Heart Failure Recovered

HEART FAILURE
HEART FAILURE
Heart failure (HF), often called congestive heart
failure (CHF) or congestive cardiac failure (CCF),
occurs when the heart is unable to provide
sufficient pump action to maintain blood flow to
meet the needs of the body.
DEFINITION
Congestive heart failure is a disorder that the heart is unable to

maintain satisfactory cardiac output to meet the metabolic needs of the
body (systolic failure) or is unable to receive blood in the ventricles
during diastole (diastolic failure)
OR
Congestive heart failure is defined as inability of the heart to

maintain an output at rest or during stress, necessary for the metabolic
needs of the body (systolic failure) and inability to receive blood into
the ventricular cavities at low pressure during diastole (diastolic
failure).
CAUSES
• Ischaemic heart disease
• Cigarette smoking
• Hypertension (high blood pressure)
• Obesity
• Diabetes
• Valvular heart disease
• 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 erythematosus
• Abuse of drugs such as alcohol and cocaine
• Pharmaceutical drugs such as chemotherapeutic agents
• Arrhythmias.
• Obstructive sleep apnea (a condition of sleep wherein disordered
breathing overlaps with obesity, hypertension, and/or diabetes) is
regarded as an independent cause of heart failure.
• POOR CONTRACTABILITY OF
SYSTOLIC THE MOCARDIUM
• INCREASES THE AFTERLOAD
FAILURE
• STIFF MYOCARDIUM
DIASTOLIC • CAUSES INCREAS FLOW IN
THE LEFT ATRIUM
FAILURE • PULMONARY HEART FAILURE
ACUTE FAILURE
CHRONIC FAILURE
Left-Sided Heart Failure
• Pulmonary
•Manifestations congestion
include: • Shortness of breath
• Weakness • Oliguria
• Fatigue • Organ failure,

especially renal
• Dizziness failure
• Confusion • Death
15
(L) SIDED HF
Tissue hypoxia occurs because heart is unable to efficiently
pump blood
CLINICAL SIGNS of pulmonary congestion:

Dyspnea Orthopnea
Cough WT. gain
Fatigue Anxiety/ restless
S3 Crackles
Cardiomegaly  HR BP
Right-Sided Heart Failure
• Manifestations include:
• Distended neck veins, increased abdominal
girth
• Hepatomegaly (liver engorgement)
• Hepatojugular reflux
• Ascites
• Dependent edema
• Weight: the most reliable indicator of fluid
gain or loss
18
(R) SIDED HF
Blood “BACKS UP” into venous circulation. High oncotic
pressure pushes fluids into tissues.
CLINICAL SIGNS:
 CVP SUDDEN WT. GAIN
 JVD DEPENDENT EDEMA
FATIGUE LIVER CONGESTION
LETHARGY ASCITES
ORTHOPNEA ANOREXIA
19
Assessments
• Laboratory assessment- electrolytes,
• BNP- B type natriuretic peptide.
Normal =0
• Radiographic assessment
• Electrocardiography
• Echocardiography, TEE
• Pulmonary artery catheters
21
22
Lifestyle changes
•Stop smoking
•Loose weight
•Avoid alcohol
•Avoid or limit caffeine
•Eat a low-fat, low-sodium diet
•Exercise
Lifestyle changes
• Reduce stress
• Keep track of symptoms and weight
and report any changes or concern
to the doctor
• Limit fluid intake
• See the doctor more frequently
NURSING
CARE
NURSING MANAGEMENT
ASSESSMENT FINDINGS
Signs and symptoms of CHF vary somewhat depending

of the child age and on whether failure occurs on the
right and left sided CHF (the usual condition) may
include:
1.Respiratory distress, marked by tachypnea, dyspnea, orthopnea,

retraction, nasal flaring, grunting .
2.Cough
3.Tachycardia
4.Ventricular gallop
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
14.Chest radiograph reveals cardiomegaly and pulmonary congestion.
15.Laboratory study result commonly reveal dilutional hyponatreamia,

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. Assess for

diaphoresis, need for frequent rest period and inability to keep up
with peers
19.Follow growth chart

NURSING DIAGNOSIS
Decreased cardiac output related to myocardial dysfunction.
Excess fluid volume related to decreased cardiac contractility and

decreased excretion from the kidney
Impaired gas exchange related to pulmonary venous congestion

activity intolerance related to decreased cardiac output.
• Risk for infection related to pulmonary congestion
•Altered nutrition, less than body requirement related to increased

metabolic demands with decreased calorie intake
•Anxiety related to child diagnosis and prognosis

NURSING INTERVENTION
IMPROVING MYOCARDIAL
EFFICACY
1) Administer digoxin as prescribed.
Measure heart rate; hold

medication and notify health care
provider for hemi rate less than
90bpm .
Check most recent potassium level.

