Lorma Colleges

Carlatan, City of San Fernando

La Union

ARUGA
HEART FAILURE

Submitted by:
Angelica S. Pajarillo

January 7, 2015
HEART FAILURE
-inability of the heart to pump sufficient blood to meet the needs of the tissue
for oxygen and nutrients.
-clinical syndrome characterized by signs and symptoms of fluid overload or of
inadequate tissue perfusion=which results when the heart cannot generate a
cardiac output sufficient to meet the bodys demands.
Systolic dysfunction- problems with contraction
Diastolic dysfunction- problems with filling of the heart.

Causes:
-coronary artery disease- ischemia causes myocardial dysfunction because it
deprives heart cells of oxygen and leads to acidosis from the accumulation of
lactic acid.
-cardiomyopathy causes cellular necrosis which decreases contractility
-Systemic or pulmonary hypertension- increases afterload (resistance to
ejection), which increases the workload of the heart and leads to hypertrophy of
myocardial muscle fibers.
-vulvular disorders
-atheroscleros of the coronary arteries- primary cause of heart failure

New York Heart Association (NYHA) Classification of Heart Failure

I.

Ordinary Physical Activity does not cuase undue fatigue, dyspnea,

palpitations or chest pain.
- No pulmonary congestion or peripheral hypotension

II.

III.

IV.

- Patient is considered asymptomatic

- Usually no limitations of ADLs
Slight limitation on ADLs
- Patient reports no symptoms at rest but increased physical activity
will cause symptoms
- Basilar crackles and S3 murmur may be detected.
Marked limitation on ADL
- Patient feels comfortable at rest but less than ordinary activity will
cause symptoms.
Smptoms of cardiac insufficiency at rest

Left Sided Heart Failure

Pulomary Congestion occurs when the left ventricle cannot effectively pump
blood out of the ventricle into the aorta and the systemic circulation.
How left sided heart failure is develop?
1. The increased ventricular end-diastolic blood volume increases the enddiastolic pressure
2. The blood volume and increased pressure in the left atrium increases
which decrease the blood flow from the pulmonary vessels.
3. The pulmonary venous blood volume and pressure increased forcing fluid
from the pulmonary capillaries into the pulmonary tissues and alveoli,
causing pulmonary interstitial edema and impaired gas exchange.
Manifestations:
-crackles
-orthopnea
-dyspnea (paroxysmal nocturnal dyspnea)
-pulmonary edema
-fatigue
-hemoptysis
Right Sided Heart Failure

-occurs because the Right side of the heart cannot eject blood and cannot
accommodate all the blood that normally returns to it from the venous
circulation.
-increased venous pressure leads to jugular vein distention (JVD) and
increased capillary hydrostatic pressure throughout the venous system.
Manifestations:
-hepatomegaly- result from venous engorgement of the liver
-edema- usually affects the feet and ankles
-ascites- as hepatic dysfunction progesses, increased pressure within the
portal vessels may force fluid into the abdominal cavity
-distended jugular vein

Assessment and Diagnostic Findings

-ECG, BUN, Creatinine, CBC
-BNP level- key diagnostic indicator of HF
- increased level indicated increased cardiac filling pressure

Pharmacologic therapy
1. ACE inhibitors promotes vasodilation and diuresis by decreasing
afterload and preload
Side effect: cough
Ex. Captopril (Capoten)
2. Angiotensin II Receptor Blockers (ARBs)- block the effects of Angiotensin
II at the angiotensin II receptor
Side effect: Hyperkalemia, hypotension, renal dysfunction
Ex. Valsartan (Diovan)
Losartan (Cozaar)
3. Beta-adrenergic blocking agents (Beta-blockers) dilates blood vessels
and decreased afterload.

Decreases signs and symptoms of heart failure and improves

exercise capacity

Side effect: dizziness, hypotension and bradycardia

Ex. Metoprolor (Lopressor, Toprol)
Atenolol (Tenormin)
4. Calcium-channel blockers vasodilation and reduction of systemic
vascular resistance
Ex. Amlodipine (Norvasc)
Felodipine (Plendil)
5. Diuretics decreased fluid volume overload; decreased signs and
symptoms of heart failure
a. Loop diuretic inhibit sodium and Chloride reabsorption mainly in
the ascending loop of henle
Ex. Furosemide (Lasix)
b. Thiazide diuretic inhibit sodium and chloride reabsorption in the
early distal tubules.
- Increased excretion of potassium
- Nursing intervention: Monitor potassium level
Ex. Metolazone (Zaroxolyn)
c. Spironalactone (Aldactone) potassium sparing diuretic that blocks
the effects of aldosterone in the late distal tubule and collecting duct.
6. Hydralazine lowers systemic vascular resistance and left ventricular
afterload
7. Isosorbide Dinitrate causes venous dilation, which reduces the amount
of blood return to the heart and decreases preload.
8. Digoxin increases the force of myocardial contraction and slows
conduction through the AV node.
Therapeutic level- 0.5-2.0 ng/ml
Digitalis Toxicity: anorexia, nausea and vomiting, fatigue, depression
and malise= EARLY EFFECTS
Digibind- antidote for toxicity.
Nursing Considerations in administering Digoxin:
1. Assess apicl heart rate before administering digoxin

2. When the patients rhythm is atrial fibrillation and the heart rate is
less than 60 beats per minute, or the rhythm becomes regular, the
nurse may withhold the medication and notify the physician- this
indicates the development of AV Conduction Block.
3. Monitor for GI side effects: anorexia, nausea and vomiting and
abdominal pain and distention.
4. Monitor for neurologic side effect: head ache, malaise, nightmares,
forgetfulness, social withdrawal, depression, agitation, confusion,
paranoia, hallucination, decreased visual acuity, yellow or green halo
around objects especially lights or snowy vision.

Nursing Interventions of Heart Failure

1.
2.
3.
4.
5.
6.
7.

High-back rest or high-fowlers position

Oxygen 6-10 lpm via face mask
Suction secretion
Determine level of consciousness
Facilitate vital signs monitoring especially BP
Elevate the feet (2 pillows) EDEMA
Instruct the client to avoide large amounts of caffeine, found in coffee,
tea, cocoa, chocolate and some carbonated beverages.
8. Instruct the client about the prescribed sodium 2 g/day and low
cholesterol diet.
9. Provide the client with a list of potassium rich foods because diuretics
can cause hypokalemia (except for potassium sparing diuretics)
10.
Monitor input and output and instruct the client regarding fluid
restriction- 1 L/day
11.
Instruct the client to balance periods of activity and rest
12.
Instruct the client to monitor daily weight and measure abdominal
girth.
13.
Instruct the client to report signs of fluid retention such as edema
or weight gain.