Transcript Congestive Heart Failure: What your patients need to know.

Congestive Heart Failure:
What your patients need to know.
Lisa M. Kappers, RN, BSN
Alverno College MSN Program
Patient Care Coordinator – Infusion Therapy Center,
WFSI – All Saints
Tutorial Instructions
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Use the buttons at the bottom of each
slide to navigate through the tutorial
or follow the special instructions on
certain slides.
The “Home” button will bring you back
to the beginning.
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Tutorial Outcomes
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At the end of this tutorial you will be able to:
– Teach your patients about the pathophysiology of CHF.
– Teach your patients about the importance of a low sodium
diet.
– Teach your patients how to “live” with CHF.
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In order to complete this tutorial:
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You should know the basic pathophysiology of normal cardiac
function and normal respiratory function. If you need to
review, the links below will take you to tutorials on:
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Path of blood flow
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To return from these tutorials, click the back button on your browser.
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Cardiac Cycle
Blood pressure
Respiratory System
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Let’s review the basics.
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Which side of the heart pumps blood
to the lungs?
– Right
– Left
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Great Job!
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The right side of the heart pumps
blood to the lungs.
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Click on our friend to move forward.
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Sorry.
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Remember, the left side of the heart
pumps blood to the peripheral
circulatory system.
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Home
Click on our friend to try again.
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Which part of the respiratory
system is directly responsible
for gas exchange?
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A. Trachea
B. Larynx
C. Alveoli
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Try Again.
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The trachea is part of the lower airway
but is not directly responsible for gas
exchange.
Click the duck to try again.
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Try Again.
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The larynx is responsible for air flow in
and out of the lungs as it is a part of
the upper airway. It is not responsible
for gas exchange.
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Click the gator to try again.
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Great Job!
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The alveoli are thin sacs at the end of
the bronchioles which are directly
responsible for gas exchange.
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Now that we’ve reviewed the
basics, let’s talk about CHF.
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Remember, the basics are essential in
order to complete this tutorial. If you
need to review, return to the provided
links at the beginning of the tutorial.
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Let’s define congestive
heart failure.
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Heart failure is defined by the
ACC/AHA as a disorder where the
ventricle is prohibited from filling with
or ejecting blood (2005). There are
many different clinical signs of heart
failure.
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Right-Sided Heart Failure
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Right sided heart failure occurs when
the heart can not move the blood from
the periphery into the pulmonary
system. This causes blood to back up
into the peripheral venous system.
(Porth, 2004)
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What symptoms are caused
by right-sided heart failure?
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Peripheral edema
Dyspnea
Ascites
Hypoxia
Anorexia
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You are correct!
When the right side of the heart can not
move blood from the peripheral system
to the pulmonary system, peripheral
edema occurs.
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Click here to pick another symptom
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Dyspnea is not a symptom
of right-sided heart failure.
Click here to return to question
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In right sided heart failure, the blood
can not move from the peripheral
system to the pulmonary system. This
does not cause hypoxia.
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Good job!
When blood can not be moved from the
peripheral system to the pulmonary
system, fluid builds up in the abdominal
cavity causing ascites.
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Click to return to question
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Excellent!
Fluid in the abdomen can push on the
organs causing nausea and anorexia.
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Click to return to question
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Click to move forward
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Left-Sided Heart Failure
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Left-sided heart failure occurs when
the blood from the pulmonary system
can not be pumped into the peripheral
system. This causes the blood to back
up into the pulmonary vasculature.
(Porth, 2004)
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What symptoms would you
observe with left-sided heart
failure?
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Hypoxia
Dependent edema
Cough with frothy sputum
Orthopnea
Jugular vein distention
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Fabulous!!
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Hypoxia occurs due to the pulmonary
congestion caused by left-sided heart
failure.
Click here to return to question
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Oops, sorry.
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Dependent edema occurs when the
blood from the peripheral vasculature
can not move forward during rightsided heart failure.
Click here to return to question
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Great job!
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The cough occurs due to the
congestion in the pulmonary
vasculature.
Click here to return to question
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Great thinking!
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Orthopnea occurs when the patient is
reclined and the blood from the
peripheral vasculature settles in the
pulmonary system.
Click here to return to question
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Let’s think about this.
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Jugular vein distention occurs when
blood backs up in the peripheral
vasculature. This happens during
severe right-sided heart failure.
