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Congestive heart failure
1. 1
MEDICAL SURGICAL NURSING
CLASS TEACHING ON
CONGESTIVE HEART FAILURE
SUBMITTED TO: - SUBMITTED ON: - SUBMITTED BY: -
Mrs. Littin sunny 19/03/2020 Ms. Priya Vishwakarma
Associate professor, MSc (N) first year
Medical-Surgical Nursing. Student.
3. 3
IDENTIFICATION DATA
NAME OF THE STUDENT: - Ms. Priya Vishwakarma
COURSE AND YEAR: - M. Sc Nursing First year
NAME AND DESIGNATION OF THE SUPERVISOR: - Mrs. Littin Sunny, Associate Professor, Medical
Surgical Nursing
SUBJECT: - Medical Surgical Nursing
TOPIC: - Congestive heart failure
GROUP: -
VENUE: -
DATE: -
TIME: -
DURATION: - 40 minutes
METHODS OF TEACHING: - Lecture cum Discussion
A.V. AIDS: - Power point slides, hand-out, chart, blackboard
PREVIOUS KNOWLEDGE OF PARTICIPANTS: - Inadequate.
5. 5
OBJECTIVES
GENERAL OBJECTIVE: -
At the end of my class teaching participants will be able to acquire in depth knowledge regarding congestive heart
failure, its types, causes, symptoms, assessment complete management and develops positive attitude towards practice in
their daily living.
SPECIFIC OBJECTIVE: -
At the end of my class teaching, the students will be able to;
❖ define congestive heart failure
❖ list out types of congestive heart failure
❖ describe the stages of congestive heart failure
❖ enumerate risk factors of congestive heart failure
❖ enlist symptoms of congestive heart failure
❖ highlight assessment and diagnostic findings of congestive heart failure
❖ explain treatment of congestive heart failure.
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S.
N
O
TIME
DURA
TION
SPECI
FIC
OBJE
CTIV
E
CONTENT TEACH
ING
ACTIVI
TY
LEAR
NING
ACTIV
ITY
A.V.
AIDS
EVALUA
TION
1. 2 min CONGESTIVE HEART FAILURE
INTRODUCTION: -
Heart failure does not mean the heart has stopped working. Rather, it
means that the heart works less efficiently than normal. Due to various
possible causes, blood moves through the heart and body at a slower
rate, and pressure in the heart increases. As a result, the heart cannot
pump enough oxygen and nutrients to meet the body's needs. The
chambers of the heart may respond by stretching to hold more blood to
pump through the body or by becoming stiff and thickened. This helps
to keep the blood moving, but the heart muscle walls may eventually
weaken and become unable to pump as efficiently. As a result,
the kidneys may respond by causing the body to retain fluid (water)
and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other
organs, the body becomes congested, and congestive heart failure is
the term used to describe the condition. CHF can be life-threatening.
Congestive heart failure (CHF) is a chronic progressive condition
that affects the pumping power of your heart muscles. While often
7. 7
referred to simply as “heart failure,” CHF specifically refers to the
stage in which fluid builds up around the heart and causes it to
pump inefficiently.
Heart have four chambers. The upper half of heart has two atria,
and the lower half of your heart has two ventricles. The ventricles
pump blood to your body’s organs and tissues, and the atria receive
blood from your body as it circulates back from the rest of your
body.
CHF develops when ventricles can’t pump enough blood volume to
the body. Eventually, blood and other fluids can back up inside
your:
• lungs
• abdomen
• liver
• lower body.
8. 8
2. 3 min define
congesti
ve heart
failure
DEFINITION: -
“Congestive heart failure (CHF) is a chronic progressive condition
that affects the pumping power of your heart muscles.”
- Brunner and Suddharth
“Congestive heart failure: Inability of the heart to keep up with the
demands on it, with failure of the heart to pump blood with normal
efficiency. When this occurs, the heart is unable to provide
adequate blood flow to other organs, such as the brain, liver, and
kidneys”.
- Lipincott
defines listening power
point
slide
define
congestive
heart failure
9. 9
3. 4 min list out
types of
congesti
ve heart
failure
TYPES OF CONGESTIVE HEART FAILURE: -
1. LEFT-SIDED CHF: -
It is the most common type of CHF. It occurs when your left
ventricle doesn’t properly pump blood out to your body. As the
condition progresses, fluid can build up in your lungs, which makes
breathing difficult.
There are two kinds of left-sided heart failure:
• Heart failure with reduced ejection fraction (HFREF),
Systolic heart failure: - It occurs when the left ventricle
fails to contract normally. This reduces the level of force
available to push blood into circulation. Without this force,
the heart can’t pump properly.