Hold medications and notify health
care provider for less than 3.5gm
potassium level.
Run lead II ECG if ordered to monitor PR interval. If first degree
A V block occurs, notify health care provider and hold medication as
ordered
Report signs of possible digoxin toxicity, vomiting, nausea, visual

changes, bradycardia.
Double check dose of digoxin with another nurse before

administering the dose. Make sure the digoxin order has two
signatures.
Administer after load reduction medications as prescribed .
Measure BP before and after giving the patient the medication. Hold
the medication and notify the health care provider for low BF (greater
than 15mm of Hg drop from baseline) .
Observe for other signs of hypotension, dizziness, light headedness,

syncope.
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 children: provide

dietary assistance as needed.
3) Fluid restriction- not usually needed in children.

RELIEVING RESPIRATORY DISTRESS
1) Administer oxygen therapy as prescribed.

2) Elevate head end of bed
PROMOTING ACTIVITY TOLERANCE
1) Organize nursing care to provide periods of

uninterrupted sleep and rest
2) Avoid unnecessary activities
3) Respond efficiently to a crying infant. Provide

comfort and treat the source of distress: wet,
dirty diaper, hunger.
4) Provide divisional activities that require

limited expenditure of energy.
5) Provide small frequent feedings.

DECREASING RISK FOR INFECTIONS
•Ensure good hand washing by everyone.
•Avoid exposure to ill children/care taker.
•Monitor signs of infections; fever, cough, running

nose, diarrhea, vomiting.
PROVIDING ADEQUATE NUTRITION
1) For older child
Provide nutritious foods that the child likes, along

with supplemental high calories snacks (milk shake,
pudding).
2) For the infants
 High calorie formula (24-30 cal/oz)
 Supplement oral intake with naso-gastric feedings

allow intake through the day with continuous naso-
gastric feedings at night.
REDUCING FEAR AND ANXIETY
1.Communicate the care plan and family
2) Educate the family about CHF and provide home

care nursing referrals to reinforce teaching after
discharge
3) Encourage question: answer question as able to or

refer to another member of health care team.
FAMILY EDUCATION AND HEALTH MAINTENANCE
1) Teach the signs and symptoms of CCF

2) Teach medication: brand name and generic name, expected
adverse effect, dose
3) Demonstrate medication administration
4) 4) With the family, design a medication administration time
schedule
6. Provide guidelines for when to seek medical help
7. Teach infant and child cardio-pulmonary resuscitation as needed
8. Reinforce dietary guidelines; provide a recipe to the parents on how

to. Prepare high calorie formula
9. Reinforce ways to prevent infection
10.Make sure that follow up visits with health care providers is

scheduled.
11.Educate the parents and family on infective endocarditis guidelines

a provide them with written materials.
EVALUATION
1) Heart rate within normal range for age; adequate

urine output
2) No unexpected weight gain
3) Clear lungs, normal respiratory rate and effort
4) Participates in diversional activities

COMPLICATION
•Pulmonary edema
•Metabolic acidosis
•Failure to thrive
•URI
•Arrhythmias
•Death

Heart Failure Recovered

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HEART FAILURE

Congestive heart failure is a disorder that the heart is unable to

Congestive heart failure is defined as inability of the heart to

• Fatigue • Organ failure,

CLINICAL SIGNS of pulmonary congestion:

Signs and symptoms of CHF vary somewhat depending

1.Respiratory distress, marked by tachypnea, dyspnea, orthopnea,

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

12.Neck vein distension hepatomegaly

15.Laboratory study result commonly reveal dilutional hyponatreamia,

16.Assess response to medical treatment plan.

17.Document vital signs and oxygen saturation

18.Observe infant or child during feeding or activity. Assess for

19.Follow growth chart

Decreased cardiac output related to myocardial dysfunction.

Excess fluid volume related to decreased cardiac contractility and

Impaired gas exchange related to pulmonary venous congestion

•Altered nutrition, less than body requirement related to increased

•Anxiety related to child diagnosis and prognosis

1) Administer digoxin as prescribed.

Measure heart rate; hold

Check most recent potassium level.

Report signs of possible digoxin toxicity, vomiting, nausea, visual

Double check dose of digoxin with another nurse before

Observe for other signs of hypotension, dizziness, light headedness,

1) Administer diuretics as prescribed

2) Sodium restriction not usually needed in the children: provide

3) Fluid restriction- not usually needed in children.

1) Administer oxygen therapy as prescribed.

1) Organize nursing care to provide periods of

2) Avoid unnecessary activities

3) Respond efficiently to a crying infant. Provide

4) Provide divisional activities that require

5) Provide small frequent feedings.

•Ensure good hand washing by everyone.

•Avoid exposure to ill children/care taker.

•Monitor signs of infections; fever, cough, running

1) For older child

Provide nutritious foods that the child likes, along

2) For the infants

 High calorie formula (24-30 cal/oz)

 Supplement oral intake with naso-gastric feedings

1.Communicate the care plan and family

2) Educate the family about CHF and provide home

3) Encourage question: answer question as able to or

1) Teach the signs and symptoms of CCF

7. Teach infant and child cardio-pulmonary resuscitation as needed

8. Reinforce dietary guidelines; provide a recipe to the parents on how

9. Reinforce ways to prevent infection

10.Make sure that follow up visits with health care providers is

11.Educate the parents and family on infective endocarditis guidelines

1) Heart rate within normal range for age; adequate

2) No unexpected weight gain

3) Clear lungs, normal respiratory rate and effort

4) Participates in diversional activities