Click here to return to the question
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Chronic Heart Failure
Chronic heart failure is a
combination of right and left
heart failure. The right and
left ventricles must maintain
an equal output. Persistent
left sided failure can lead to
right sided failure. (Porth, 2004)
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How does blood pressure
affect heart failure?
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Hypertension
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There are two types of hypertension: primary and
secondary.
Primary hypertension accounts for 90 – 95% of all
cases and does not result from another disease
process.
Secondary hypertension is the direct cause of a
primary disease process such as renal disease.
(Porth, 2004)
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Uncontrolled hypertension increases the
workload of the left ventricle by increasing
the pressure against which the heart must
pump. The left ventricle hypertrophies or
thickens, decreasing ejection fraction and
putting the patient at risk for CHF.
(Porth, 2004)
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Hypertension is a risk factor for all
major cardiovascular disorders such as
atherosclerosis, stroke, heart failure,
coronary artery disease, and
peripheral artery disease.
(Porth, 2004)
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Atherosclerosis and
Coronary Artery Disease
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Atherosclerosis is defined as fatty
lesions developing in the intimal lining
of the aorta, coronary arteries, and the
large arteries that supply blood to the
brain.
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Joe has hypertension.
How does Joe develop CHF?
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Hypertensio
n
Click to see how
comorbidities
might fit together.
Vessel
Wall
Damage
Coronar
y
Artery
Disease
Atherosclerosi
s
Myocardial
Infarction
Ventricular
Dysfunction
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CHF
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How bad is Joe’s CHF?
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There are different classification
systems:
New York Heart Association
American College of Cardiology/
American Heart Association guidelines
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New York Heart
Association classification
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Based on the ability to function
Level I – No symptoms, no activity limits
Level II – Mild symptoms, slight limits, comfortable
at rest
Level III – Moderate limited activity, comfortable
only at rest
Level IV – Severe restrictions, symptomatic at rest
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(Porth, 2004)
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ACC/AHA Heart Failure
Guidelines
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Based on risk factors, ventricular remodeling, and
progressive symptoms
Stage A - High risk for HF, no structural heart
disease, no symptoms
Stage B – Structural heart disease, no symptoms
Stage C – Structural heart disease with prior or
current symptoms
Stage D – Refractory HF
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(Hunt et al, 2005)
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Joe becomes very short of
breath and presents to the
emergency room:
56 YEAR OLD MALE
 Hx: diabetes, CAD, HTN
 C/O SOB, “light headed”
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Admitted by Dr. Heart
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Diagnosis: CHF
Physician orders:
– Chest XRAY
– Chemistry panel, BNP, CBC
– EKG
– Echocardiogram
– 2 gram sodium diet
– Activity as tolerated
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For the next three days
you monitor Joe:
Daily weight
Intake and output
Blood sugars
Vital signs
Activity level
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Dr. Heart discharges Joe and
tells you to do patient
education prior to discharge.
What do you teach?
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 #1
reason for readmission to
the hospital is non-compliance
with treatment.
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(Clark & Dunbar, 2003)
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What do we teach?
Medications and side effects
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Which classification of medications
promotes the excretion of fluid, reduces
preload, and operates at an optimal part
of the Frank-Starling curve?
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Diuretics
Beta
blockers
ACE inhibitors
Digitalis
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Great Job!!
Click here
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Sorry, let’s think about
that again.
Click here
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Which group of drugs increase the force
and strength of ventricular contraction,
decreases heart rate, and increases
diastolic filling time?
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Diuretics
Beta
blockers
ACE inhibitors
Digitalis
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You are so smart!
Click here
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You may need to review.
Click here
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Which group of drugs interferes with the
RAA pathway?
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Diuretics
Beta
blockers
ACE inhibitors
Digitalis
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Great Job!!
Click here
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Sorry, let’s think about
that again.
Click here
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Which group of drugs decrease left
ventricular dysfunction associated with
the sympathetic nervous system?
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Diuretics
Beta
blockers
ACE inhibitors
Digitalis
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Very good!
Click here
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Sorry.
Click here
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Common side effects that your
patient should be aware of:
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Diuretics: excessive urination, hypotension &
dizziness, hypokalemia
Beta Blockers: fatigue, impotence, bradycardia,
dizziness & hypotension
ACE Inhibitors: Excessive urination, angioedema,
electrolyte imbalance, dizziness & hypotension
Digitalis: bradycardia, toxicity
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Medications such as diuretics can alter
the levels of electrolytes such as
potassium within the blood. Nutrition
can be an important factor in
maintaining a balance for the patient
with CHF.
