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DEEPA A, MSc(N), BSc(Psychology)
NURSING TUTOR,
TIRUPPUR MEDICAL COLLEGE,
TIRUPPUR.
MASTER PLAN FOR CCF
• Introduction
• Definition
• Risk factors
• Types
left and right HF
backward and forward HF
systolic and diastolic HF
acute and chronic HF
• Classification of heart failure
stage A
stage B
stage C
stage D
• Pathophysiology
• Compensatory mechanism
• Clinical manifestation
Right heart failure
Left heart failure
• Diagnostic evaluation
• Management
Pharmacological management
Non-pharmacological management
-IABP
-CPAP
-Cardiac Resynchronization Therapy
-Endo ventricular patch circulation
-Acron cardiac support
-Heart Transplantation
• Complication
• Nursing management
• Health education
• Conclusion
• Heart failure is the inability of the heart to pump
sufficient blood to meet the body’s metabolic
needs. An estimate of the heart’s efficiency as a
pump is its ejection fraction, the percentage of
blood the left ventricle ejects when it contracts.
Normally, a healthy heart ejects 55% or more of
the blood that fills the left ventricle during
diastole. As the heart fails, the amount of ejected
blood decreases. The heart’s ejection fraction is
measured using an echocardiogram or multiple
gated acquisition scan.
• The heart’s inability to pump enough blood to
meet the body’s oxygen and nutrient
demands, formerly called as congestive heart
failure.
• Heart failure is a term that describes as
inability of the heart to keep up it’s work load
of pumping blood to the lungs and to the rest
of the body.
• Hypertension
• Hyperlipidemia
• Diabetes
• CAD
• Family history
• Smoking
• Alcohol consumption
• Uses of cardio toxic drugs
• Pulmonary embolism, chronic lung disease
• Hemorrhage and anemia
• Anesthesia and surgery
• Transfusion or infusion
• Increased body demands (fever, infection,
pregnancy,)
• Physical and emotional stress
• Excessive sodium intake
Systolic and diastolic heart
failure
Acute and Chronic Heart Failure
Left-Sided and Right-Sided Heart
Failure
Forward and backward heart
failure
Inability of the heart to
contract to provide enough
blood flow forward.
Inability of the left ventricle
to relax normally, resulting in
fluid back up into the lungs.
FILLING
PROBLEM
LEFT SIDED HEART DISEASE
Inability of the left ventricle
to pump enough blood causing
fluid back up into the lungs
RIGHT SIDED HEART DISEASE
Inefficient pumping of the right side of the
heart causing fluid build up in the abdomen,
leg, and feet.
ACUTE HEART FAILURE
• An emergency situation in which a patient was
completely asymptomatic before the onset of
heart failure.
CHRONIC HEART FAILURE
• Long term syndrome in which a patient exhibits
symptoms over a long period of time, usually as a
result of preexisting cardiac condition.
FORWARD HEART FAILURE
• Decreased cardiac output results in
inadequate perfusion
BACKWARD HEART FAILURE
• Blood remain in ventricle after systole,
increasing atrial and venous pressure and rise
in venous fluid out of capillary membrane into
extracellular space.
Class I (Mild)
Ordinary physical activity does not cause undue fatigue,
palpitations, or dyspnea. The client does not experience any
limitation of activity.
Class II (Mild)
The client is comfortable at rest, but ordinary physical activity
results in fatigue, heart palpitations, or dyspnea.
Class III (Moderate)
There is marked limitation of physical activity. The client is
comfortable at rest, but less than ordinary activity causes
fatigue, heart palpitations, or dyspnea.
Class IV (Severe)
The client is unable to carry out any physical activity without
discomfort. Symptoms of cardiac insufficiency occur at rest.
