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Draft for HF project

Draft for HF project

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  • Heart FailureAround 5 million people in the United States have heart failure.  About 550 thousand new cases are diagnosed each year.  More than 287 thousand people in the United States die each year with heart failure.1 Hospitalizations for heart failure have increased substantially.  They rose from 402,000 in 1979 to 1,101,000 in 2004.(National Hospital Discharge Survey) Heart failure is the most common reason for hospitalization among people on Medicare.  Hospitalizations for heart failure are higher in black than white people on Medicare.2,3 The most common causes of heart failure are coronary artery disease, hypertension or high blood pressure, and diabetes. About 7 of 10 people with heart failure had high blood pressure before being diagnosed.  About 22 percent of men and 46 percent of women will develop heart failure within 6 years of having a heart attack.1,4 Heart failure as an underlying or contributing cause of death—286,700 (2003)1  From 1993–2003, deaths from heart failure (ICD–9 428) increased 20.5%. In the same time period, the death rate declined 2%. The 2003 overall death rate for heart failure was 19.7 per 100,000. Death rates were 20.5 for white males, 23.4 for black males, 18.4 for white females and 20.4 for black females.1 
  • Increase pressure = increased stretch of ventricular wall.Ventricular muscle fibers are stretched by blood volume.Major factor that affects preload is venous return.Ventricular compliance – the elasticity or amount of give when blood enters ventricle.Ventricular hypertrophy = decreased ventricular compliance
  • Discuss the diameter and distensibility of the great vessels and effect on PVR and afterload.Discuss the diameter of the semilunar valves and effect of PVR and afterload.
  • Answer D : all of the above
  • Heart Failure:The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrientsA syndrome characterized by fluid overload or inadequate tissue perfusionThe term HF indicates myocardial disease, in which there is a problem with the contraction of the heart (systolic failure) or filling of the heart (diastolic failure).Some cases are reversible.Most HF is a progressive, lifelong disorder managed with lifestyle changes and medications.
  • Discuss pathophysiology of HFFollow chart discussing:Causes of HFPathophysiology (resulting low C/O, decreased B/P, decreased renal perfusion)Baroreceptors activation = activation of SNSActivation of Renin-angiotensin-aldosterone system = sodium and water retention, vasoconstriction = increased afterload, increased B/P, increased HR = Remodeling and LVHRemodeling and ventricular hypertrophy = impaired filling and contractility
  • Open space inside the ventricles can be restricted by heart muscle that “bulks up” due to overwork or other causes or that stiffens and loses it flexibility.Diastolic Failure When your heart is thick and stiff, you have diastolic failure. Your EF may be normal (over 40%), but your heart resists filling with blood because it cannot relax. Pumping against high blood pressure is the most common cause of this type of heart failure. Diastolic failureNormal ejection fractionBlood backs up in systemic systemsOpen space inside the ventricles can be restricted by heart muscle that “bulks up” due to overwork or other causes or that stiffens and loses it flexibility.The heart’s ventricles can have trouble filling with blood for two main reasons. Overworked heart muscle can “bulk up,” like a weightlifter; this reduces the open space inside the ventricles. Alternatively, the heart muscle may stiffen and become less flexible.Bulking and stiffening are sometimes the result of genetic signals. Most of the time, though, they have more immediate causes. High blood pressure is one of the most common causes of diastolic trouble. Diabetes, cholesterol-clogged arteries, and narrowed heart valves also contribute to the problem. Less common causes include conditions that cause protein, iron, and other substances to infiltrate heart muscle. Such conditions include amyloidosis, hemochromatosis, and sarcoidosis.


  • 1. NURS 5263 Introduction to Chronic Heart Failure
  • 2. Student Resources
    Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medical-surgical nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins.
    Chapter 26: Assessment of Cardiovascular Function
    Chapter 30: Management of Patients with Complications from Heart Disease
  • 3. Objectives
    Explain normal and abnormal pathophysiology of the heart in relation to chronic heart failure.
    Differentiate between left and right sided heart failure.
