Congestive heart failure free essay sample

Heart Failure: failure of the cardiac muscle to pump blood to meet the body’s metabolic needs CHF is a complication that can result from problems such as cardiomyopathy, valvular heart disease, endocarditis, Acute MI Left-sided failure pulmonary congestion dyspnea, Paroxysmal nocturnal dyspnea Pulmonary edema, rales (crackles) cough ? blood-tinged, frothy sputum restlessness tachycardia S-3 gallop orthopnea pleural effusion Cheyne-Stokes respirations Decreased renal function ? elevated BUN Changes in mental status Fatigue, muscle weakness Right-sided failure (cor pulmonale) enlarged organs Dependent edema (ankle, lower extremities) Edema Weight gain Distended neck vein Liver enlargement and abdominal pain Anorexia, nausea, bloating Anxiety, fear, depression Ascites THINK: Systolic: heart can’t contract and eject Diastolic: ventricles can’t relax and fill Plan/ Implementation 1. Administer cardiac glycosides a. Digitalis (e. g. , digoxin)— fundamental drug in the treatment of heart failure, especially when associated with low cardiac output  b. Two categories of dosages 1) Digitalizing or loading dose— aimed at administering the drug in divided dosages over a period of 24 hours until an â€Å"optimum† cardiac effect is reached 2) Maintenance dose— patient placed on this dose after digitalization; smaller in amount and designed to replace the digitalis lost by excretion while maintaining â€Å"optimal† cardiac functioning 2. g. , pulmonary embolism, infection, anemia, pregnancy, drug use or abuse, fluid over load, arrhythmia, valvular heart disease, cardiomyopathies, congenital heart disease) . . The New York Heart Association (NYHA) developed a classification system, still used today to quantify the functional limitations of CHF patients. The NYHA classes are as follows: a)Class I : Degree of effort necessary to elicit CHF symptoms equals those that would limit normal individuals. b)Class II: Degree of effort necessary to elicit CHF symptoms occurs with ordinary exertion. c)Class III : Degree of effort necessary to elicit CHF symptoms occurs with less- than ordinary d)exertion. e)Class IV. Degree of effort necessary to elicit CHF symptoms occurs while at rest. Substances That May Exacerbate Heart Failure; Promote Sodium RetentionProduce Osmotic EffectDecrease Contractility Androgens Albumin Antiarrhythmic agents (e. g. , disopyramide, flecainide, quinidine) CorticosteroidsGlucose DiazoxideMannitol? -adrenergic blockers Estrogens Saline Select calcium channel blockers (e. g. , diltiazem, nifedipine, verapamil) LicoriceUrea Lithium carbonate amphetamines) Direct cardiotoxins (e. g. , doxorubicin, ethanol, cocaine) NSAIDsTricyclic antidepressants Treatment goals. CCHF requires a two-pronged therapeutic approach, the overal l goals of which are; 1. To remove or mitigate the underlying causes or risk factors; For example, by eliminating ingest ion of certain drugs or other substances that can produce or exacerbate CHF or by correcting an anemic syndrome, which can increase cardiac demands (Table 42-3) . In addition, modify risk factors that can cause cardiac injury by treating hypertension and diabetes; managing atherosclerotic disease; and controlling smoking, alcohol, and illicit drug use. 2. To relieve the symptoms and improve pump function by: a)Reducing metabolic demands through rest, relaxation, and pharmaceutical ontrols b)Reducing fluid volume excess through dietary and pharmaceutical controls c)Administering a combination of diuretics, angiotensin-converting enzyme inhibitors (ACEIs) ? -adrenergic blockers, and angiotensin- receptor blockers (ARBs) d)Promoting patient compliance and self regulation through education e)Selecting appropriate patients for cardiac transplantation Stages of CHF Based on Evolution and Progression of Clinical Findings And Approach to CCHF At Risk for Heart FailureHeart Failure Stage A Stage B Stage C Stage D PatientsPatients at high risk of developing CHF because of presence of onditions that are strongly associated with development of condition; such patients have no identified structural or functional abnormalities of the pericardium, myocardium, or cardiac valves and have never shown signs or symptoms of CHFPatients who have developed Structural heart disease that is strongly associated with development of CHF but who have never shown signs or symptoms of the conditionPatients who have structural heart disease with current or prior symptoms of CHFPatients with refractory CHF who require specialized interventions GoalsTreat hypertensionSame as stage ASame as stage ASame as stage.