2 Congestive Heart Failure

CONGESTIVE HEART
FAILURE
Definition:
• Congestive heart failure
(CHF), or heart failure, is a
condition in which the heart
can't pump enough blood to
the body's other organs.
• Can be one sided or both
sided failure
ETIOLOGY
A. Narrowed arteries that supply blood to
the heart muscle — coronary artery
disease
B. Past heart attack, or myocardial

infarction, with scar tissue that interferes
with the heart muscle's normal work
C. High blood pressure

ETIOLOGY
D. Heart valve disease due to past
rheumatic fever or other causes
E. Primary disease of the heart muscle

itself, called cardiomyopathy.
F. Heart defects present at

birth — congenital heart defects.
G. Infection of the heart valves and/or heart

muscle itself — endocarditis and/or
myocarditis
CCF-PATHOPHYSIOLOGY
LEFT SIDED HEART
FAILURE (LVF)
Pulmonary Edema
The most severe manifestation of Left
Heart Failure
Fluid leak into the pulmonary interstitial

spaces (Pulmonary congestion/edema)
Hypoxia and poor 02 exchange

CLINICAL
MANIFESTATIONS
(LVF)
LEFT VENTRICULAR FAILURE
• Dyspnea
• Orthopnea – difficulty in breathing
at rest or when lying flat in bed
(supine position causes the fluid to
back up in the lung)
• Cough or wheezing
• Frothy pink sputum
• Crackles can be heard in the
lungs
• Paroxysmal Nocturnal Dyspnea –
waking up at night short of breath.
CLINICAL MANIFESTATIONS
(LVF)
• Cerebral hypoxia- result of decreased
cardiac output causes:
 Anxiety
 Irritability
 Restlessness
 Confusion
 Impaired memory
 Insomnia
• Nocturia-
• Oliguria-late manifestation
RIGHT SIDED HEART FAILURE
(RVF)
CLINICAL MANIFESTATIONS
(RVF)
 Shortness of breath
 Swelling of feet and ankles
 Urinating more frequently at night
 Pronounced neck veins
 Palpitations (sensation of feeling the heart beat)
 Irregular fast heartbeat
 Fatigue
 Weakness
 Fainting
 Hepatomegaly - liver congestion
 Ascites –due to liver congestion
• Jugular venous distention
• S3
• Rales
• Pleural effusion
• Edema
• Hepatomegaly
• Ascites
Clinical
Manifestations
• Fatigue and weakness
• Irregular heartbeats .
• Weight gain- due to retention of fluid
• Anorexia, nausea & bloating develop
secondary to venous congestion of GIT
• Intestinal edema- causes mal-absorption
of food and intestinal hypo motility.
Heart Failure Clinical manifestations :
Pulmonary Congestion (L)
and Systemic Congestion (R)
Right Heart Failure Left Heart Failure
Pulmonary fluid overload

Peripheral fluid overload
21
CCF- INVESTIGATIONS
A. Serum electrolytes ,urea & nitrogen

B. Liver function test
C. Arterial blood gases – to evaluate gas
exchange
D. Kidney functions test
E. Chest X-Ray – may show pulmonary
vascular congestion, cardiomegaly
F. ECG – Ventricular enlargement
G. Echocardiography– to evaluate left
ventricular function
CCF-MEDICATIONS
to reduce cardiac work and improve cardiac
function
a. Diuretics
b. Beta blockers.
c. Digitalis –Digoxin
d. Inotropes-Dopamine, Dobutamine
e. Angiotensin – converting enzyme
inhibitors
SURGICAL MANAGEMENT
Heart Transplantation
 A heart transplant removes a damaged or
diseased heart and replaces it with a healthy
one.
 The healthy heart comes from a donor who has
died. It is the last resort for people with heart
failure when all other treatments have failed.
The most common procedure is to take a

working heart from a recently deceased organ
donor (allograft) and implant it into the
patient. The patient's own heart may either be
removed (orthotopic procedure) or, less
commonly, left in to support the donor heart
(heterotopic procedure).
• HEART TRANSPLANTATION
• Heart Transplantation
•Cardiomyoplasty
This is a procedure in which
skeletal muscles are taken from a
patient's back or abdomen.
Then they're wrapped around an

ailing heart.
This added muscle, aided by

ongoing stimulation from a device
similar to a pacemaker, may boost
the heart's pumping motion.
CCF-Nursing Management
 Assessment of patient- general
condition & vital sign
 Spo2 monitoring
 O2 support-to relieve hypoxia &
dyspnea
 Position client-high fowler or chair to
reduce pulmonary venous congestion
 Position of leg –dependant
 Limit sodium & H2O intake- for severe
CCF patient ,limit H2O to 1L/day
 RIB
NURSING DIAGNOSIS
a. Decreased cardiac output
b. Impaired gas exchange
c. fluid and electrolyte imbalance related
to fluid volume excess
d. Imbalanced nutrition: less than body
requirements
e. Risk for impaired tissue integrity
f. Activity intolerance
g. Sleep pattern disturbance
h. Fear/Anxiety
Breathlessness related to impaired
Pulmonary gas exchange / impaired
gas exchange related to pulmonary
congestion
 Assess and record respiratory
pattern include rate depth and
rhythm.
 Observe color of patient – lips and
nails.
 Reassure patient during distress
episodes.
 Put patient in upright position
supported with by pillows-
encourage lung expansion.
Promote rest – reduces
oxygen demand.
Administer Oxygen therapy
 Give medication as
prescribed to reduce
pulmonary edema.- Diuretics
Strict intake and output
chart
DECREASED CARDIAC
OUTPUT
Assess patient for sign of
decreased cardiac output-e.g.
confusion, dizziness, irritability
Vital sign –BP,PR & Spo2
monitoring
ECG monitoring-monitor for sign
of dysrhythmias
Monitor lung sound-sign of
crackles & coughing
DECREASED CARDIAC
OUTPUT
 Monitor IO -detect sign of reduced
renal perfusion
 Medication as prescribed to
increase myocardial contractility- e.g
Dopamine, Digoxin
 Promotes rest to reduce myocardial
workload & oxygen demand
SELF CARE DEFICIT RELATED TO
FATIGUE / SHORTNESS OF
BREATH
 Assess and record patient’s level of tolerance to
activities of daily living.
 Encourage patient to verbalize activities that
increase fatigue or shortness of breath.
 Provide rest period between and during
activities
 Keep frequently used items within reach of
patient.
 Give encouragement and promotes
independence in activities within patient’s limit.
 Assist patient in activities of daily living.
IMPAIRED SKIN INTEGRITY
RELATED PHYSICAL
IMMOBILITY.
 Assess and record skin integrity.
 Lift correctly to avoid dragging on the
patient’s skin.
 Use pressure relieving mattress as necessary.
 Encourage patient to move position frequently
 If she/ he is unable to do so, assist patient in
changing position every 4 hourly and gently
massage pressure area to promote blood
circulation.
Impaired skin integrity
related physical
immobility.
 Ensure bedclothes are smooth and

free from crumbs.
 Change pampers or bed sheet when
soiled.
 Keep skin clean and dry at all time.
INADEQUATE NUTRITIONAL
INTAKE RELATED TO LOSS
OF APPETITE
 Assess nutritional status.
 Record all intake and output chart
strictly.
 Observe and record for nausea and
vomiting.
 Note vomitus for frequency, amount
and color.
 Refer to dietitian
 Advise on dietary supplements
 Avoid process and canned food.
INADEQUATE
NUTRITIONAL INTAKE
RELATED TO LOSS OF
APPETITE
 Offer small and frequent diet.
 Plan meals with patient and dietitian.
 Assist patient with meals as needed.
 Ensure pleasant environment during
meals.
 Soft diet as tolerated.

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CONGESTIVE HEART

B. Past heart attack, or myocardial

C. High blood pressure

E. Primary disease of the heart muscle

F. Heart defects present at

G. Infection of the heart valves and/or heart

Fluid leak into the pulmonary interstitial

Hypoxia and poor 02 exchange

Pulmonary fluid overload

A. Serum electrolytes ,urea & nitrogen

The most common procedure is to take a

Then they're wrapped around an

This added muscle, aided by

 Ensure bedclothes are smooth and

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