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7/31/2019 Living With Congestive Heart Failure CHF 4
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A Case Study by
Jasmine Hunter, Rose Larsen, and Amy
Sauls-Crenshaw
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Heart Failure may develop after a Heart Attack due to long term
hypertension, diabetes, valvular, or inflammatory heart disease. It is the
most common diagnosis for hospitalized patients over 65 years old. It
usually starts in the left ventricle and if left untreated it progresses to right
sided failure. Even though the right side can fail without left side failure.
Mr. Evans is a 72 year old
man who was admitted to the
cardiac unit with a diagnosis
of heart failure.
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It is when the body is no longer able to
pump the blood it needs to maintain its
metabolic needs. It is caused when there
is a over release of hormones in the body.
(epinephrine and norepinephrine) The
release causes a negative effect on the
failing heart and the circulatory system.
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Decreased Cardiac Output
Fatigue
Anginal Pain
Anxiety
Oliguria
Decreased Gastrointestinal Motility
Pale, Cool Skin
Weight Gain
Restlessness
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Left Ventricular Failure
Dyspnea
Cough
Frothy, blood-tinged sputum
Orthopnea
Paroxysmal nocturnal dyspnea
Pulmonary CracklesRadiographic evidence of pulmonary
vascular congestion with pleuraleffusion.
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Right Ventricular Failure
Distended Jugular VeinsAscites
AnorexiaNauseaAbdominal DistentionLiver enlargement with right upper
quadrant pain.Edema: feet, ankles, and sacrum. May
progress up legs into thighs andexternal genitalia and lower trunk
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Respiratory DistressNumber of pillows needed to breathecomfortably when resting.Edema (site, degree of pitting)Abdominal distention secondary toascites.Weight gainAdventitious breath soundsAbnormal heart soundsActivity intoleranceJugular vein distentionBlood flow to the kidneys is diminished,resulting in oliguria.Oxygen deficit in tissues results incyanosis and general debilitation.
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Shortness of breath (dyspnea)Fatigue or weakness
Swelling in legs, ankle, & feetPersistent coughSudden weight gain
** Women are more likely than men to have swollenankles and shortness of breath**
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Kidney Damage - The kidneys are not functioning in the
correct way and the body is retaining fluidinstead of eliminating it from the body
PVD (tissue damage) - The heart is not functioning properly and
the heart is not pumping the blood
everywhere it needs to goPneumonia - Fluid could get into the lungs and cause
aspiration
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BNP- is a neurohormone secreted by the heart in response to expansion
of ventricular and pressure overload
< 100 normal
> 100 is suggestive of HF
Blood chemistry
- will reveal elevated BUN and creatinine resulting from a decreased
glomerular filtration
http://www.google.com/imgres?um=1&hl=en&biw=1093&bih=418&tbm=isch&tbnid=z2SG59OvrNs39M:&imgrefurl=http://www.stmd.com/triage.php&docid=IUnutXB7vZcDEM&imgurl=http://www.stmd.com/images/triage.gif&w=230&h=197&ei=UfQQT-WqG-nr0gGvmtWJAw&zoom=17/31/2019 Living With Congestive Heart Failure CHF 4
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Chest radiographReveals pulmonary vascular congestion and pleural effusionECGReveals cardiac dysthymiasEchocardiogramDone to determine presence of pericardial fluid, heart failure andejection fractionPulmonary artery Catheterization
Asses right and left ventricular function
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Action
Digoxin Increases the force of the heart's contractions, which can be beneficial in heart failure and for irregular heart
beats. Used to relieve heart failure symptoms, especially when the patient isn't responding to ACE inhibitorsand diuretics. Also slows certain types of irregular heartbeat (arrhythmias), particularly atrial fibrillation.
Lasix Used to help lower blood pressure. Used to help reduce swelling (edema) from excess buildup of fluid in the
body. Causes the body to rid itself of excess fluids and sodium through urination. Helps to relieve the heart's
workload. Also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles andlegs. Different diuretics remove fluid at varied rates and through different methods.
K-Lyte Potassium supplement. Restores electrolyte loss.
Cardabid Nitroglycerin (nitrates). Used to ease chest pain (angina). Relaxes blood vessels and increases the supply of
blood and oxygen to the heart while reducing its workload.
Toprol - XL Decreases the heart rate and cardiac output, which lowers blood pressure and makes the heart beat more
slowly and with less force. Used to lower blood pressure. Used with therapy for cardiac arrhythmias (abnormalheart rhythms) and in treating chest pain (angina). Used to prevent future heart attacks in patients who have
had a heart attack.
Aspirin Keeps blood clots from forming by preventing blood platelets from sticking together. Helps prevent clotting in
patients who have had a heart attack, unstable angina, ischemic strokes, TIA (transient ischemic attacks, or"little strokes") and other forms of cardiovascular disease. Usually prescribed preventively when plaque
buildup is evident but there is not yet a large obstruction in the artery.
Lotensin Used to treat or improve symptoms of cardiovascular conditions including high blood pressure and heart
failure. Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood toflow more easily and makes the heart's work easier or more efficient.
Coumadin Helps to prevent harmful clots from forming in the blood vessels. May prevent the clots from becoming larger
and causing more serious problems. Helps to prevent harmful clots from forming in the blood vessels. May
prevent the clots from becoming larger and causing more serious problems. Often prescribed to prevent firstor recurrent stroke.
