heart failure

موضوع: heart failure سبتمبر 23rd 2008, 6:21 pm

What is heart failure

Heart failure, also called congestive heart failure, ia a condition in which the heart cannot pump enough oxygenated blood to meet needs of the body

Case Study

Mr. Hasan a 77- year old unmarried, is admitted to CCU with swelling of legs, peripheral edema, shortenees of breath, wheezing, fatigue, increase in weight,anorexia. Distended neck veins(JVD). He has a 8- year history of rheumatic fever and HTN.His Brother has also revealed that Mr. Hasan complained of a dyspnea, sweating while feeding, is needing to take frequent rest breaks while working and during exercises.

When Staff Nurse see him he is visibly

blood pressure 190/80, the peripheries are cool and a high jugular venous pressure. Pulse is 78 regular aortic or mitral valvular abnormalities, S3 or S4 blood and urine tests
auscultation of chest may identify abnormal hert sounds, ECG should be undertaken to identify arrythmiams or ischemia events
echocardiogram(echo) - anoninvasive test that uses sound waves to produce a study of the motion of the heart chambers and valves.
Electrocardiogram(ECG or EKG) - To records the electrical activity of the heart ( arrythmiams or dysrthymias), and detects problems with the heart muscle.

Medications that are commonly prescribed to treat heart failure:
Digoxin
Helps strengthen the heart muscle

Diuretics

helps the kidneys to romove excess fluid from the body.Lasix potassium-sparing diuretics-helps the body retain potassium, an important mineral that is often lost when taking diuretics.

ACE(angiotensin converting enzyme) inhibitors dilates the blood vessels, making it easier for the heart to pump blood forward into the body

captopril

beta blockers

decrease the heart rate and blood pressure, and improve heart function by blocking the stress hormone adrenaline .inderal

Nursing Diagnosis
Impaired ges exchang relatd to ventilation / perfusion mismatching or intrapulmonary shunting.

Decrease cardiac output related to alteration in preload, contractility, heart rate avd rythme.

Activity intolerance related to cardiopulmonary dysfunction.

Anxiety related to threat to biology, psychology or social integrity.

Disturbed sleep pattern related to circardian desychronization.

Nursing Interventions
oxygen is administered to relieve dyspnea
Monitor respiratory status and
Assess edema and reduce it
Morphine may be administered to decrease hyperventilation and anxiety

Client teaching and discharge planning:
Need to monitor self daily for S/S
Medication regimen
Prescribed dietary plan
Need to avoid fatigue and plan for rest period

What causes heart failure?
* Congenital
* heart valve disease caused by past rheumatic fever or other infections
*infections of the heart valves and/or heart muscle ( endocarditis)
*cardiac arrhythmias
*cardiomyopathy
*Anemia
*HTN
*Hemorrhage

Congestive Heart Failure
Failure of the heart to eject blood from the ventricles as it enterst the atria, leading to venus stasis of blood and fluid in organs
Failure of on side will shortly affect the other side of the heart
CHF usually starts with L sided failyre.

Right Sided Failure ,complication of COPD
Ascites(axcessive fluid in the peritoneal cavity)
Distended neck veins JVD
Hydrothorax: axcessive fluid in the pleural cavity

Left Sided Failure- complication of HTN
Chyne stoke respiration
Hymoptysis
Orthopnea
Dyspnea