    Discuss current medical treatments for patients with heart failure.
    Discuss common teaching principles related to heart failure.
    Utilize the nursing process as a framework for care in patients with heart failure.
    Demonstrate competent and compassionate nursing care for the heart failure patient.
  • 4. Stroke Volume
    The amount of blood pumped by the ventricles per beat.
    Average resting SV is 60-80 ml
    (2 Ounces) per beat.
  • 5. Cardiac Output
    CO – the amount of blood pumped by the heart in 1 minute.
    Normal CO = 5 Liters per min
    CO = Heart rate X stroke volume
    The entire blood volume passes through the heart every minute
  • 6. Starling’s Law of the Heart
    The greater the stretch of the myocardial fibers, the stronger the force of the contraction.
  • 7. Inotropic effect
    Positive inotropic effect – increase stroke volume by increasing the force of contraction without stretching the fibers.
    Negative Inotropic Effect – decrease in contraction
  • 8. Congestive Heart Failure
    Heart is unable to pump adequate amount of blood to meet metabolic needs
    CHF describes the accumulation of blood and fluid in organs and tissues from impaired circulation.
  • 9.
  • 10. HF Video
  • 11. Preload
    The amount of blood presented to the ventricles just before systole.
    Blood volume - stretches cardiac muscle fibers
    Ventricular compliance – the elasticity or amount of give when blood enters ventricle.
    Ventricular hypertrophy = decreased ventricular compliance
  • 12. Afterload
    The amount of resistance to the ejection of blood from the ventricle.
    Resistance caused by tension in aorta and systemic vessels.
  • 13.
  • 14. Contractility
    The force of contraction
    Catecholamines – released by SNS, increases contractility and stroke volume
    MI = myocardial cell damage = decreased contractility = HF
  • 15. Test Your Knowledge
    Stroke Volume of the heart is determined by:
    The degree of cardiac muscle strength.
    The intrinsic contractility of the cardiac muscle.
    The pressure gradient against which the muscle ejects blood during contraction.
    All of the above
  • 16. Heart Failure
    The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
  • 17.
  • 18. Compensatory Mechanisms:
    Ventricular dilation
    Muscle fibers stretch.. Increase contractile force
    Increases cardiac output / blood pressure
    Eventually inadequate …overstretched/overstrained
    Ventricular hypertrophy
    Increase in muscle mass
    Hypertrophic muscle has POOR contractility
    Increased SNS stimulation
    First mechanism triggered
    LEAST EFFECTIVE mechanism
    Increased workload causes increased demand for O2
  • 19. Chronic Heart Failure
    Pathology of Ventricular Failure:
    • Systolic failure
  • Chronic Heart Failure
    Diastolic failure
    Heart muscle that doesn’t relax properly between beats. This is called diastolic heart failure.
  • 20.
  • 21. Chronic Heart Failure
    Risk Factors:
    Cigarette smoking
    High cholesterol level
  • 22. What conditions might contribute to HF?
    Slide 119
  • 23. Hypertension
    Valvular disease
    Renal failure
  • 24. Hypertension, tachydysrhythmias, valvular disease, cardiomyopathy, and renal failure reduce C/O by:
  • 25. Chronic Heart Failure
    Types of CHF:
    Usually manifested by biventricular failure
    One ventricle may precede the other
    Prolonged strain …. causes remaining side to fail
  • 26. Left-Sided Heart Failure
    Results from LV dysfunction
    Blood backs up into LEFT atrium
    Pulmonary congestion and edema
  • 27. Left Sided CHF
    What are the Signs & Symptoms?
  • 28. S & S Left Sided HF
    Pulmonary symptoms
    Cough, may have frothy sputum
    Crackles on auscultation
    Extra Heart Sound - S3
  • 29. S3 Heart Sound Audio
  • 30. Lung Sounds – Crackles Audio
  • 31. Pulmonary Edema
  • 32. Acute Pulmonary Edema
    Pulmonary edema : Severe dyspnea, orthopnea
    Tachycardia, pallor
    Blood tinged frothy sputum
    Wheezing, crackles
    Bubbling respirations
    Acute anxiety, apprehension, restlessness
    Diaphoresis cold clammy skin
    Nasal faring
    Use of accessory muscles
    Hypocapnia evidenced by muscle cramps, weakness, dizziness
  • 33.
