failure • Left Heart Failure • Key aspects of heart failure include: • Weakened heart contractions • Increase in blood volume and congestion • Decreased cardiac output

  7. Causes of Heart Failure • Age • CAD • HTN • Valve Disease • Congenital Heart Disease • Cardiomyopathy • Endocarditis • Myocarditis • COPD

  8. NYHA Classification of Heart Failure • Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities. • Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion. • Class III: marked limitation of any activity; the patient is comfortable only at rest. • Class IV: any physical activity brings on discomfort and symptoms occur at rest.

  9. Right-Sided Heart Failure • The Right Ventricle is unable to fill with a sufficient amount of venous blood AND/OR • The Right Ventricle is unable to effectively pump blood forward to the pulmonary circulation

  10. Right-Sided Heart Failure • Causes: • ↑ pressure of blood backing up from a failing Left ventricle • Pulmonary Hypertension • Primary (idiopathic) • Secondary (caused by another pathology) • If related to COPD: COR Pulmonale • Pulmonary or Tricuspid Valve disease

  11. Right-Sided Heart Failure • Causes (cont.) • Preexisting left sided heart failure • Myocardial changes • Body fluid overload • Rhythm Disturbances

  12. Right-Sided Heart Failure • Signs & Symptoms are related to: Peripheral Congestion Low cardiac output L/R Ventricular Failure See p. 334 Box 8-3

  13. CorPulmonale • COPD increases pressure in the Pulmonary Arteries. • Over time the increased pressure on the Right Ventricle causes it to dilate and/or hypertrophy. • The inability of the RV to eject all of its volume forward causes blood to back up into the Right Atrium and the veins  peripheral edema • Special note: 1 liter fluid = 1 kg (2.2 lbs) • Wt. gain of 2.2 lbs = 1 liter body fluid gain

  14. Left-Sided Heart Failure • The Left Ventricle is unable to fill with a sufficient amount of blood AND/OR • The LV is unable to effectively pump blood out to the rest of the body

  15. Left-Sided Heart Failure • Causes: • Hypertension (peripheral arteries) • Aortic and Mitral Valve disease, • Aortic coarctation • Myocardial Changes • Rhythm Disturbances

  16. Left-Sided Heart Failure • Signs & Symptoms are related to: *Decreased Cardiac Output *Pulmonary Congestion: Pulmonary edema Pleural Effusion

  17. Heart Failure • Nursing Assessment • Subjective Data: pt. c/o: • Dyspnea • Orthopnea • Cough • Paroxysmal nocturnal dyspnea • Fatigue • Anxiety • Weight gain

  18. Heart Failure • Nursing Assessment • Objective Data: • Clinical manifestations

  19. Heart Failure • Diagnostic Tests • CXR • EKG • Echo • Cardiac Catheterization • Multiple-gated acquisition scanning • Lab tests

  20. Heart Failure • Medical Management • Goals: Increase cardiac efficiency Lower oxygen requirements Provide oxygen Treat edema and pulmonary congestion • Medications • Prognosis is good with treatment

  21. MEDICATIONS • Diuretics • Thiazides (HCTZ) • Loop Diuretics (Lasix) • Digoxin • Ace Inhibitors (possibly ARB’s) • Beta Blockers • Coreg

  22. MEDICATIONS • Positive Inotropes • Dobutamine infusion • Vasodilators • Nitrates • Hydralazine

  23. Digoxin • Onset of action 2-6 hours, half-life 2-4 days • Action: • Strengthens the force and efficiency of cardiac contraction • Slows heart rate • Increases circulation, effecting diuresis • Therapeutic Levels • Normal serum dig level range 0.5- 2 ng/mL

  24. Digoxin • Side Effects • Bradycardia • Hypokalemia leads to: • Toxicity- N/V, Visual disturbances, confusion, severe bradycardia • Antidote • Digibind (Digoxin immune Fab) • Duration 2-6 hours

  25. Nursing Interventions • Goals • Prevent disease progression • Prevent complications • Patient & family education including end-of-life decisions

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