Nursing and heart failure

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Nursing and heart failure
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• Congestive Heart Failure (CHF) or cardiac
  failure, is one of the most common causes of
  in-hospital mortality for patients with cardiac
  diseases. It is the second most common
  complication after myocardial infarction (MI).
  Men are affected more than women. The 5 year
  mortality rate for men is 60 and about 45 for
  women.

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The aim for nurses

• to improve patient outcomes and quality of
  patients life
• to decrease hospital admissions and, therefore,
  cost

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Definition

• Congestive Heart Failure indicates the inability
  of the heart to pump enough blood to meet the
  bodys metabolic requirements for oxygen and
  nutrients leading to discrepancies between
  myocardial oxygen supply and demand.

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PATHOPHYSIOLOGY

• Changes in
• heart rate
• stroke volume
• contractility
• preload
• afterload

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Compensatory Mechanisms

• ADRENERGIC MECHANISM
• RENAL MECHANISM (RENIN-ANGIOTENSIN-ALDOSTERON
  SYSTEM)
• VENTRICULAR HYPERTROPHY

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ETIOLOGY

• coronary heart disease
• long-standing hypertension
• cardiomyopathy
• valvular dysfunction, valvular diseases
• inflammatory or degenerative cardiac muscle
  diseases

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Precipitating factors

• cessation of cardiac drug intake
• dysrythmias
• fever
• hypoxia
• hypoxemia
• anemia
• respiratory and/or metabolic acidosis
• electrolyte imbalance

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CLASSIFICATION

• Right-Sided Cardiac Failure
• Left-Sided Cardiac Failure
• Forward Cardiac Failure (inability of the right
  and left ventricles to pump blood into the
  pulmonary and systemic circulation, respectively.
  It occurs due to increased pressure in the
  arterial system (afterload) causing decreased
  cardiac output and hypoperfusion of vital organs.
  This frequently occurs with aortic stenosis
  and/or systemic hypertension)
• Backward Cardiac Failure (inadequacy of the
  ventricles to empty the blood into the arterial
  circulation. This causes accumulation of fluid
  and elevation of pressure (e.g. increasing in all
  chambers of the heart and in the venous system
  behind the affected ventricles). Myocardial
  infarct and cardiomyopathy causes decreased
  systolic ejection which can lead to backward CHF)
  
• Acute and Chronic Cardiac Failure
• Low ventricular output (infarction, hypotension,
  cardiomyopathy or hemorrhage) and high
  ventricular output (fever, thyrotoxicosis,
  anemia, pregnancy) CHF

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Assessment Parameters

• Respiratory Assessment
• Cardiovascular Assessment (including capillary
  wedge pressure)
• Renal Function Assessment
• Peripheral Assessment
• CNS Assessment

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Laboratory Result Analysis

• arterial blood gases
• liver function tests
• kidneys function tests

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Pharmacological Management

• Increasing Oxygen Supply
• Decreasing Oxygen Demand (Positive Inotropic
  Agents) cardiac glycosides
• Negative chronotropic agents (beta-blockers,
  calcium channel blockers)
• Reducing afterload and preload (nitrates,
  hydralazine, angiotensin-converting enzyme (ACE)
  inhibitors)
• Diuretics (Thiazides, Loop Diuretics)

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Nursing Interventions

• Promoting Rest
• Promotion of Tissue Perfusion (moderate daily
  exercise, adequate oxygen administration as
  ordered, and diuresis)
• Fluid and Dietary Considerations

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Patient Education

• Patient teaching is one of the most important
  factors in nursing management of congestive heart
  failure. Recurrent episodes of cardiac failure
  are often due in part to noncompliance, such as
  failing to follow medication therapy, straying
  from dietary guidelines, missing medical
  appointments, engagement in excessive and
  unregulated exercise, and failing to recognize
  recurring symptoms. Topics which should be
  covered in teaching include gradual increase in
  activity as tolerated, which should be
  discontinued when symptomatic medication
  actions, side effects, dosage, scheduling,
  administration, and signs of toxicity
  encouragement of medical follow ups report of
  any untoward symptoms that could indicate
  worsening of the condition (shortness of breath,
  nocturnal dyspnea, productive cough, ankle edema,
  anginal pain, palpitations, and extreme fatigue)
  maintaining weight sodium and fluid restriction
  prevention of infection, and avoidance of coffee
  and tobacco, which increase the workload on the
  heart by increasing sympathetic stimulation and
  causing vasoconstriction.