This document discusses congestive heart failure (CHF), including its definition, causes, symptoms, diagnostic assessments, and management. CHF occurs when the heart fails as a pump and cannot supply adequate oxygen to the body. It affects over 1 million people in India yearly. Management involves medical therapies like ACE inhibitors, diuretics, and beta-blockers. Surgical options include angioplasty, bypass surgery, and transplants. Nurses monitor for symptoms, educate patients, and ensure proper treatment adherence to improve outcomes for those suffering from CHF.

2. INTRODUCTION
CHF IS A CONDITION IN WHICH THE HEART FAILS
AS A PUMP AND DELIVERS INADEQUATE AMOUNT
OF OXYGEN TO THE BODY.
CHF IS A SERIOUS, PROGRESSIVE CONDITION
THAT IS USUALLY CHRONIC AND CAN BE LIFE
THREATENING.
CHF IS MOST COMMONLY USED WHEN REFERRING
TO RIGHT AND LEFT SIDED HEART FAILURE.
MORE THAN 1 MILLION CASES ARE REPORTED PER
YEAR OF CHF IN INDIA.

3. ANATOMY AND PHYSIOLOGY OF HEART
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6. DEFINATION
HEART FAILURE CAN BE DEFINED AS A PHYSIOLOGICAL STATE IN
WHICH THE HEART IS UNABLE TO PUMP ENOUGH BLOOD TO
MEET THE METABOLIC NEEDS OF THE BODY AT REST OR DURING
EXERCISE EVEN THOUGH FILLING PRESSURES ARE ADEQUATE .
CONGESTIVE HEART FAILURE MEANS THAT ONE OR MORE
CHAMBERS OF HEART FAIL TO KEEP UP WITH THE VOLUME OF
THE BLOOD FLOWING THROUGH THEM.

7. ETIOLOGY
CAUSES

10. ASSESSMENT &DIAGNOSTIC FINDINGS
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13. MANAGEMENT

14. MEDICAL MANAGEMENT
FOLLOWING THINGS ARE USED IN MEDICAL MANAGEMENT OF CHF:
1. ANGIOTENSION-CONVERTING ENZYME INHIBITORS
• EX-LISINOPRIL
2. ANGIOTENSION RECEPTOR BLOCKERS
• EX-VALASTAN
3. DIGITALIS
EX-DIGOXIN
4. DIURATICS
EX- FUROSEMIDE
5. BETA –ADRENERGIC BLOCKING AGENTS
EX -BISOPROLOL

15. FOLLOWING METHOD ARE USE IN SURGICAL
MANAGEMENT OF CHF:-
1) CORONARY ANGIOPLASTY: PROCEDURE
USE TO WIDEN BLOCKED OR NARROWED
CORONARY ARTERIES.
2) CORONARY ARTERY BY PASS SURGERY
:THE SURGEON REMOVES A HEART
VESSEL FROM ANOTHER PART OF THE
BODY AND FASHIONS IT INTO NEW
PATHWAY TO WORK AROUND A CLOGGED
ARTERY.
SURGICAL MANAGEMENT

16. 3) IMPLANTABLE CARDIAC
DEFIBRILLATOR: THEY ARE IMPLANTED
UNDER THE SKIN AS PACEMAKER.
4) INTRA AORTIC BALLOON PUMP.

17. 5) LEFT VENTRICULAR ASSIST DEVICE : THESE ARE
IMPLANTED INTO THE CHEST OR ABDOMEN AND ATTACHED TO
A WEAKENED HEART TO HELP IT PUMP.
6) VALVE REPAIR OR VALVE REPLACEMENT SURGERY.
7) HEART TRANSPLANTATION- IT IS CONSIDERED WHEN
HEART FAILURE IS SO SEVERE.

18. NURSING MANAGEMENT
ASSESSMENT
SUBJECTIVE DATA-
1. OBTAIN PAST HISTORY LIKE CAD, HYPERTENSION, CARDIOMYOPATHY, DIABETES MELLITUS ETC.
2. COLLECT FUNCTIONAL HEALTH PROBLEMS.
• HEALTH PERCEPTION- FATIGUE, DEPRESSION, ANXIETY
• NUTRITIONAL- STOMACH BLOATING, NAUSEA, LOW SODIUM DIET, ANOREXIA, WT GAIN
• ACTIVITY, EXERCISE- DYPNEA, COUGH, ORTHOPNEA
• COGNITIVE PERCEPTUAL- CHEST PAIN, ABDOMINAL DISCOMFORT.
OBJECTIVE DATA-
• INTEGUMENTARY- COOL, PALLOR, PERIPHERAL EDEMA, CYANOSIS
• RESPIRATORY- TACHYPNEA, CRACKLES, RHONCHI, WHEEZE
• CARDIOVASCULAR- TACHYCARDIA, JUGULAR VEIN DISTENSION, MURMURS
• NEUROLOGIC- RESTLESSNESS, CONFUSION, DECREASED ATTENTION

