Congestive cardiac failure

2nd Year B.Sc. Nursing, Medical Surgical nursing I

2. CONGESTIVE CARDIAC FAILURE
PREPARED BY:
Roshani P. Naik
2
nd
year B.Sc. Nursing
DATE: 27-4-2015

3. Normal
functions
of the
heart:

4. INTRODUCTION
•Congestive cardiac failure is inability of the heart to
pump sufficient blood to meet the needs of the tissue for
oxygen and nutrients.
•Congestive cardiac failure also referred as HEART
FAILURE. The term heart failure indicates myocardial
disease in which there is a problem with systolic and
diastolic dysfunction that may or may not cause
pulmonary or systemic congestion.

6. DEFINITION
Heart failure is the
pathological process in
which the systolic
or/and diastolic function
of the heart is impaired,
and as a result, cardiac
output decreases and is
unable to meet the
metabolic demands of
the body

7. EPEDEMICS
•Heart failure can affect both women & men.
Although the mortality rate is higher among
women.
•Mainly older people have this disease
condition.

10. •Dysfunction of myocardium
•Myocardial damage
•Myocardial infarction
•Cardiomyopathy
•Myocarditis
•Metabolic disturbance

11. •Ischemia and hypoxia
•Coronary artery disease
•Dysrhythmias
•Valvular disease
•Constructive pericarditis

12. RISK FACTORS
•Hypertension
•Age
•Obesity
•Life style
•Gender
•Diet

13. PATHOPHYSIOLOGY

17. •Cardiovascular symptoms:
oThird heart sound s3
oPallor and cyanosis
oJugular venous distention
•Gastrointestinal symptoms:
oAnorexia
oEnlarged liver
oascites

18. •General
oFatigue
oDecreased activity tolerance
oEdema
oWeight gain
•Respiratory symptoms:
oDyspnea
oOrthopnea
oParoxysmal nocturnal dyspnea
ocough

19. •Cerebrovascular symptoms:
oConfusion
oAltered mental status
•Renal symptoms
oOliguria
onocturia

21. STAGES OF CONGESTIVE CARDIAC
FAILURE
•STAGE A:-
Risk for developing left ventricular
dysfunction without symptoms of heart failure
•STAGE B:-
Develop left ventricular dysfunction
without developed symptoms of heart failure

22. •STAGE C:-
Left ventricular failure with current or
prior symptoms of heart failure
•STAGE D:-
Developed heart failure requiring
specialized intervention

23. DIAGNOSTIC EVALUATION
•History collection
•Physical examination
•ECG-echocardiography
•2-dimensional echocardiogram
•Angiography
•B-type natriuretic peptide

24. •BUN-blood urea nitrogen
•LFT-liver functional test
•Renal function test
•ABG analysis
•Pulse oximetry

25. MEDICAL MANAGEMNET

26. •The goal of management:-
Reduce myocardial work load
improve ventricular pump performance
perfuse essential organs
reduce myocardial remodeling

27. The treatment of decompensated
heart failure are:
•B BLOKERS-Bisoprolol: 1.25-2.5mg once
•Vasodilator –nitroglycerine, morphine
•AGE inhibitor-Capotopril: 6.25mg thrice
•ACE inhibitor -Losartan: 25-50mg once
•Digitalis :-Dopamine and Dobutamine

28. •Diuretics –Furosimide(20-40mg once or twice)
-Hydroclorothiazide(25mg once or twice)
-Hydroclorothiazide(25mg once or twice)
•Analgesic
•positive inotropic agents
•Milrinone

29. SURGICAL MANAGEMENT
•There are mainly three surgical interventions:
•Ventricular assist devices
•Heart transplantation
•Cardiomyoplasty

30. Ventricular assist devices
-It is a mechanical pump that is used to support
heart function and blood flow in people who have
weakened heart
-the device take blood from a lower chamber of
the heart & helps pumps it to the body & vital
organs
•The INTRA AORTIC BALLON PUMP is a
mechanical device that increases myocardial
oxygen perfusion while at same time increasing
cardiac output.

31. Heart transplantation
•It is a procedure by which the failing heart is
replaced with another heart from a suitable
donor.
•In that patient is put on cardio pulmonary
bypass machine.

33. Cardiomyoplasty
•It is a surgical procedure in which healthy
muscle from another part of the body is wrapped
around the heart to provide support for the
failing heart.
•Latissimus dorsi muscle is used for this purpose.
•A special pacemaker is implanted to make the
skeletal muscle contract.

34. NURSING
MANAGEMENT

35. •The following are the goals of nursing
management for the client with heart failure:
To monitor reduced cardiac output
To maintain adequate fluid balance
To reduce myocardial workload
To monitor for pulmonary edema
To assess response to medical therapies.

36. Nursing diagnosis
•Decreased cardiac output related to heart failure
•Excess fluid volume related to decrease cardiac
output, reduced glomerular filtration
•Impaired gas exchange related to flyuid in
alveoli
•Ineffective tissue perfusion related to decrease
cardiac output

37. •Risk for activity intolerance related to decrease
cardiac output
•Risk for skin integrity related to decrease tissue
perfusion and activity
•Risk for anxiety related to decrease cardiac
output, hypoxia

38. Decreased cardiac output related to
heart failure
•Assess heart rate, rhythm, Note heart sound,
monitor BP.
•Inspect skin for pallor and cyanosis.
•Provide quiet environment, explain medical and
nursing management.
•Administer supplemental oxygen.
•Administer medication as indicated-
-loop diuretics, ACE inhibitor, vasodilators, beta
adrenergic receptor antagonists.

39. Excess fluid volume related to
decrease cardiac output, reduced
glomerular filtration
•Monitor urine output, noting amount and color,
•Monitor intake output chart.
•avoid excessive amount of fluid intake.
•Restrict the sodium rich diet.
•Administer the diuretics such as furosemide and
potassium sparing diuretics

40. Ineffective tissue perfusion related to
decrease cardiac output
•Note color and temperature of the skin.
•Monitor peripheral pulses.
•Provide a warm environment.
•Monitor urine output.
•Protect the skin from trauma by applying cotton
socks.

41. Risk for activity intolerance related to
decrease cardiac output
•Space nursing activities.
•Schedule rest periods.
•Monitor the client’s response to activities.
•Increase activity as ordered or according to the
rehabilitation nurse’s directions.
•Instruct the client to avoid activities that
increase cardiac workload.

42. Overview of congestive
cardiac failure

43. What are you doing if you are posted in
emergency ward and patient come with
the complaint of chest pain,
breathlessness, edema on extremities and
in past patient is suffered from heart
disease.

44. CONCLUSION