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Heart failure
Definition
 Heart failure, also called "congestive heart
failure," is a disorder where the heart loses its
ability to pump blood efficiently.
 Heart failure is almost always a chronic, long-term
condition that is managed with medications and
lifestyle changes.
Introduction
 Heart failure occurs when the heart is unable to
pump enough blood through the body. This
condition usually occurs over time and is the
result of some form of heart disease.
 The condition is slightly more common among
men than women.
Pathophysiology
 Heart failure is a clinical syndrome that occurs
when the heart does not function adequately
as a pump and fails to pump enough blood to
meet the body's metabolic needs.
 Congestion (the buildup of fluid).
 intravascular and interstitial volume overload
and decreased tissue perfusion.
Pathophysiology
 Systolic heart failure occurs when the heart's
ability to contract decreases.
 Left ventricular systolic heart failure cause fluid
congestion in the lungs, a condition known as
pulmonary edema.
 Right ventricular heart failure causes
hepatomegaly and peripheral edema.
Pathophysiology
 Diastolic heart failure occurs when the heart has
a problem relaxing. This form of heart failure may
lead to fluid accumulation in the pulmonary and
peripheral vasculature
 Heart failure almost never occurs at the same
time as an acute myocardial infarction
The Onset of Heart Failure Is an
Indicator of One or More of the
Following Problems
 Acute myocardial infarction
 Hypertension
 Fluid overload
 Intracranial injury
 Dysrhythmias
The Onset of Heart Failure Is an
Indicator of One or More of the
Following Problems
 Valvular heart disease
 Hyperthyroidism
 Cardiomyopathy
 Fever
 Adult respiratory distress syndrome
Heart Failure Can Also Occur in
Conjunction With
 Pneumothorax
 Oxygen toxicity syndrome
 Intracranial tumors
 Uremic pneumonia
 Drugs (methotrexate, busulfan, hexamethonium,
nitrofurantoin)
Nursing Assessment
 Symptoms
 Severe dyspnea (especially on exertion)
 Orthopnea
 Weakness & fatigue
 Paroxysmal nocturnal dyspnea
 Weight gain
Nursing Assessment
 Swelling of extremities
 Palpitations
 Reduced exercise capacity
 Nocturia
 Gastrointestinal symptoms (nausea, bloating,
constipation, anorexia)
Nursing Assessment
 Record the patient's medical history
Diabetes
Thyroid disease
Cardiomyopathy
Collagen vascular disease
Nursing Assessment
 Assessed for a history of
 Previously compromised heart (chronic heart
failure)
 Hypertension
 Myocardial infarction
 Medications
 Allergies
Nursing Assessment
 Perform a physical examination
 Decreased pulse pressure
 Diaphoresis
 Tachycardia
 Edema (extremities, anasarca, ascites)
 Tachypnea
Nursing Assessment
Pulmonary rales or wheezes
Hepatomegaly
Distended neck veins
Increased venous pressure
Third heart sound (gallop)
Pulsus alternans
Hepatojugular reflux
Pleural effusion (hydrothorax)
Diagnostic Procedures
Diagnostic Procedures
 Chest x-ray
 Elevated BUN and creatinine levels
 Hypokalemia (may be present if the patient is
taking thiazides or loop diuretics)
 Abnormal liver function test values
Diagnostic Procedures
 Proteinuria and high urine specific gravity
 Hyponatremia (evident in cases of severe heart
failure)
 Anemia
 Impaired gas exchange (anxiety and fear)
Nursing Interventions
 Airway, breathing, and circulation
 Provide supplemental oxygen
 Anticipate the need for endotracheal intubation
 Suction as needed
 Provide humidified oxygen
 Elevate the head of the bed into a semi- to high
fowler's position
Nursing Interventions
 Cardiac rhythm and vital signs, including heart
rate, pulse oximetry, blood pressure, lung
sounds, and respiratory rate. Monitor the
patient's level of consciousness, intake and
output, and skin perfusion.
 Establish IV access.
 Laboratory and ABG.
 Chest x-ray.
Pharmacologic Agent

Diuretics (furosemide) decreases preload
secondary to reduction in blood volume
=hypokalemia, hyponatremia, need for Foley
catheterization
Pharmacologic Agent

Morphine venous and arterial vasodilation by
decreasing preload and afterload, reducing
anxiety and resulting heart stimulation, and
myocardial workload.
Avoid for patients: dyspnea, decreased level
consciousness, hypercarbia, or inadequate
ventilation.
Pharmacologic Agent

Vasodilators
 Vasodilators (nitroglycerin, isosorbide)
 Arteriolar dilators (hydralazine, minoxidil)
 Combined dilators (nitroprusside)
 ACE inhibitors (captopril, enalapril)
Pharmacologic Agent

Positive Inotropic agents
Sympathomimetics (dopamine, dobutamine)
Digitalis glycosides
Phosphodiesterase inhibitors (amrinone,
milrinone)
Decrease myocardial workload, improve
oxygen delivery to tissues, and increase
contractility and cardiac output
Pharmacologic Agent

Bronchodilators
Monitor the patient for pulmonary wheezing, as well
as side effects such as nausea, vomiting, and
tachyarrhythmias
Prepared to initiate advanced cardiac life
Patient Education
 A patient who is experiencing heart failure, with or
without pulmonary edema, will be fearful and filled
with anxiety. Therefore, it is critical to maintain a
calm and efficient manner throughout the
assessment, diagnosis, and treatment of the
patient.
Patient Education
 Once the patient is out of immediate danger,
always provide a thorough explanation of what is
happening in clear, straightforward terms. And
whenever possible, educate family members and
significant others who are present.
Conclusion
 The proper identification and management of
heart failure requires a thorough understanding of
the pathophysiology of the disease and in-depth
knowledge of appropriate diagnostics,
interventions, and patient management
techniques.
Conclusion
 When an understanding of all these elements is
achieved, better care can be given to the patient
experiencing heart failure, and mortality and
morbidity can be reduced.