Discomfort is increased if any physical activity is undertaken
Stage A
Patients at high risk for developing left ventricular dysfunction but
without structural heart disease or symptoms of heart failure
Stage B
Patients with left ventricular dysfunction or structural heart disease
who have not developed symptoms of heart failure
Stage C
Patients with left ventricular dysfunction or structural heart disease
with current or prior symptoms of heart failure
Stage D
Patients with refractory end-stage heart failure requiring specialized
interventions
Decreased
Cardiac output
hypotension
Medullary
activation
Of sympathetic
Nervous system
Stimulation of
adrenal medulla
Catecholamine
release
Vasoconstruction
Tachycardia
tachypnea
Increased
Venous return
Transitory increase
In blood pressure
Blood shunted to
brain and heart
Decreased
blood flow
to kidney
Stimulation
of renin angiotensin
aldosterone
secretion
Maintenance of level
Of conseiousness and
Dilation of
Coronary arteries
RIGHT SIDED
HEART FAILURE
 Lower extremity edema
 Liver enlargement
 Ascites
 Weight gain
 JV distention
 Abdominal pain
 Nausea
 Weakness
 Anorexia
 Anxiety
LEFT SIDED
HEART FAILURE
 Dyspnea
 Unexplained cough
 Pulmonary cackles
 Low oxygen saturation
 Third heart sound
 Reduced urine output
 Altered digestion
 Dizziness and high-headache
 Confusion
 Restlessness
 Fatique and weakness
 History collection
 Physical examination
 Echocardiography
 ECG
 Chest X-Ray
 Cardiac catheterization
 ABG studies
 Liver function studies
 Human B-type natriuretic peptide
 As volume and pressure in the cardiac
chambers rise, cardiac cells produce and
released more BNP. This test aids in the
diagnosis of heart failure.
A level greater than 100/ml is diagnostic for
heart failure. Inaddition the higher the BNP
the more severe the heart failure.
BNP is used in emergency department to
quickly diagnose and start treatment.
Radio nuclear ventriculogram.
PHARMACOLOGICAL
MANAGEMENT
GOAL
Aimed at diminishing the compensatory
mechanism of low cardiac output and also
improving contractility.
Eliminate excess body water and decrease
ventricular pressures.
A low-sodium diet and fluid restriction
complement this therapy
Some diuretics may have slight vasodilator
properties.
Lasix
Hydrochlorothiazide
spironolactone
Increase the heart’s ability to pup more
effectively by improving the contractile force of
the muscle.
Digoxin
Dopamine
Dobutamine
Increases the workload of the heart by dilating
peripheral vessels. By relaxing capacitance
vessels, vasodilators reduce ventricular filling
pressures and volumes.
By relaxing resistance vessels vasodilators can
reduce impedance to left ventricular ejection
and improve stroke volume.
Nitrates – nitroglycerin isosorbide,
nitroglycerin ointment predominantly dilate
systemic veins
Hydralazine predominantly affects arterioles,
reduces arteriolar tone.
Prazosin balanced effects on both arterial and
venous circulation
Sodium nitroprusside predominantly affects
arterioles
Morphine decreases and thus cardiac work.
• Inhibits the adverse effects of angiotensin II
• Decreases left ventricular after with a
subsequent decreases in heart rate associated
with heart failure, thereby reducing the work
load of the heart and increasing
corbondioxcide, may decrease remodeling of
the ventricle.
Captopril
• Decrease myocardial workload and protect
against fatal dysrhythmias by blocking
norepinephrine effects of the symptomatic
nervous system.
Metoprolol
Carvedilol
• Similar to ACE inhibitors.
• Used in patients who cannot tolerate ACE
inhibitors due to cough or angioedema.
• Decrease sodium retention, sympathetic
nervous system activation and cardiac
remodeling.
• Used patient with decompensated heart
failure.
• It produces smooth muscle cell relaxation,
diuretics and a reduction in afterload.
Diet therapy
Restricted sodium
Restricted fluid
Promotion of rest
Do not make these patients walk
Could start a fluid ‘rush’ into the alveoli
Try to get them to sit still if they appear
agitated an hypoxic
Relief Anxiety
It may leads to increase in O2 demand and
cardiac workload.
Explain what you are doing
Anti anxiety drugs and for decreasing preload.