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Nutrition
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Low Sodium Diet
– Define “What is a low sodium diet?”
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2000 milligrams or less per 24 hours
– How to read food labels.
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Low sodium means 140mg or less per serving
Patients must also monitor their daily fluid
intake.
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How does sodium work?
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Sodium enters the body through the
GI tract and is excreted primarily by
the kidneys. Water follows sodium.
(Porth, 2004)
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High sodium foods
 Canned
foods
 Ham, bacon, sausage
 Deli meats and hot dogs
 Prepared mixes, frozen dinners,
seasoning packages
 Salad dressings
 Fast foods
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How does potassium
work?
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Potassium regulates the electrical
membrane potentials controlling the
contractility of skeletal, cardiac, and smooth
muscles. Hypokalemia causes EKG changes
and ventricular arrythmias. Hyperkalemia
can cause ventricular fibrillation and cardiac
arrest.
(Porth, 2004)
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What about potassium?
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Some diuretics cause potassium loss.
– Loop diuretics
– Thiazide diuretics
– Thiazide-like diuretics
Also, excessive vomiting/diarrhea.
Potassium excess is typically caused by
renal insufficiency or failure.
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Do you know which foods
are rich in potassium?
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Click on the foods rich in potassium.
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VEGETABLES !!!
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You are correct but did you pick them
all? Click our friend to move forward or
click the question mark to choose
another.
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FRUIT!!
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Great job but did you get them all?
Click on our friend to move forward or
click the question mark to return to
the question.
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Turkey, fish, & beef!!
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Great job! Click on our friend to move
forward or click the question mark to
return to the question.
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Candy??
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Did you really mean that? Click our
friend to return to the question.
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Potato chips??
Did you make a mistake? Click our friend
to return to the question.
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The kidneys regulate
electrolytes.
The function of the kidneys
are to filter the blood and
maintain fluid and
electrolyte balance. The
kidneys produce 1.5 liters
of urine per day. (Porth, 2004)
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Teach patients to observe their urinary
output daily. If they notice it
decreasing and their weight
increasing, they should
notify their doctor.
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When do I call the doctor?
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Weight gain > 2
lbs. in 24 hours
Trouble sleeping
Shortness of breath
Dry cough
Increased swelling
in abdomen or
extremities
Fatigue
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Congestive heart failure affects and is affected
by multiple body systems. With your increased
understanding comes an improved foundation
for patient education and improved patient
outcomes.
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THANK YOU!
Thank you for
completing this
tutorial. I hope it has
provided you with
information to use
when educating your
CHF patients.
Good Luck!
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References
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Hunt, S.A., Abraham, W.T., Chin, M.H., Feldman, A.M., Francis, G.S., Ganiats, T.G., Jessup, M., Konstam, M.A., Mancini,
D.M., Michl, K., Oates, j.A., Rahko, P.S., Silver, M.A., Stevenson, L.W., & Yancy, C.W. (2005). ACC/AHA guideline update for
the diagnosis and management of chronic heart failure in the adult: A report of the American College of Cardiology/
American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the
Evaluation and Management of Heart Failure). American College of Cardiology Web Site. Available at:
http://www.acc.org/clinical/guidelines/failure//index.pdf.
Porth, C.M. (2004). Essentials of pathophysiology: Concepts of altered health states. Philadelphia, PA: Lippincott Williams &
Wilkins.
Clark, P.C., & Dunbar, S.B. (2003). Family partnership intervention: A guide for a family approach to care of patients with
heart failure. AACN Clinical Issues: Advanced Practice in Acute Critical Care, 14(4), 467-476.
Images retrieved from Microsoft Office Clip Art.
Bowne, P. S., 2004. Path of Blood Flow Tutorial. Retrieved April 27, 2007 from
http://faculty.alverno.edu/bowneps/pathofbloodflow/pathmap.htm.
Bowne, P., 2004-2006. PATHO Interactive Physiology Tutorials. Retrieved May 11, 2007 from http://
faculty.alverno.edu/bowneps/cardiaccycle/cardiaccycle1map.htm.
Bowne, P., 2004-2006. PATHO Interactive Physiology Tutorials. Retrieved May 11, 2007 from
http://faculty.alverno.edu/bowneps/bp/bpindex.htm.
Sheffield, S., (2007). Get Body Smart-The respiratory system – Anatomy & physiology. Retrieved May 11, 2007 from
http://getbodysmart.com/ap/respiratorysystem/menu/menu.html.
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