• Heart failure with preserved ejection fraction (HFPEF),
Diastolic failure, or diastolic dysfunction, happens when
the muscle in the left ventricle becomes stiff. Because it can
no longer relax, the heart can’t quite fill with blood between
beats.
2. RIGHT-SIDED CHF: -
listing out watching
and
listening
power
point
slide
what are the
types of
congestive
heart failure
10. 10
It occurs when the right ventricle has difficulty pumping blood to
your lungs. Blood backs up in your blood vessels, which causes
fluid retention in your lower extremities, abdomen, and other vital
organs. It’s possible to have left-sided and right-sided CHF at the
same time. Usually, the disease starts in the left side and then
travels to the right when left untreated.
4. 4 min describe
the
stages of
congesti
ve heart
failure
CONGESTIVE HEART FAILURE STAGES: -
Stage Main symptoms Outlook
Class
I
You don’t
experience any
symptoms during
typical physical
activity.
CHF at this stage
can be managed
through lifestyle
changes, heart
medications, and
monitoring.
Class
II
You’re likely
comfortable at rest,
but normal
physical activity
may cause fatigue,
palpitations, and
shortness of breath.
CHF at this stage
can be managed
through lifestyle
changes, heart
medications, and
careful monitoring.
describes watching
and
listening
and
discussing
power
point
slide
what are the
stages of
congestive
heart failure
11. 11
Class
III
You’re likely
comfortable at rest,
but there’s a
noticeable
limitation of
physical activity.
Even mild exercise
may cause fatigue,
palpitations, or
shortness of breath.
Treatment can be
complicated. Talk
with your doctor
about what heart
failure at this stage
may mean for you.
Class
IV
You’re likely
unable to carry on
any amount of
physical activity
without symptoms,
which are present
even at rest.
There’s no cure for
CHF at this stage,
but there are still
quality-of-life and
palliative care
options. You’ll want
to discuss the
potential benefits
and risks of each
with your doctor.
5. 3 min enumerat
e risk
factors of
congesti
ve heart
failure
RISK FACTORS OF CHF: -
CHF may result from other health conditions that directly affect
your cardiovascular system. This is why it’s important to get annual
enumerates listening
and
discussing
power
point
slide
what factors
increase the
risk for
congestive
heart failure
12. 12
check-ups to lower your risk for heart health problems, including
high blood pressure (hypertension), coronary artery disease, and
valve conditions.
1. Hypertension: -
When your blood pressure is higher than normal, it may lead to
CHF. Hypertension has many different causes. Among them is the
narrowing of your arteries, which makes it harder for your blood to
flow through them.
2. Coronary artery disease: -
Cholesterol and other types of fatty substances can block the
coronary arteries, which are the small arteries that supply blood to
the heart. This causes the arteries to become narrow.
Narrower coronary arteries restrict your blood flow and can lead to
damage in your arteries.
3. Valve conditions: -
Your heart valves regulate blood flow through your heart by
opening and closing to let blood in and out of the
chambers. Valves that don’t open and close correctly may force
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your ventricles to work harder to pump blood. This can be a result
of a heart infection or defect.
4. Other conditions: -
While heart-related diseases can lead to CHF, there are other
seemingly unrelated conditions that may increase your risk, too.
These include diabetes, thyroid disease, and obesity. Severe
infections and allergic reactions may also contribute to CHF.
6. 3 min enlist
symptom
s of
congesti
ve heart
failure
SYMPTOMS OF CHF: -
Symptoms
you may
notice first
Symptoms that
indicate your
condition has
worsened
Symptoms
that indicate
a severe
heart
condition
Fatigue irregular heartbeat
chest pain that
radiates
through the
upper body
enlisting listening power
point
slide
what are the
signs and
symptoms of
congestive
heart failure
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swelling in
your
ankles, feet,
and legs
a cough that
develops from
congested lungs
rapid
breathing
weight gain wheezing
skin that
appears blue,
which is due
to lack of
oxygen in
your lungs
increased
need to
urinate,
especially
at night
shortness of breath,
which may
indicate pulmonary
edema
fainting
Chest pain that radiates through the upper body can also be a sign
of a heart attack. If you experience this or any other symptoms that
may point to a severe heart condition, seek immediate medical
attention.
SYMPTOMS OF LEFT SIDE HEART FAILURE: -
The clinical manifestations of pulmonary congestion include: -
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1. dyspnea,
2. cough,
3. pulmonary crackles, and low oxygen saturation levels
4. An extra heart sound, the S3, or “ventricular gallop,” may
be detected on auscultation. It is caused by a large volume
of fluid entering the ventricle at the beginning of diastole.
