Heart Failure

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Heart Failure

• Karen Ruffin RN, MSN Ed.

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Incidence and Prevalence of Heart Failure

• Leading cause of death in the US
• More than 5 million Americans are living with
  heart failure, and 550,000 new cases are
  diagnosed each year.
• About 250,000 people a year die from heart
  disease.
• That means more than 680 Americans a day die from
  it!!!!!!!!
• Women have a poorer survival rate then men

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Basic Needs Oxygenation
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Oxygenation

• Oxygen is required to sustain life, primary basic
  human need
• The cardiac respiratory systems function to
  supply the bodys oxygen demands
• Cardiopulmonary physiology involves delivery of
  deoxygenated blood to the right side of the heart
  to the pulmonary system

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What are the 3 concepts in oxygenation?

• Ventilation
• Perfusion
• Diffusion

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What are the 2 mechanisms that drive the function
of the heart?

• Electrical/conduction

• Mechanical/pump

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What is Heart Failure?

• Heart cannot pump enough blood to meet the
  metabolic demands of the body.
• Results from changes in the systolic or diastolic
  function of the ventricles
• There are many causes?????
• What are they????

http//www.americanheart.org/presenter
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Types of Heart Failure

• Left Sided
• Right sided
• Systolic
• Diastolic

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Left Sided Heart Failure

• Most Common
• LV dysfunction causes blood to back up through
  the left atrium and into the pulmonary system.
• Common causes of left heart failure are
• HTN, CAD, mitral and/or aortic valve disease,
  decreased tissue perfusion.

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What does that patient look like?????
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Right Sided Heart Failure

• Most common cause is left sided heart failure.
• Other causes MI or pulmonary HTN
• RV dysfunction causes the blood to back up in the
  right atrium and then the venous circulation.

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What does that patient look like?????
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Systolic Failure

• Defect in ventricular contraction
• Left Ventricle loses ability to generate enough
  pressure to eject blood forward through the high
  pressure aorta Decreased ejection fraction
• Afterload hypertension, cardiomyopathy, and
  valvular heart disease

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Diastolic Failure

• Impaired ability of ventricles to fill
• Decreased filling decreased stroke volume Which
  decreased WHAT?
• Pulmonary congestion, pulmonary hypertension,
  with normal ejection fraction

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Heart Failure
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Diagnostic Studies

• Goal Assess the cause degree of failure
• History and Physical Exam
• B-Type Natriuretic Peptide level (BNP).
• elevated in acute and chronic heart failure
• useful in following the response to treatment of
  congestive heart failure.
• ABGs, Serum chemistries, LFTs
• Chest x-ray
• EKG
• Echocardiogram
• Nuclear imaging studies
• Cardiac catheterization
• Hemodynamic monitoring

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Lets Compare!!!!
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Classification of Heart Failure

• Class 1 No limitation of physical activity
• Class 2 Slight limitation fatigue, dyspnea,
  palpitations
• Class 3 marked limitation. Comfortable at
  rest ordinary activities cause symptoms
• Class 4 Inability to carry out any physical
  activity without symptoms
• Pain/discomfort at rest

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Management and Outcome Measures

• Use of ß-blockers at discharge and during
  admission.
• Use of aspirin at discharge and during
  admission.
• Timely and appropriate acute reperfusion
  (thrombolysis or primary angioplasty).
• The use of angiotensin-converting enzyme (ACE)
  inhibitors for patients with depressed left
  ventricular systolic function. Similarly, a
  minority of patients with AMI are potential
  candidates for this care process,

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Management and Outcome Measures

• The proportion of patients eligible for
  smoking-cessation counseling is relatively small,
  and ascertainment can be difficult, given the
  variability in documentation as well as practice.
  
• Diet and exercise counseling
• Cholesterol status assessment and management.

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Congestive Heart FailureMedical Treatment Goals

• Decreasing Intravascular Volume
• Decreasing Venous Return
• Decreases preload decreases the volume to the
  left ventricle during diastole
• Med Diuretics Lasix (furosemide)
• Decreasing Afterload
• Decrease systemic vascular resistance
• CO increases
• Pulmonary congestion decreases
• Meds Nitroglycerine (NTG) Morphine Calcium
  Channel Blockers

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Congestive Heart FailureMedical Treatment Goals

• Improving Gas Exchange Oxygenation
• Supplemental oxygen
• Morphine
• Severe cases intubation / ventilation
• Improving Cardiac Function
• Increase cardiac contractility without increasing
  cardiac oxygen consumption
• Hemodynamic Monitoring
• pulmonary artery pressure pulmonary artery wedge
  pressure (14-18mmg HG)
• Inotropic Meds Digoxin
• Inotropic meds used with hemodynamic monitoring
• Dobutamine
• Inodilators (inotropic vasodilator) Milrinone
  

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Congestive Heart FailureMedical Treatment Goals

• Reducing Anxiety
• Sedative action of IV Morphine
• Complication respiratory depression
• Determine Treat Underlying Cause
• Systolic or Diastolic failure
• Aggressive drug therapy

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• So what medical complications do you think can
  occur???????

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• What basic needs are being effected?
• Why and how?

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Nursing Care for the Patient with Heart Failure

• What will you assess????
• What are some potential nursing diagnosis?????
• What are your goals for those diagnosis????
• What are your interventions?????
• How will you evaluate your goals?????

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Case Study

• A 74-year-old woman is admitted to the hospital
  with heart failure. She had been growing
  progressively weaker and has ankle edema, dyspnea
  on exertion, and three-pillow orthopnea. On
  admission, she is severely dyspneic and can
  answer questions only with one-word phrases. She
  is diaphoretic and has central cyanosis, with a
  heart rate of 132 beats/min, and blood pressure
  98/70. She is extremely anxious.

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Case Study

• 1. Because this client cannot breath or talk
  easily, prioritize the immediate nursing
  assessments and intervetions upon admission.
• 2. Considering the process of congestive heart
  failure, explain the symptoms she is having.
• 3.Based on assessment, identify nursing diagnoses
  for this client.
• 4. What diagnostic studies do you anticipate
  being ordered and why?

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Case Study

• 5. The physician orders the following items for
  this client. (Start an IV, then give dobutamine 3
  mcg/kg/min IV Furosemide (Lasix) 40 mg IV stat
  Digoxin 0.5 mg IV stat, then 0.125mg PO every 6
  hours for three doses, with ECG before doses 3
  and 4 Morphine 2 mg IV stat and then 2 mg IV
  every 1 to 2 hours prn Oxygen to maintain O2 sat
  gt94 Schedule for an echocardiogram Low Na,
  Fat, Cardiac diet Weigh daily and monitor input
  and output) Explain the rationale for these
  medications and treatments. Would you ask for any
  other ORDERDS and why?