19. 1) DECREASED CARDIAC OUTPUT R/T IMPAIRED
CONTRACTIBILITY, INCREASED PRELOAD AND AFTER LOAD,
ALTERED HEART RATE AND RHYTHM AS EVIDENCED BY
BRADYCARDIA.
GOAL:- MAINTAIN ADEQUATE CARDIAC OUTPUT.
INTERVENTION:-
• AUSCULTATE HEART SOUNDS FREQUENTLY AND MONITOR CARDIAC
RHYTHM.
• ASSESS FOR ABNORMAL HEART AND LUNG SOUNDS.
• PROVIDE PSYCHOLOGICAL AND PHYSICAL REST.
NURSING DIAGNOSIS

20. 2) FLUID RETENTION EXCESS RELATED TO DECREASED
CARDIAC OUTPUT.
GOAL:- RESTORING FLUID BALANCE.
INTERVENTION:-
• MONITOR FOR EDEMA AND WEIGHT AND JUGULAR VEIN DISTENSION
AND LUNG CRACKLES.
• ADMINISTER IV FLUIDS THROUGH A INTERMITTENT ACCESS.
• WEIGHT PATIENT DAILY AND COMPARE PREVIOUS WEIGHTS.
• ADMINISTER PRESCRIBED DIURETICS AS ORDERED. GIVE DIURETICS
EARLY IN THE MORNING AS IN NIGHT TIME THEY DISTURBS SLEEP.

21. 3) INEFFECTIVE TISSUE PERFORMANCE RELATED
TO DECREASED CARDIAC OUTPUT.
GOAL:- TO IMPROVE CIRCULATION.
INTERVENTION:-
• ASSESS PAIN FOR INTENSITY USING PAIN RATING SCALE FOR LOCATING
AND FOR PRECIPITATING FACTORS.
• ADMINISTER OR ASSIST WITH SELF ADMINISTRATION OF VASODILATORS.
• ASSESS RESPONSE TO MEDICATIONS EVERY 5 MINT.
• GIVE BETA-BLOCKERS AS ORDERED.
• ESTABLISH A QUIET ENVIRONMENT.
• ELEVATE HEAD OF BED.

22. 4) INEFFECTIVE THERAPEUTIC REGIMEN RELATED
OF KNOWLEDGE.
GOALS:- TO RELIEF ANXIETY.
INTERVENTION:-
• ASSESS KNOWLEDGE AND UNDERSTANDING OF CHF.
• PROVIDE WRITTEN AND VERBAL INSTRUCTIONS ABOUT PRESCRIBED
MEDICATIONS AND THEIR USE.
• TELL THE PATIENT ABOUT THE ADVANTAGES OF ADHERING TO THE
PRESCRIBED REGIMEN.
• AVOID UNNECESSARY CLINICAL VISITS.

23. 5) RISK FOR INFECTION RELATED TO
SURGERY.
GOAL:- TO REDUCE RISK OF INFECTION.
INTERVENTIONS:-
• USE ASEPTIC TECHNIQUE FOR ALL INVASIVE PROCEDURES.
• ASSESS WOUND SITES FOR REDNESS, SWELLING, PAIN.
• ADMINISTER ANTIBIOTICS AS ORDERED.
• MONITOR WBC AND DIFFERENTIAL. NOTIFY PHYSICIAN FOR LEUKOCYTOSIS OR
LEUKOPENIA.

24. 6) ACTIVITY INTOLERANCE RELATED TO FATIGUE
SECONDARY TO CARDIAC INSUFFICIENCY AND
PULMONARY CONGESTION.
GOAL:- WILL ACHIEVE A REALISTIC PROGRAM OF ACTIVITY THAT
BALANCES PHYSICAL ACTIVITY WITH ENERGY CONSERVING ACTIVITIES.
INTERVENTIONS:-
• ENCOURAGE REST AND SLEEP ACTIVITY PERIODS TO REDUCE
CARDIAC WORKLOAD.
• PROVIDE CALMING DIVERSIONARY ACTIVITIES TO PROMOTE
RELAXATION TO REDUCE OXYGEN CONSUMPTION AND TO RELIEVE
DYSPNEA AND FATIGUE.
• MONITOR PATIENT’S OXYGEN RESPONSE.

25. 7) IMPAIRED GAS EXCHANGE RELATED TO INCREASED
PRELOAD MECHANICAL FAILURE OR IMMOBILITY.
GOAL:- MAINTAINS ADEQUATE RESPIRATORY RATE AND RHYTHM FOR
ACTIVITIES OF DAILY LIVING.
INTERVENTIONS:-
• ADMINISTER SUPPLEMENT OXYGEN TO MAINTAIN OXYGEN LEVELS.
• GIVE SEMI-FOWLER’S POSITION TO ALLEVIATE DYSPNEA.
• CHANGE OXYGEN DELIVERY FROM MASK TO NASAL PRONGS DURING MEALS
AS TOLERATED TO SUSTAIN OXYGEN LEVELS.