INTRA-AORTIC BALLOON PUMP
CONTINUOUS POSITIVE
AIRWAY PRESSURE
CARDIAC
RESYNCHRONIZATION
THERAPY
ENDOVENTRICULAR
CIRCULAR PATCH PLASTY
ACRON
CARDIAC
SUPPORT
HEART TRANSPLANT
HUMAN HEART TRANSPLANTATION
ARTIFICIAL HEART TRANSPLANT
ARTIFICIAL HEART TRANSPLANT
Pleural effusion
Cardiac dysrhythmias
Hepatomegaly
Pulmonary infarction
Renal failure
NURSING ASSESSMENT
Obtain history of symptoms, limits of activity,
response to rest and H/O response to drug therapy.
Assess the arterial pulse (quality & character)
Assess the heart rhythm and rate, BP, assess edema.
Obtain hemodynamic measurements
Assess weight
Identify sleep patterns.
Note the results of serum electrolytes
NURSING DIAGNOSIS
Decreased cardiac output related to impaired
contractility and increased preload and
afterload.
Impaired gas exchange related to alveolar
edema due to elevated ventricular pressures
Excess fluid volume related to sodium and
water retention.
Activity intolerance related to oxygen supply
and demand imbalance.
NURSING INTERVENTIONS
a) Maintaining adequate cardiac output
 Place patient at physical and emotional rest to reduce work
of the heart.
 Evaluate frequently for progression of left sided heart
failure. Take frequent BP reading.
 Auscultate heart sounds frequently and monitor cardiac
rhythm
 Observe for signs and symptoms of reduced peripheral
tissue perfusion, cool temperature of skin, facial pallor,
poor capillary refill of nail buds.
 Administered pharmacotherapy as directed.
 Monitor clinical response of patient with respect to relief of
symptoms.
b)Restoring fluid balance
 Assess for signs of hypovolemia caused by diuretic
therapy thirst, decreased urine output, orthostatic
hypotension, weak, thready pulse, increased urine
specific gravity.
 Be alert for hypokalemia
 Monitor for pitting edema of lowering extremities and
sacral area
 check daily weight
 Administered prescribed diuretics potassium
supplements as ordered.
 Maintain I/O chart
 Administered I.V. fluids
c)Improving Activity tolerance
Increase patient’s activities gradually.
Observe the pulse, symptoms, behavioral
response to increased activity.
Relieve night time anxiety and provide rest
and sleep.
Give appropriate sedation to relieve insomnia
and restlessness
Explain the disease process to the patient
Teach the signs and symptoms of recurrence.
Review medication, regimen.
Review activity program.
Restrict sodium as directed.
Congestive Cardiac Failure..presentation

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Congestive Cardiac Failure..presentation

  • 1. DEEPA A, MSc(N), BSc(Psychology) NURSING TUTOR, TIRUPPUR MEDICAL COLLEGE, TIRUPPUR.
  • 2. MASTER PLAN FOR CCF • Introduction • Definition • Risk factors • Types left and right HF backward and forward HF systolic and diastolic HF acute and chronic HF • Classification of heart failure stage A stage B stage C stage D • Pathophysiology • Compensatory mechanism
  • 3. • Clinical manifestation Right heart failure Left heart failure • Diagnostic evaluation • Management Pharmacological management Non-pharmacological management -IABP -CPAP -Cardiac Resynchronization Therapy -Endo ventricular patch circulation -Acron cardiac support -Heart Transplantation • Complication • Nursing management • Health education • Conclusion
  • 4. • Heart failure is the inability of the heart to pump sufficient blood to meet the body’s metabolic needs. An estimate of the heart’s efficiency as a pump is its ejection fraction, the percentage of blood the left ventricle ejects when it contracts. Normally, a healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole. As the heart fails, the amount of ejected blood decreases. The heart’s ejection fraction is measured using an echocardiogram or multiple gated acquisition scan.
  • 5.