5. orthopnea, difficulty breathing when lying flat. Some
patients have sudden attacks of dyspnea at night, a condition
known as paroxysmal nocturnal dyspnea (PND).
6. cough associated with left ventricular failure is initially dry
and nonproductive. Most often, patients complain of a dry
hacking cough that may be mislabeled as asthma or chronic
obstructive pulmonary disease (COPD). The cough may
become moist over time. Large quantities of frothy sputum,
which is sometimes pink (blood-tinged), may be produced,
usually indicating severe pulmonary congestion (pulmonary
edema).
7. A reduction in CO decreases blood flow to the kidneys,
reducing urine output (oliguria).
RIGHT SIDE HEART FAILURE: -
The systemic clinical manifestations include: -
1. edema of the lower extremities (dependent edema),
2. hepatomegaly (enlargement of the liver),
3. ascites (accumulation of fluid in the peritoneal cavity),
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4. anorexia and nausea, and
5. weakness and weight gain due to retention of fluid.
6. Hepatomegaly and tenderness in the right upper quadrant of
the abdomen result from venous engorgement of the liver.
7. 3 min highlight
the
assessme
nt and
diagnosti
c
findings
of
congesti
ve and
heart
failure
ASSESSMENT AND DIAGNOSTIC FINDINGS: -
There are a variety of tests used to diagnose heart conditions.
Because these tests measure different things, your doctor may
recommend a few to get a full picture of your current condition.
1. ELECTROCARDIOGRAM: -
An electrocardiogram (EKG or ECG) records your heart’s rhythm.
Abnormalities in your heart’s rhythm, such as a rapid heartbeat or
irregular rhythm, could suggest that the walls of your heart’s
chamber are thicker than normal. That could be a warning sign for a
heart attack.
2. ECHOCARDIOGRAM: -
An echocardiogram uses sound waves to record the heart’s
structure and motion. The test can determine if you already have
highlights watching
and
listening
power
point
slide
how can we
diagnose
congestive
heart failure
17. 17
poor blood flow, muscle damage, or a heart muscle that doesn’t
contract normally.
3. MRI: -
An MRI takes pictures of your heart. With both still and moving
pictures, this allows your doctor to see if there’s damage to your
heart.
4. STRESS TEST: -
Stress tests show how well your heart performs under different
levels of stress. Making your heart work harder makes it easier for
your doctor to diagnose problems.
5. BLOOD TESTS: -
Blood tests can check for abnormal blood cells and infections. They
can also check the level of BNP, a hormone that rises with heart
failure.
6. CARDIAC CATHETERIZATION: -
Cardiac catheterization can show blockages of the
coronary arteries. Your doctor will insert a small
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tube into your blood vessel and thread it from your
upper thigh (groin area), arm, or wrist.
At the same time, the doctor can take blood samples,
use X-rays to view your coronary arteries, and check
blood flow and pressure in your heart chambers.
7. MODIFIED FRAMINGHAM CRITERIA: –
Major Criteria: -
• Neck-vein distention
• Orthopnoea or paroxysmal nocturnal dyspnoea
• Crackles (10 cm above base of lung)
• Cardiomegaly on chest radiograph
• S3 gallop
• Central venous pressure 12 mm Hg
• Left ventricular dysfunction on echocardiogram
• Weight loss 4.5 kg in response to CHF treatment
• Acute pulmonary oedema
Minor Criteria: -
• Bilateral ankle oedema
• Night cough
• Dyspnea on exertion
• Hepatomegaly
• Pleural effusion
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• Tachycardia (120 beats/min)
8. 10 min explain
treatment
of
congesti
ve heart
failure
TREATMENT: -
1. CONGESTIVE HEART FAILURE DRUGS: -
There are several medications that can be used to treat CHF,
including:
a) ACE inhibitors: -
Mechanism of action: - Angiotensin-converting enzyme inhibitors
(ACE inhibitors) open up narrowed blood vessels to improve blood
flow. Vasodilators are another option if you cannot tolerate ACE
inhibitors.
• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Zestril)
• Quinapril (Accupril)
explaining watching
and
listening
attentively
power
point
slide
how can we
treat
management
of congestive
heart failure
20. 20
• Ramipril (Altace)
• Moexipril (Univasc)
• Perindopril (Aceon)
• Trandolapril (Mavik)
ACE inhibitors shouldn’t be taken with the following
medications without consulting with a doctor, because they may
cause an adverse reaction:
• Thiazide diuretics can cause an additional decrease in blood
pressure.
