Cardiovascular Congestive Heart Failure

Front 1

Congestive Heart Failure

Back 1

Main cause is Cardiovascular Disease
Not pumping enough blood to meet the body's needs, may be due to either the increased cellular demands or, more commonly, to impaired pumping of the heart.

Front 2

Compensatory mechanisms to improve CO

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Increased HR, Improved Stroke volume, Arterial vasoconsriction, Sodium and water retention, Myocardial hypertrophy

Front 3

Systolic vs Diastolic dysfunction

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Systolic dysfunction results when the ventricle is unable to contract forcefully enough during systole to eject adequate amounts of blood into circulation
Diastolic- when L ventricle is unable to relax adequately during diastole.

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Contributing factors to heart failure

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*Cardiovascular Disease*
Hypoxia, Anemia, Elecrolyte abnormalitites

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Left Ventricle Failure

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Left ventricle becomes stiff and resistant to filling.
Uncontrolled left-sided heart failure and lead to right-sided heart failure.

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Signs and Symptoms of Left Ventricular Failure

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SOB, Edema (in extremeties, then lungs), fatigue, weakness.
Orthopnea (SOB-when laying flat) paroxysmal nocturnal dyspnea, cough, restlessness, confused, weight gain (fluid)

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Right-sided Heart Failure
S/S

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Edema (sacral area, abdominal area, and jugular distention), weight gain, liver enlargement, ascites, anorexia & nausea, nocturia, weakness

Front 8

Differences in s/s

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L-SOB,orthopnea, cough, restlessness, confused.

R-liver enlargement, ascites, anorexia & nausea (b/c of pressure from fluid),nocturia.

Front 9

Shared s/s in L and R heart failure

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Edema, weakness, weight gain.
In R side failure there is systemic congestion (jugular, legs and sacrum, distended abd, swollen hands and fingers)
In L side failure edema starts in extremities and moves to lungs.

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Left ventricular failure info

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Decreased Stroke volume, increase of blood in L ventricle and atrium
RESPIRATORY-dyspnea, cough

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Right ventricular failure info

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Venous congestion, periphral edema, shows both L & R failure symptoms, decreased urinary output

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Medical Treatment Goals

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Reduce cardiac workload, stregthen myocardial contractility (w/ meds; digoxin), eliminate excess fluid (Diuretics & low sodium diet)

Front 13

Cardiac Glycosides
(Digitalis)

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Digitalis: increases HR & force of contractions which increases CO which increases circulation and tissue perfusion. Also increases renal blood folw and decreases edema

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Cardiac glycosides

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Digoxin(lanoxin): .25mg Q day or .125mg Q day
Digitoxin(Crystodigin): 0.05mg-0.3mg -longer half life (increases toxicity) ANTIDOTE- Digoxin immune AFB (Ovine)

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Digoxin Side effects & Toxicity

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Typical side effects: decreased appetite, slight nausea, altered taste. -All GI symptoms.
Toxicity- Nausea & vomiting, visual disturbances, arrythmias, confusion.
Therapeutic levels: 0.9-2.0
Interactions/Precautions: Diuretics (decreases K+ level, which ^ effects of dig.), Steroids (promote Na retention), Antacids (interfere w/ absorption of meds.)

Front 16

CHF Nursing Assessment

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Medical Hx, s/s, current medical dx and tx, VS, heart sounds (Q4hrs), tissue perfusion, edema/weight (2 or more lbs-call Dr.), urinary output (25-30cc/hr), change positions freq.