  • 6. • The heart’s inability to pump enough blood to meet the body’s oxygen and nutrient demands, formerly called as congestive heart failure. • Heart failure is a term that describes as inability of the heart to keep up it’s work load of pumping blood to the lungs and to the rest of the body.
  • 7. • Hypertension • Hyperlipidemia • Diabetes • CAD • Family history • Smoking • Alcohol consumption • Uses of cardio toxic drugs
  • 8. • Pulmonary embolism, chronic lung disease • Hemorrhage and anemia • Anesthesia and surgery • Transfusion or infusion • Increased body demands (fever, infection, pregnancy,) • Physical and emotional stress • Excessive sodium intake
  • 9. Systolic and diastolic heart failure Acute and Chronic Heart Failure Left-Sided and Right-Sided Heart Failure Forward and backward heart failure
  • 10. Inability of the heart to contract to provide enough blood flow forward.
  • 11. Inability of the left ventricle to relax normally, resulting in fluid back up into the lungs. FILLING PROBLEM
  • 12. LEFT SIDED HEART DISEASE Inability of the left ventricle to pump enough blood causing fluid back up into the lungs
  • 13. RIGHT SIDED HEART DISEASE Inefficient pumping of the right side of the heart causing fluid build up in the abdomen, leg, and feet.
  • 14. ACUTE HEART FAILURE • An emergency situation in which a patient was completely asymptomatic before the onset of heart failure. CHRONIC HEART FAILURE • Long term syndrome in which a patient exhibits symptoms over a long period of time, usually as a result of preexisting cardiac condition.
  • 15. FORWARD HEART FAILURE • Decreased cardiac output results in inadequate perfusion BACKWARD HEART FAILURE • Blood remain in ventricle after systole, increasing atrial and venous pressure and rise in venous fluid out of capillary membrane into extracellular space.
  • 16. Class I (Mild) Ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) The client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class III (Moderate) There is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class IV (Severe) The client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken
  • 17. Stage A Patients at high risk for developing left ventricular dysfunction but without structural heart disease or symptoms of heart failure Stage B Patients with left ventricular dysfunction or structural heart disease who have not developed symptoms of heart failure Stage C Patients with left ventricular dysfunction or structural heart disease with current or prior symptoms of heart failure Stage D Patients with refractory end-stage heart failure requiring specialized interventions
  • 18.
  • 19. Decreased Cardiac output hypotension Medullary activation Of sympathetic Nervous system Stimulation of adrenal medulla Catecholamine release Vasoconstruction Tachycardia tachypnea Increased Venous return Transitory increase In blood pressure Blood shunted to brain and heart Decreased blood flow to kidney Stimulation of renin angiotensin aldosterone secretion Maintenance of level Of conseiousness and Dilation of Coronary arteries
  • 20. RIGHT SIDED HEART FAILURE  Lower extremity edema  Liver enlargement  Ascites  Weight gain  JV distention  Abdominal pain  Nausea  Weakness  Anorexia  Anxiety LEFT SIDED HEART FAILURE  Dyspnea  Unexplained cough  Pulmonary cackles  Low oxygen saturation  Third heart sound  Reduced urine output  Altered digestion  Dizziness and high-headache  Confusion  Restlessness  Fatique and weakness
  • 21.  History collection  Physical examination  Echocardiography  ECG  Chest X-Ray  Cardiac catheterization  ABG studies  Liver function studies
  • 22.  Human B-type natriuretic peptide  As volume and pressure in the cardiac chambers rise, cardiac cells produce and released more BNP. This test aids in the diagnosis of heart failure. A level greater than 100/ml is diagnostic for heart failure. Inaddition the higher the BNP the more severe the heart failure. BNP is used in emergency department to quickly diagnose and start treatment. Radio nuclear ventriculogram.
  • 23. PHARMACOLOGICAL MANAGEMENT GOAL Aimed at diminishing the compensatory mechanism of low cardiac output and also improving contractility.
