Congestive cardiac failure

Presented by
TAN, Li Luren Raphaelle S.
Congestive
Cardiac
Failure
NSG 128 ER LECTURE

What is congestive cardiac failure?

N E X T
A progressive abnormal clinical condition involving impaired
cardiac pumping. It’s often caused by hypertension, coronary
artery disease, or other valve conditions of the heart.
Fluid overload and decrease of tissue perfusion when the heart
can not generate oxygen sufficient to meet the body's demands.
When fluid begins to accumulate in the lungs, this is known as
pulmonary edema and it leads to several different breathing and
respiratory issues.
Congestive Cardiac Failure
AKA HEART FAILURE
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N E X T
Fluid overload
Hypoxemia
Dyspnea
Tachypnea
Orthopnea
Diaphoresis
Cyanosis
Peripheral edema
Jugular venous distention
A patient with CHF may show the following signs and
symptoms:
GENERAL
SIGNS AND SYMPTOMS
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N E X T
Apical pulse
Third heart sounds
Cardiac murmurs
Tachychardia
Increase JVD
symptoms:
CARDIOVASCULAR
SIGNS AND SYMPTOMS
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Light headedness
Dizziness
Confusion
CEREBROVASCULAR

N E X T
Nausea
Anorexia
Hepatomegally
Ascites
symptoms:
GIT
SIGNS AND SYMPTOMS
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Decreased urinary frequency
during the day
Nocturia
RENAL
Dyspnea
Orthopnea
Paroxysmal noctural dyspnea
Cough on exertion when
supine
RESPIRATORY

N E X T
Cardiac injury e.g. chronic hypertension
Pathologic changes lead to low Stroke Volume and Cardiac
Output
The Renin Angiotensin Aldosterone System cascade leads to:
Vasoconstriction mediated by angiotensin II
Salt retention mediated by aldosterone
Sodium and water retention expands intravascular volume
Extravascular volume subsequently rises as well
This manifests as signs and symptoms of CHF such as:
shortness of breath
elevated JVD
edema
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PATHOPHYSIOLOGY
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Assessment & Diagnostic Findings

N E X T
History and physical examination
Chest x-ray
Electrocardiogram (EKG)
12 lead Echocardiogram
Arterial Blood Gas (ABG)
Complete Blood Count (CBC)
Hemodynamic monitoring
Cardiac enzyme analysis
The patient’s signs and symptoms play a role in the
diagnosis of CHF, however, the following diagnostic
tests would also be useful:
DIAGNOSIS
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Sreum electolytes
BUN
TSH
BNP (B-type natriuretic
peptide)
Urine analysis

N E X T
Eliminate or reduce etiologic factors
Reduce heart workload
Optimize all therapeutic regimen
Prevent exacerbations of CHF
Treatment options vary accdg to severity of condition and may include basic
lifestyle change, oral or IV pharmacologic management, supplemental
oxygen, manipulation of assistive devices and surgical approaches including
CABG, open heart surgery and heart transplantation
Managing of the patient includes providing general education, counseling to
the patient and family.
The medical management goals are to relieve patient symptoms to improve
functional status and quality of life and extend of survival. Managment may vary
based on the type, severity and cause of CHF.
MEDICAL MANAGEMENT
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N E X T
Preload reducers
Afterload reducers
Positive inotropic agents
Analgesic medications
ACE inhibitors
Beta-blockers
Digitals
Calcium channel blockers
The treatment methods for CHF will vary from patient to patient depending on
the severity of their signs and symptoms. As a Respiratory Therapist, one thing
that you may notice is severe hypoxemia which can be treated with oxygen
therapy.
Diuretic agents would be recommended to treat fluid overload. Some other
medications that may be considered include:
PHARMACOLOGIC THERAPY
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N E X T
CABG A coronary artery bypass graft (CABG) is a surgical
procedure used to treat coronary heart disease. It diverts blood
around narrowed or clogged parts of the major arteries to improve
blood flow and oxygen supply to the heart.
Open Heart Surgery is any type of surgery where the chest is cut
open and surgery is performed on the muscles, valves, or arteries
of the heart.
Heart Transplantation is a surgery to remove the diseased heart
from a person and replace it with a healthy one from an organ
donor.
Surgical approaches include:
SURGICAL MANAGEMENT
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N E X T
Administering medications and assessing the patient response to the
pharmacologic regimen
Assessing the fluid balance, including intake and output
Weighing the patient daily at the same time and on the same scale,
usually after morning urination
Auscultation of lung sounds to detect an increase or decrease
pulmonary crackles
Determine the degree of JVD
Identify and evaluating the severity of dependent edema
Monitoring pulse, BP and cardiac function
Examination of skin turgor and mucuos membranes for signs of
dehydration
Assesing for symptoms of fluid over load
NURSING MANAGEMENT
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Nursing Diagnosis + Interventions

N E X T
Activity intolerance and Fatigue related to Imbalance
between oxygen supply and demand because of
decreased Cardiac Output
Excess fluid volume related to excess fluid or sodium
intake and retention of fluid Related to the CHF syndrome
Anxiety related to breathlesness and restlenessness from
inadequate exygenation
Powerlessness related to inability to perform role
responsibilitites because of chronic illness and
hospitalization
Noncompliance related to lack of knowledge
NURSING DIAGNOSIS
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N E X T
Promoting activity intolerance
Managing fluid volume
Controlling anxiety
Minimizing powerlessness
INTERVENTIONS
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Congestive cardiac failure

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