Download - Congestive Heart Failure Ppt
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WHAT IS CHF?
- General term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues with vital blood-borne nutrients.
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1. SYSTOLIC DYSFUNCTION
2. DIASTOLIC DYSFUNCTION
2 TYPES OF CHF?
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Also known as “Pulomnary Congestion”
Heart is unable to pump the total volume of blood it receives from the right side of the heart.
LEFT SIDED HEART FAILURE
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Also known as “Venous Congestion”
Impairs the ability to move deoxygenated blood from the systemic circulation into the pulmonary circulation
RIGHT SIDED HEART FAILURE
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R – enal disease
A – nemia
P – ulmonary embolism
I – nfection (myocarditis, pericarditis)
D – elivery after pregnancy
F – orget to take the meds
A – rrythmias
I – schemia/infarction
L – ipid aggregation
U – ncontrolled hypertension
R – HD
E – ndocarditits
RISK FACTORS:
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GENERAL:
2%- 40 to 59 years old
5%- 60 to 69 years old
25% greater among black than white population.
PHILIPPINES:
1,521,912 filipinos have CHF
6th leading cause of death
affects male more than male
INCIDENCE:
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A. LEFT SIDED HEART FAILURE
Drinking too much alcohol
Heart attack
Heart muscle infections
High blood pressure
Hypothyroidism
Leaking or narrow heart valves
Any other disease that damages the heart muscle
Poor left-side heart function due to prior heart attacks
ETIOLOGY:
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B. RIGHT SIDED HEART FAILURE
Persistent left sided heart failure
Stenosis/Regurgitation of tricuspid or pulmonic valves
Right ventricular infarction
Acute/chronic pulmonary disease: COPD, severe pneumonia, pulmonary embolus
Pulmonary hypertension (Cor Pulmonale)
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PATHOPHYSIOLOGY OF CONGESTIVE HEART FAILURE
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FUNCTIONAL CLASSIFICATION
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Left:
• Dyspnea in the early stages
• Decreases O2 saturation
• Increase RR
• Easy fatigability, weakness and dizziness
• Orthopnea
• Auscultation reveals S3 gallop
• Pulsusalternans
• Paroxysmal Nocturnal Dyspnea
• Cardiac asthma
• Acute pulmonary edema= life-threatening since it may progress to shock & death
CLINICAL MANIFESTATIONS:
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RIGHT:
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• Chest x-ray
• Echocardiography
• Elevated SGPT
• Decrease CVP
DIAGNOSTICS:
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ACE inhibitors Diuretics Digitalis glycosides Angiotensin Receptor BlockersOxygen Therapy
MEDICAL/ PHARMACOLOGIC MANAGEMENT:
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SURGICAL MANAGEMENTS
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LEFT VENTRICULAR ASSIST DEVICE
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HEART TRANSPLANTATION
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CORONARY ARTERY BYPASS GRAFT
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CORONARY ANGIOPLASTY
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CARDIAC RESYNCHRONIZATION THERAPY
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• Ineffective tissue perfusion
• Excess fluid volume
• Activity intolerance
NURSING CARE PLANS
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a. O2 saturation at 99%;
b. capillary refill time of 2 seconds from 4; and
c. absence of cyanosis.
OBJECTIVES OF CARE:
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® Oxygen corrects hypoxemia and alleviates
client’s need for air.
® To promote greater lung expansion.
® Any alteration in the ABG components may
inidicate sogns of respiratory failure.
® Respiratory distress and presence of
adventitious breath sounds are indicative of
pulmonary congestion.
® It could be indicative of falling arterial pH.
1. Administer oxygen therapy per nasal cannula
at 2-6 LPM as ordered.
2. Semi-Fowler’s or High-Fowler’s position
3. Evaluate ABG analysis results
4. Auscultate lung fields at least every 4 hours for crackles and wheezes in dependent lung fields
5. Observe for increased rate of respirations.
NURSING INTERVENTIONS:
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OBJECTIVES OF CARE:
a. balance intake and output;
b. stable weight;
c. free from signs of edema; and
d. demonstration of behaviors to monitor fluid status.
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® Helps rid body fluids and sodium.
® To prevent peaks/ valleys in fluid level and thirst.
® Provides a comparative baseline and evaluates the effectiveness of diuretic therapy when used.
® To determine fluid balance.
® To facilitate movement of diaphragm, thus improving respiratory effort.
1. Administer diuretics as ordered.
2. Set an appropriate rate of fluid intake/ infusion throughout 24 hour period.
3. Weigh daily or on a regular schedule, as indicated.
4. Record intake and output accurately.
5. Place in semi- Fowler’s position, as appropriate.
NURSING INTERVENTIONS:
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a. verbalize relief from fatigue;
b. vital signs within normal range; and
c. able to turn to sides without experiencing dyspnea
OBJECTIVES OF CARE:
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®To conserve energy and protect the client from injury
® Articles within reach minimizes client’s effort
® Restores energy needed for activity and cellular regeneration
® A simple exercise can enhance circulation thus improving clients wellness
® to promote tolerance to certain activities
® To sustain motivation
1. Assist client with self-care activities as needed
2. Keep supplies and personal articles within easy reach
3. Provide a quiet environment and uninterrupted rest periods
4. Encourage range of motion exercise such as Moving client’s arms and legs as far as they can comfortably go in any direction
5. Gradually increase clients level of activity if tolerated well
6. Give client information that provides daily/weekly progress
NURSING INTERVENTIONS:
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