  • 24. Eliminate excess body water and decrease ventricular pressures. A low-sodium diet and fluid restriction complement this therapy Some diuretics may have slight vasodilator properties. Lasix Hydrochlorothiazide spironolactone
  • 25. Increase the heart’s ability to pup more effectively by improving the contractile force of the muscle. Digoxin Dopamine Dobutamine
  • 26. Increases the workload of the heart by dilating peripheral vessels. By relaxing capacitance vessels, vasodilators reduce ventricular filling pressures and volumes. By relaxing resistance vessels vasodilators can reduce impedance to left ventricular ejection and improve stroke volume.
  • 27. Nitrates – nitroglycerin isosorbide, nitroglycerin ointment predominantly dilate systemic veins Hydralazine predominantly affects arterioles, reduces arteriolar tone. Prazosin balanced effects on both arterial and venous circulation Sodium nitroprusside predominantly affects arterioles Morphine decreases and thus cardiac work.
  • 28. • Inhibits the adverse effects of angiotensin II • Decreases left ventricular after with a subsequent decreases in heart rate associated with heart failure, thereby reducing the work load of the heart and increasing corbondioxcide, may decrease remodeling of the ventricle. Captopril
  • 29. • Decrease myocardial workload and protect against fatal dysrhythmias by blocking norepinephrine effects of the symptomatic nervous system. Metoprolol Carvedilol
  • 30. • Similar to ACE inhibitors. • Used in patients who cannot tolerate ACE inhibitors due to cough or angioedema. • Decrease sodium retention, sympathetic nervous system activation and cardiac remodeling.
  • 31. • Used patient with decompensated heart failure. • It produces smooth muscle cell relaxation, diuretics and a reduction in afterload.
  • 32. Diet therapy Restricted sodium Restricted fluid Promotion of rest Do not make these patients walk Could start a fluid ‘rush’ into the alveoli Try to get them to sit still if they appear agitated an hypoxic
  • 33. Relief Anxiety It may leads to increase in O2 demand and cardiac workload. Explain what you are doing Anti anxiety drugs and for decreasing preload.
  • 36.
  • 37.
  • 41. HEART TRANSPLANT HUMAN HEART TRANSPLANTATION
  • 45. NURSING ASSESSMENT Obtain history of symptoms, limits of activity, response to rest and H/O response to drug therapy. Assess the arterial pulse (quality & character) Assess the heart rhythm and rate, BP, assess edema. Obtain hemodynamic measurements Assess weight Identify sleep patterns. Note the results of serum electrolytes
  • 46. NURSING DIAGNOSIS Decreased cardiac output related to impaired contractility and increased preload and afterload. Impaired gas exchange related to alveolar edema due to elevated ventricular pressures Excess fluid volume related to sodium and water retention. Activity intolerance related to oxygen supply and demand imbalance.
  • 47. NURSING INTERVENTIONS a) Maintaining adequate cardiac output  Place patient at physical and emotional rest to reduce work of the heart.  Evaluate frequently for progression of left sided heart failure. Take frequent BP reading.  Auscultate heart sounds frequently and monitor cardiac rhythm  Observe for signs and symptoms of reduced peripheral tissue perfusion, cool temperature of skin, facial pallor, poor capillary refill of nail buds.  Administered pharmacotherapy as directed.  Monitor clinical response of patient with respect to relief of symptoms.
  • 48. b)Restoring fluid balance  Assess for signs of hypovolemia caused by diuretic therapy thirst, decreased urine output, orthostatic hypotension, weak, thready pulse, increased urine specific gravity.  Be alert for hypokalemia  Monitor for pitting edema of lowering extremities and sacral area  check daily weight  Administered prescribed diuretics potassium supplements as ordered.  Maintain I/O chart  Administered I.V. fluids
  • 49. c)Improving Activity tolerance Increase patient’s activities gradually. Observe the pulse, symptoms, behavioral response to increased activity. Relieve night time anxiety and provide rest and sleep. Give appropriate sedation to relieve insomnia and restlessness
  • 50. Explain the disease process to the patient Teach the signs and symptoms of recurrence. Review medication, regimen. Review activity program. Restrict sodium as directed.