• Potassium-sparing diuretics, such as triamterene
(Dyrenium), eplerenone (Inspra),
and spironolactone (Aldactone), can cause potassium
buildup in the blood. This may lead to abnormal heart
rhythms.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, aspirin, and naproxen, can cause sodium and
water retention. This may reduce the ACE inhibitor’s effect
on your blood pressure.
21. 21
b) Beta-Blockers: -
Mechanism of action: - Beta-blockers can reduce blood pressure
and slow a rapid heart rhythm.
• Acebutolol (Sectral)
• Atenolol (Tenormin)
• Bisoprolol (Zebeta)
• Carteolol (Cartrol)
• Esmolol (Brevibloc)
• Metoprolol (Lopressor)
• Nadolol (Corgard)
• Nebivolol (Bystolic)
• Propranolol (Inderal LA)
Beta-blockers should be taken with caution with the following
medications, as they may cause an adverse reaction:
• Antiarrhythmic medications, such
as amiodarone (Nexterone), can increase cardiovascular
effects, including reduced blood pressure and slowed heart
rate.
22. 22
• Antihypertensive medications, such
as lisinopril (Zestril), candesartan (Atacand),
and amlodipine (Norvasc), may also increase the likelihood
of cardiovascular effects.
• The effects of albuterol (AccuNeb) on bronchodilation may
be cancelled out by beta-blockers.
• Fentora (Fentanyl) may cause low blood pressure.
• Antipsychotics, such as thioridazine (Mellaril), may also
cause low blood pressure.
• Clonidine (Catapres) may cause high blood pressure.
c) Diuretics: -
Mechanism of action: - Diuretics reduce your body’s fluid content.
CHF can cause your body to retain more fluid than it should.
• Thiazide diuretics. These cause blood vessels to widen and
help the body remove any extra fluid. Examples
include metolazone (Zaroxolyn), indapamide (Lozol),
and hydrochlorothiazide (Microzide).
• Loop diuretics. These cause the kidneys to produce more
urine. This helps remove excess fluid from your body.
Examples include furosemide (Lasix), ethacrynic acid
(Edecrin), and torsemide (Demadex).
23. 23
• Potassium-sparing diuretics. These help get rid of fluids
and sodium while still retaining potassium. Examples
include triamterene (Dyrenium), eplerenone (Inspra), and
spironolactone (Aldactone).
Diuretics should be taken with caution with the following
medications, as they may cause an adverse reaction:
• ACE inhibitors, such
as lisinopril (Zestril), benazepril (Lotensin),
and captopril (Capoten), can cause decreased blood
pressure.
• Tricyclics, such
as amitriptyline and desipramine (Norpramin), may cause
low blood pressure.
• Anxiolytics, such as alprazolam (Xanax), chlordiazepoxide
(Librium), and diazepam (Valium), may cause low blood
pressure.
• Hypnotics, such as zolpidem (Ambien) and triazolam
(Halcion), may cause low blood pressure.
• Beta-blockers, such as acebutolol (Sectral)
and atenolol (Tenormin), may cause low blood pressure.
• Calcium channel blockers, such as amlodipine (Norvasc)
and diltiazem (Cardizem), may cause a drop in blood
pressure.
24. 24
• Nitrates, such as nitroglycerin (Nitrostat) and isosorbide-
dinitrate (Isordil), may cause low blood pressure.
• NSAIDS, such as ibuprofen, aspirin, and naproxen, may
cause toxicity of the liver.
2. SURGERIES: -
If medications aren’t effective on their own, more invasive
procedures may be required.
Angioplasty: - A procedure to open up blocked arteries, is one
option.
Heart valve repair surgery: - This is done to help your valves
open and close properly.
25. 25
NURSING CARE PLAN: -
ASSESSMENT NURSING
DIAGNOSIS
GOAL PLANNING RATIONALE EVALUATION
Objective data: -
Patient is unable to
carry out daily
activities.
Activity intolerance
and fatigue related to
decreased CO
Normal activity will
be maintained.
Prolonged bed rest,
which may be self-
imposed, should be
avoided.
A total of 30 minutes
of physical activity
every day should be
encouraged.
The exercise regimen
should include 5
minutes of warm-up
activities followed by
about 30 minutes of
exercise at the
prescribed intensity
level.
Because of its
deconditioning
effects and risks such
as pressure ulcers
(especially in
edematous patients),
venous thrombosis,
and pulmonary
embolism.
Exercise training has
many favorable
effects for HF,
including increasing
functional capacity
and decreasing
dyspnea.
On evaluation, the
normal activity is
maintained.
26. 26
A typical program for
a patient with HF
might include a daily
walking regimen,
with duration
increased over a 6-
week period.
Objective data: -
patient’s legs are
swollen.
