Congestive Heart Failure By Dr. Hanan Said Ali

1. Congestive Heart Failure By Dr. Hanan Said Ali

2. Objectives • Define congestive heart failure. • Enumerate causes of congestive heart failure. • Explain how to assess patients physically and physiologically. • Identify principles of care. • Identify nursing care for patients with congestive heart failure.

3. Congestive Heart Failure Definition • Acute heart failure is pump failure due to ischemia or infarction. Causes • Myocardial infarction • Drugs as Beta blocker • Dysrhythmias • Valve dysfunction • Ventricular septal defect

4. Causes Cont. • Pericardial tamponade • Constrictive pericarditis • Haemorrhage and anaemia • Pulmonary embolus • Cardiomyopathy • Hypertension • Thyrotoxic crisis • Wet beri – beri ( vitamin B deficiency) • myocaditis

5. Assessment ( Signs & Symptoms.) Physical assessment Skin • Cyanosis, pallor, and sweating. • Organ hypoperfusion produces cold. • Peripheral oedema. Respiration • The patient may be tachypnoeic. • Blood- stained frothy sputum as a result of pulmonary oedema. • Wheeze

6. Physical assessment Cont. General • The patient may show signs of generalized weakness and fatigue. Auscultation • Fourth heart sound may be heard. • Crepitation may be heard at the lung bases in left heart failure.

7. Physiological Assessment • CVP will be high with right- sided heart failure. • Blood pressure may be low, normal, or high. • Heart rate tachycardia will usually be evident unless bradycardia is the main cause of failure. • Renal function urine output may be reduced and renal dysfunction evident from blood urea and creatinine levels

8. Neurological/Psychological assessment • The patient may exhibit anxiety and distress, drowsiness, confusion as a result of poor cardiac output and cerebral hypoperfusion.

9. Investigations • 12- lead ECG • Chest x- ray • Blood investigation ( urea, electrolytes, haemoglobin, glucose, cardiac enzymes, and brain type natriuretic peptide, this released into bloodstream from the ventricle when it is excessively stretched.

10. Priorities of care • Basic resuscitation measures are aimed at restoring an adequate circulation as quickly. • Administration of high – flow, high- concentration oxygen. • vasodilators, and diuretics

11. Priorities of care • Diamorphine 2.5mg IV, reassurance, information and comfort. • Mechanical ventilation.

12. Principles of care Monitoring • Continuous ECG monitoring. • Pulse oximetry and frequent BP monitoring. • Invasive arterial pressure and CVP monitoring. Rest • The heart can be rested by reducing the work of breathing through mechanical ventilation.

13. Principles of care Optimizing intravascular fluid volume • The circulating volume should be optimized before introducing other drugs. Supporting the cardiac output. • In low- output states the tissues compensate for the decrease in oxygen delivery by extracting more oxygen .

14. Principles of care Therapies Diuretic • Cause an initial vasodilatation followed, 20- 30 min later, by a diuresis. Nitrates • Can be given rapidly either by oral or sublingual while an infusion is being prepared. • ( A drop in blood pressure on a low- dose infusion is suggestive of hypovolaemia)

15. Principles of care Calcium sensitizer agent Improvesventricular contractility and vasodilates peripherally without having a major impact on cardiac work. Mechanical ventilation

16. Nursing care plan • Activity intolerance related to fatigue secondary to cardiac insufficiency.

17. Nursing care plan • Impaired gas exchange related to increased preload mechanical failure or immobility.

18. Nursing care plan • Fluid volume excess related to pump failure.

19. Nursing care plan • Sleep pattern disturbance related to nocturnal dyspnea.

20. Nursing care plan • Potential impaired skin integrity related to oedema or immobility

21. Nursing care plan • Anxiety related to dyspnea or perceived threat to death

22. Nursing care plan • Self care deficit related to dyspnea and fatigue

23. Thank You