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Percutaneous coronary intervention
(PCI) (formerly referred to as
angioplasty)
Coronary artery bypass
Heart transplant
Valve replacementDefibrillator implantation
Left ventricular assist device (LVAD)
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PCI is one type of procedure to reopen blocked vessels. The
procedure is usually performed in the cardiac catherizationlab. A small tube a catheter with a tiny deflated balloon
on the end is inserted through an incision in the groin area
and pushed through to the diseased artery. Then the
balloon is inflated to push open the artery. The balloon is
removed once the artery has been fully opened. A stentmay be placed during the procedure to keep the blood
vessel open. Although there's a slight risk of damage to the
artery during this procedure, PCI usually improves the
patient's condition.
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Coronary artery bypass surgery reroutes the blood
supply around a blocked section of the artery. During
this procedure, surgeons remove healthy blood
vessels from another part of the body, such as a leg or
the chest wall. They then surgically attach the vessels
to the diseased artery in such a way that the blood
can flow around the blocked section.
After a bypass operation, it's especially important foryou to watch your diet and reduce the amount of fat
and cholesterol you eat, since these substances cause
the arteries to clog. Doctors also recommend
following a routine of increased physical activity to
strengthen the heart muscles.
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Some people have severe, progressive heart failure that
can't be helped by medications and dietary and lifestyle
changes. In such cases a heart transplant may be the only
effective treatment option.
Surgeons replace the damaged heart with a healthy one
taken from a donor who has been declared brain dead. It
can take several months to find a donor heart that closelymatches the tissues of the person receiving the transplant.
But this matching process increases the likelihood that the
recipient's body will accept the heart.
During a transplant procedure, the surgeon connects thepatient to a heart-lung machine, which takes over the
functions of the heart and lungs. The surgeon then
removes the diseased heart and replaces it with the donor
heart. Finally, the major blood vessels are reconnected and
the new heart is ready to work.
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Heart failure is sometimes caused by a defective or
diseased heart valve. Heart valves regulate the flow ofblood inside the heart. When they don't work
properly, this puts extra strain on the heart and can
lead to heart failure. Correcting the problem surgically
can often improve or resolve the condition.
A variety of different replacement valves can be used:
a mechanical valve made from metal and plastic, one
made from human or animal tissue. During the
surgery, the patient is connected to a heart-lung
machine that supplies blood to the brain and body.
The bad valve is removed and replaced.
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Some people who have severe heart
failure or serious arrhythmias (irregularheartbeats) are candidates for implantable
defibrillators. These devices are surgically
placed and deliver pacing, or an electric
countershock, to the heart when a life-
threatening abnormal rhythm is detected.
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A left ventricular assist device (LVAD) is a battery-operated,
mechanical pump-type device that's surgically implanted. It helps
maintain the pumping ability of a heart that can't effectively work
on its own.
This device is sometimes called a "bridge to transplant," but is
now used in long-term therapy. People awaiting a heart transplantoften must wait a long time before a suitable heart becomes
available.
A common type of LVAD has a tube that pulls blood from the left
ventricle into a pump. The pump then sends blood into the aorta
(the large blood vessel leaving the left ventricle). This effectivelyhelps the weakened ventricle. The pump is placed in the upper
part of the abdomen. Another tube attached to the pump is
brought out of the abdominal wall to the outside of the body and
attached to the pump's battery and control system.
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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
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Place patient at physical and emotional rest
Rationale: to reduce work of heart.
Auscultate heart sounds frequently and monitor cardiac rhythm. Take frequent
BP readings
Rationale: to detect further complications and attacks
Administer pharmacotherapy as directed
Rationale: administer medications as ordered to control the signs and symptoms
of CHF
Observe for signs and symptoms of reduced peripheral tissue perfusion: cool
temperature of skin, facial pallor, poor capillary refill of nail beds
Rationale: to monitor for signs and symptoms of CHF leading to further
complications
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Raise head of bed 8 to 10 inches (20 to 30 cm)
Rationale: reduces venous return to heart and lungs; alleviates pulmonary
congestion.
Auscultate lung fields at least every 4 hours for crackles and wheezes in
dependent lung fields
Rationale: to detect fluid accumulates in areas affected by gravity
Encourage deep-breathing exercises every 1 to 2 hours
Rationale: to avoid atelectasis
Offer small, frequent feedings
Rationale: to avoid excessive gastric filling and abdominal distention with
subsequent elevation of diaphragm that causes decrease in lung capacity
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Administer prescribed diuretic as ordered
Rationale: to eliminate the excess water retained in body tissues
Give diuretic early in the morning nighttime
Rationale: diuresis disturbs sleep
Keep input and output record
Rationale: patient may lose large volume of fluid after a single
dose of diuretic
Be alert for signs of hypokalemia
Rationale: may cause weakening of cardiac contractions and may
precipitate digoxin toxicity
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Increase patients activities gradually and stay within patients limits of his
cardiac reserve
Rationale: avoid exhaustion but encourage and maintain increases in activity
tolerance
Assist patient with self-care activities early in the day
Rationale: fatigue sets in as day progresses
Monitor the pulse, symptoms, and behavioral response
to increased activity
Rationale: to detect signs of exhaustion or complications
Relieve nighttime anxiety and provide for rest and sleep
Rationale: patients with heart failure have a tendency to be restless at night
because of cerebral hypoxia with superimposed nitrogen retention
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The overall goal of therapy for Mr. Evans is toreduce the signs and symptoms associated with
CHF. Therefore this goal would include the
following:
Decreasing dyspnea
Decreasing adventitious lung sounds
Maintain vital signs within acceptable levels
Decreasing edema
Consistent lab readings within acceptable ranges
Adherence to an established nutritional diet
Adherence to established medication therapy
Avoid alcohol and exercise regularly
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