Excess fluid volume
related to the HF
syndrome
Normal fluid volume
will be maintained
Administer IV
diuretic therapy,
Oral diuretics should
be administered early
in the morning.
The patient’s fluid
status is monitored
closely, auscultating
the lungs, monitoring
daily body weight.
Assisting the patient
to adhere to a low-
sodium diet by
reading food labels
and avoiding high-
sodium foods such as
canned, processed,
Patients with less
severe symptoms
may receive oral
diuretic medication.
Diuresis does not
interfere with the
patient’s night time
rest.
Single dose of a
diuretic may cause
the patient to excrete
a large volume of
fluid shortly after its
administration.
On evaluation,
normal fluid volume
is maintained.
27. 27
and convenience
foods.
Objective data: -
Patient appears
anxious.
Anxiety related to
breathlessness from
inadequate
oxygenation
Anxiety level will be
reduced.
Because patients with
HF have difficulty
maintaining adequate
oxygenation, they are
likely to be restless
and anxious and feel
overwhelmed by
breathlessness. These
symptoms tend to
intensify at night and
may interfere with
sleep. Emotional
stress stimulates the
sympathetic nervous
system, which causes
vasoconstriction,
elevated arterial
pressure, and
increased heart rate.
Oxygen may be
administered during
an acute event to
diminish the work of
breathing and to
increase the patient’s
comfort.
By decreasing
anxiety, the patient’s
cardiac workload also
is decreased.
As the patient’s
anxiety decreases,
On evaluation,
anxiety level is
reduced.
28. 28
Takes steps to
promote physical
comfort and provide
psychological
support.
Along with
reassurance, teaching
the patient ways to
control anxiety and
avoid anxiety
provoking situations.
cardiac function may
improve and
symptoms of HF may
decrease.
The patient learns
how to identify
factors that contribute
to anxiety and how to
use relaxation
techniques to control
anxious feelings.
29. 29
SUMMARY: -
Chronic heart failure is a complex cardiac condition that encompasses several etiologies and comorbidities. It arises in the differential diagnosis
in all adult patients who present with dyspnea and/or respiratory failure. Definitive diagnosis is established by a careful history and physical
examination and supportive laboratory data. A chest radiograph is useful in excluding a pulmonary etiology (eg, pneumonia); however, a spiral
computed-tomography angiogram may be required if the diagnosis of pulmonary emboli is entertained. The availability of measuring serum
brain natriuretic peptide and bedside echocardiography has aided in our diagnostic precision. Therapy is primarily directed toward normalizing
the underlying physiologic changes with ACE inhibitors and slow titration of blockers. Diuretics are useful in reducing pulmonary vascular
congestion, which may reduce or resolve dyspnea. Excessive therapy often reduces cardiac output or causes symptomatic hypotension, which
occurs most commonly in patients with diastolic dysfunction. Treatment of the underlying etiology (silent ischemia or poorly controlled
hypertension) may halt or slow the progression of the disease. Treatment of comorbidities (eg, underlying pulmonary disease, cigarette abuse, or
diabetes) is essential in optimizing patient outcome and improving quality of life.
CONCLUSION: -
Heart failure indeed is a complex disease and so far, has been a major cause of morbidity and mortality in developing and developed countries. A
standardized medical therapy has been successful in the early stages of HF. Advanced stages of HF require frequent hospitalization due to the
presence of severe HF and or associated co-morbid conditions, which require strict implementation of an appropriately individualized
multidisciplinary approach and quality measures to reduce re-admissions. While pharmacological management has a limited role in advanced
cases of HF, novel therapeutic agents, such as regenerative and gene therapy, are in the developmental stages and need further refinement before
their approval for the treatment of HF. Despite the appropriate measures, hospitalization in HF as a DRG has been a great challenge, especially
since the adoption of the financial penalty program for excessive readmissions related to HF. In addition to the appropriate management of cases,
healthcare professionals also need to provide precise and complete medical codes for procedures and diagnosis to help hospitals to receive the
maximum reimbursement for the services provided to such patients. Current research says that there is increased risk of congestive heart failure
among patients with primary aldosteronism as compared to those who got treated for primary aldosteronism. Adrenalectomy is the treatment of
choice for patients with aldosterone-producing adenomas. Primary aldosteronism is the major cause of secondary hypertension caused by
autonomous aldosterone secretion, which leads to hypertension and hypokalemia. Moreover, long term exposure of high aldosterone levels, in
addition to high blood pressure, may eventually lead to cardiovascular, renal structural and functional damages, including left ventricular
hypertrophy, increasing collagen deposition in myocardium, and renal hyperfiltration, and proteinuria.