  • 34. Right-Sided Failure
    What is #1 Cause?
    Results from diseased right ventricle
    Blood backs up into right atrium
    and venous circulation
    S & S:
  • 35. S & S Right Sided Failure
    Peripheral edema
    Vascular congestion in GI tract
    Jugular venous distention
    ABD distention (ascites) from portal hypertension
  • 36. Cor Pulmonale
  • 37.
  • 38. Test Your Knowledge
    When collecting subjective data, the nurse could expect that the client who is developing left-sided congestive heart failure would describe having:
    a. to sleep in a reclining chair
    b. intolerance for fatty foods
    c. tight fitting shoes
    d. to urinate frequently
  • 39. Test Your Knowledge
    All of the following are clinical manifestations of right-sided heart failure except:
    Jugular vein distention
  • 40. Ejection Fraction
    The percentage of blood the LV ejects when it contracts
    Normal = 55% - 65%
    Mild reduction= 45-55%
    Moderately reduced = 35-45%
    Severely reduced = < 35%
  • 41. BNP
    Brain (B-Type) Natriuretic Peptide
    Helps regulate BP and fluid volume
    Secreted from the ventricles in response to increased preload
    Used to diagnose and monitor HF
    > 51.2 pg/mL = mild HF
    > 1000 pg/mL = severe HF
  • 42. Managementof CHF and Pulmonary Edema
    Reduce the heart’s workload
    Improve cardiac output
    How do we do that?
  • 43. Drug Therapy for Chronic HF
    Identification of TYPE of HF and underlying cause
    Correction of Na+ and water retention
    Reduction of cardiac workload
    Improvement of cardiac contractility
  • 44. Drug Categories for Treating CHF
    Drug Categories for Treating HF
    Standard TX:
    ACE inhibitors
    Beta Blockers
    Other drugs used:
    Cardiac Glycosides (Positive
    inotropic drugs)[Digoxin]
    Vasodilator drugs[Nitroprusside]
    Nonglycoside inotropic Agents (Dobutrex)
    See Brunner pgs 952-956
  • 45. Review HF Medication Therapy Handout
  • 46. Test Your Knowledge
    A client admitted with heart failure who is taking a thiazide diuretic has been ordered to receive furosemide (Lasix). What side effect of these medications should the nurse be alert for?
    a. Hypertension
    b. Headache
    c. Bradycardia
    d. Arrhythmias
  • 47. Test Your Knowledge
    The treatment of cardiac failure is directed at:
    Decreasing oxygen needs of the heart
    Increasing CO by strengthening muscle contraction and decreasing PVR
    Reducing the amount of circulating blood volume
    All of the above
  • 48. Test Your Knowledge
    The physiologic effect of an angiotensin converting enzyme inhibitor in the management of congestive heart failure includes which of the following: (Mark all that apply)
    a. Decrease peripheral vascular resistance (PVR)
    b. Decrease in heart rate
    c. Increase myocardial contractility
    d. Decrease in afterload
  • 49. Nursing Diagnoses for HF
    Name some Nursing Diagnoses for HF
  • 50. Nursing Interventions for Patient with HF
  • 51. Test Your Knowledge
    If a client with left sided heart failure experiences paroxysmal nocturnal dyspnea, which one of the following would be most appropriate to add to the plan of care?
    a. Place the client on an alternating pressure mattress
    b. Use several pillows to support the head and thorax
    c. Administer oxygen per nasal cannula at bedtime
    d. Cough forcefully to expectorate accumulated secretions
  • 52.
  • 53. Resources
    Lehne, R.A., Pharmacology For Nursing Care,  7th Edition, 2010, Elsevier  
    Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medical-surgical nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins.