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HEART FAILURE
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HEART FAILUREHeart failure (HF), often called congestive
failure (CHF) or congestive cardiac failure
occurs when the heart is unable to psufficient pump action to maintain blood fl
meet the needs of the body.
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DEFINITION
Congestive heart failure is a disorder that the heart is
maintain satisfactory cardiac output to meet the metabolic nbody (systolic failure) or is unable to receive blood in theduring diastole (diastolic failure)
OR
Congestive heart failure is defined as inability of themaintain an output at rest or during stress, necessary for thneeds of the body (systolic failure) and inability to receivethe ventricular cavities at low pressure during diastolefailure).
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CAUSES Ischaemic heart disease
Cigarette smoking
Hypertension (high blood pressure)
ObesityDiabetes
Valvular heart disease
http://en.wikipedia.org/wiki/Ischaemic_heart_diseasehttp://en.wikipedia.org/wiki/Tobacco_smokinghttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Tobacco_smokinghttp://en.wikipedia.org/wiki/Ischaemic_heart_disease -
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Rarer causes of heart failure include:
Viral myocarditis (an infection of the heart muscle)
Infiltrations of the muscle such as amyloidosis
HIV cardiomyopathy (caused by human immunodeficiency virus
Connective tissue diseases such as systemic lupus erythematosu
Abuse of drugs such as alcohol and cocaine
Pharmaceutical drugs such as chemotherapeutic agents
Arrhythmias.
Obstructive sleep apnea (a condition of sleep wherein disorderebreathing overlaps with obesity, hypertension, and/or diabetesregarded as an independent cause of heart failure.
http://en.wikipedia.org/wiki/Myocarditishttp://en.wikipedia.org/wiki/Amyloidosishttp://en.wikipedia.org/wiki/Human_immunodeficiency_virushttp://en.wikipedia.org/wiki/Systemic_lupus_erythematosushttp://en.wikipedia.org/wiki/Obstructive_sleep_apneahttp://en.wikipedia.org/wiki/Obstructive_sleep_apneahttp://en.wikipedia.org/wiki/Systemic_lupus_erythematosushttp://en.wikipedia.org/wiki/Systemic_lupus_erythematosushttp://en.wikipedia.org/wiki/Human_immunodeficiency_virushttp://en.wikipedia.org/wiki/Amyloidosishttp://en.wikipedia.org/wiki/Myocarditis -
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POOR CONTRACTABILITY OF
THE MOCARDIUM
INCREASES THE AFTERLOAD
SYSTOLIC
FAILURE
STIFF MYOCARDIUM
CAUSES INCREAS FLOW IN
THE LEFT ATRIUM
PULMONARY HEART FAILUR
DIASTOLICFAILURE
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ACUTE FAILURE
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CHRONIC FAILURE
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http://upload.wikimedia.org/wikipedia/commons/9/99/Heartfailure.jpg -
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Left-Sided Heart Failure
Manifestationsinclude:Weakness
Fatigue
DizzinessConfusion
Pulmonarycongestion
Shortness of breat
Oliguria
Organ failure,
especially renalfailure
Death
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(L) SIDEDHFTissue hypoxia occurs because heart is unable to efficie
pump blood
CLINICAL SIGNS of pulmonary congestion:
Dyspnea Orthopnea
Cough WT. gainFatigue Anxiety/ restless
S3 Crackles
Cardiomegaly HR BP
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Right-Sided Heart Failure
Manifestations include:Distended neck veins, increased abdominal
girthHepatomegaly (liver engorgement)Hepatojugular refluxAscitesDependent edemaWeight: the most reliable indicator of fluid
gain or loss
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(R) SIDEDHFBlood BACKS UP into venous circulation. High oncot
pressure pushes fluids into tissues.CLINICAL SIGNS:
CVP SUDDEN WT. GAIN JVD DEPENDENT EDEMAFATIGUE LIVER CONGESTION
LETHARGY ASCITES
ORTHOPNEA ANOREXIA
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Assessments
Laboratory assessment- electrolytes,
BNP- B type natriuretic peptide.
Normal =0
Radiographic assessment
Electrocardiography
Echocardiography, TEE
Pulmonary artery catheters
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Lifestyle changes
Stop smokingLoose weightAvoid alcoholAvoid or limit caffeineEat a low-fat, low-sodium dietExercise
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Lifestyle changes
Reduce stressKeep track of symptoms and weightand report any changes or concernto the doctor
Limit fluid intakeSee the doctor more frequently
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NURSING
CARE
NURSING MANAGEMENT
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NURSING MANAGEMENT
ASSESSMENT FINDINGS
Signs and symptoms of CHF vary somewhat depending
of the child age and on whether failure occurs on theright and left sided CHF (the usual condition) mayinclude:
1.Respiratory distress, marked by tachypnea, dyspnearetraction, nasal flaring, grunting .
2.Cough
3.Tachycardia
4.Ventricular gallop
5 P ll ttli i
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5.Pallor, mottling or cyanosis
6.Edema (peripheral and periorbital)
7.Feeding difficulties and failure to thrive
8.Restlessness and irritability
9.Weakness and easy fatigability
10.Unexplained weight gain
11.Abdominal distension
12.Neck vein distension hepatomegaly
13.Diaphoresis
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14.Chest radiograph reveals cardiomegaly and pulmonary cong
15.Laboratory study result commonly reveal dilutional hy
hypochloremia and hyperkalemia
16.Assess response to medical treatment plan.
17.Document vital signs and oxygen saturation
18.Observe infant or child during feeding or activity. diaphoresis, need for frequent rest period and inability with peers
19.Follow growth chart
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NURSING DIAGNOSIS
Decreased cardiac output related to myocardial dysfuncti
Excess fluid volume related to decreased cardiac contradecreased excretion from the kidney
Impaired gas exchange related to pulmonary venous activity intolerance related to decreased cardiac output. Risk for infection related to pulmonary congestion
Altered nutrition, less than body requirement related tometabolic demands with decreased calorie intake
Anxiety related to child diagnosis and prognosis
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NURSING INTERVENTION
IMPROVING MYOCARDIALEFFICACY
1) Administer digoxin as prescribed.
Measure heart rate; holdmedication and notify health careprovider for hemi rate less than
90bpm .
Check most recent potassium level.Hold medications and notify healthcare provider for less than 3.5gmpotassium level.
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Run lead II ECG if ordered to monitor PR interval. If fA V block occurs, notify health care provider and hold meordered
Report signs of possible digoxin toxicity, vomiting, nauchanges, bradycardia.
Double check dose of digoxin with another nuradministering the dose. Make sure the digoxin ordersignatures.
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Administer after load reduction medications as prescribed .
Measure BP before and after giving the patient the medic
the medication and notify the health care provider for low than 15mm of Hg drop from baseline) .
Observe for other signs of hypotension, dizziness, light syncope.
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MAINTAINING FLUID AND ELECTROLYTE BALANCE
1) Administer diuretics as prescribed
Obtain daily weight. Keep strict intake and out put record. Monitor serum electrolyte provide potassium supplement as needed.
2) Sodium restriction not usually needed in the childredietary assistance as needed.
3) Fluid restriction- not usually needed in children.
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RELIEVING RESPIRATORY DISTRESS
1) Administer oxygen therapy as prescribed.
2) Elevate head end of bed
PROMOTING ACTIVITY TOLERANCE
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PROMOTING ACTIVITY TOLERANCE
1) Organize nursing care to provide periods ofuninterrupted sleep and rest
2) Avoid unnecessary activities
3) Respond efficiently to a crying infant. Providecomfort and treat the source of distress: wet,dirty diaper, hunger.
4) Provide divisional activities that requirelimited expenditure of energy.
5) Provide small frequent feedings.
DECREASING RISK FOR INFECTIONS
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DECREASING RISK FOR INFECTIONS
Ensure good hand washing by everyone.
Avoid exposure to ill children/care taker.
Monitor signs of infections; fever, cough, runninnose, diarrhea, vomiting.
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PROVIDING ADEQUATE NUTRITION
1)For older child
Provide nutritious foods that the child likes, alongwith supplemental high calories snacks (milk shake,pudding).
2) For the infants
High calorie formula (24-30 cal/oz)
Supplement oral intake with naso-gastric feedingsallow intake through the day with continuous naso-gastric feedings at night.
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REDUCING FEAR AND ANXIETY
1.Communicate the care plan and family
2) Educate the family about CHF and provide homecare nursing referrals to reinforce teaching afterdischarge
3) Encourage question: answer question as able to or
refer to another member of health care team.
FAMILY EDUCATION AND HEALTH MAINTENANCE
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FAMILY EDUCATION AND HEALTH MAINTENANCE
1) Teach the signs and symptoms of CCF
2) Teach medication: brand name and generic name, expect
adverse effect, dose
3) Demonstrate medication administration
4) 4) With the family, design a medication administration t
schedule
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6.Provide guidelines for when to seek medical help
7.Teach infant and child cardio-pulmonary resuscitation as n
8.Reinforce dietary guidelines; provide a recipe to the pareto. Prepare high calorie formula
9.Reinforce ways to prevent infection
10.Make sure that follow up visits with health care pscheduled.
11.Educate the parents and family on infective endocarditisa provide them with written materials.
EVALUATION
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EVALUATION
1)Heart rate within normal range for age; adequateurine output
2)No unexpected weight gain
3)Clear lungs, normal respiratory rate and effort
4)Participates in diversional activities
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COMPLICATION
Pulmonary edema
Metabolic acidosis
Failure to thrive
URI
Arrhythmias
Death
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