26. 8) POWERLESSNESS RELATED TO DECREASED
CARDIAC OUTPUT AND DECREASED
OXYGENATION.
GOALS:- PATIENT DISPLAYS CONTENT WITH LIFE CHOICES.
INTERVENTIONS:-
• ENCOURAGE THE PATIENT TO IDENTIFY THE STRENGTHS.
• ENCOURAGE AN INCREASED RESPONSIBILITY FOR SELF.
• HELP THE PATIENT IN RE-EXAMINING NEGATIVE PERCEPTION OF THE
SITUATION.
• GIVE PATIENT CONTROL OVER HIS/HER ENVIRONMENT.
• AVOID USING COERCIVE POWER WHEN APPROACHING THE PATIENT.

27. 9) IMPAIRED TISSUE PERFUSION.
GOAL:- TO RESTORE THE DELIVERY OF BLOOD AND OXYGEN TO TISSUES.
INTERVENTIONS:-
• ASSESS AND DOCUMENT VITAL SIGNS. REPORT INCREASE IN HEART RATE AND CHANGES
IN RHYTHM.
• ASSESS FOR CHANGES IN LEVEL OF CONSCIOUSNESS.
• AUSCULTATE HEART AND BREATH SOUNDS. NOTE ABNORMAL HEART SOUNDS OR
ADVENTITIOUS LUNG SOUNDS.
• MONITOR ECG RHYTHM CONTINUOUSLY.

28. 10) DEFICIENT KNOWLEDGE RELATED TO DISEASE AS
EVIDENCED BY QUESTIONS ABOUT DISEASE BY
PATIENT.
GOAL:- TO DESCRIBE DISEASE PROCESS TO PATIENT.
INTERVENTIONS:-
• APPRAISE THE PATIENT’S CURRENT LEVEL OF KNOWLEDGE RELATED TO SPECIFIC DISEASE
PROCESS TO IDENTIFY NEEDED AREAS OF TEACHING.
• DESCRIBE COMMON SIGN AND SYMPTOMS OF DISEASE TO PATIENT SO PATIENT CAN
IDENTIFY THEM AND REPORT TO HEALTHCARE.
• INSTRUCT THE PATIENT ON MEASURES TO PREVENT/MINIMIZE SIDE EFFECTS OF TREATMENT
OF DISEASE.

29. HEALTH TEACHING
• MODIFY DAILY ACTIVITIES AND GET ENOUGH REST TO AVOID STRESSING THE HEART.
• DON’T SMOKE AND AVOID EXPOSURE TO SECOND HAND-SMOKE. AS SMOKING INCREASES
HEARTBEAT, DECREASES THE AMOUNT OF OXYGEN IN THE BLOOD AND ELEVATES THE
BLOOD PRESSURE.
• EAT A HEART HEALTHY DIET THAT IS LOW IN SODIUM AND FAT AND LIMIT CHOLESTEROL.
• DON’T DRINK ALCOHOL OR LIMIT INTAKE TO NO MORE THAN ONE DRINK OR THREE TIMES
A WEEK.
• LOSE WEIGHT, WEIGH YOURSELF DAILY FOR A SUDDEN INCREASE MAY SIGNAL FLUID BUILD
UP.
• AVOID OR LIMIT CAFFEINE INTAKE.
• GET REDUCE STRESS.
• HAVE REGULAR CHECK-UP.

30. RESEARCH FINDINGS
Potential risk factors responsible for development of doxorubicin – induced cognetive
heart failure were examined through retrospective analysis of 4018 patient records.
The overall incidence of drug –induced congestive heart failure was 2.2%(88 cases).
The probability of incurring doxorubicin- induced congestive heart failure was related
to the total dose of doxorubicin administered.
There was a continuum of increasing risk as the cumulative amount of administered
drug increased.
A weekly dose schedule of doxorubicin was associated with a significantly lower
incidence of congestive heart failure than was the usually employed Every 3 week
schedule.
An increase in drug related congestive heart failure was also seen with advancing
patient age. Performance status, sex, race, and tumor type we’re not risk factors.
These data will enable clinicals to better estimate the risk/benifits ratio in individual
patients receiving prolonged administration of doxorubicin.
They also provide a basis for the investigation of less cardiotoxic anthracycline
analogues or for designing measures to prevent doxorubicin-induced
cardiomyopathy.

31. SUMMARY
TODAY WE DISCUSSED THE TOPIC CONGESTIVE HEART FAILURE IN DETAIL, THE
CAUSE, THE CLINICAL MANIFESTATIONS, DIAGNOSTIC EVALUATIONS,
MANAGEMENT- MEDICAL, SURGICAL AND NURSING AND HEALTH TEACHING.

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33. BIBILIOGRAPHY
• TEXTBOOK OF MEDICAL SURGICAL NURSING BY BRUNNER
AND SUDDARTH, SOUTH ASIAN EDITION, VOLUME-01, PAGE:
615-630
• TEXTBOOK OF MEDICAL SURGICAL NURSING BY CHINTAMANI,
PAGE: 828-837
• TEXTBOOK OF MEDICAL SURGICAL NURSING BY ANSARI, PAGE:
926-943
• HTTP://WWW.SLIDESHARE.NET/CONGESTIVE-HEART-FAILURE-4093772
• HTTP://WWW.ACPJOURNALS.ORG/DOI/10.7326/0003-4819-91-5-710
• HTTP://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/PII/S1071916421001986