This document provides an overview of chronic heart failure for nursing students. It defines heart failure as the heart's inability to pump enough blood to meet the body's needs. It explains the pathophysiology of heart failure including compensatory mechanisms and the differences between left and right sided heart failure. The document discusses medical treatments to reduce workload on the heart including diuretics, ACE inhibitors, and beta blockers. Nursing diagnoses and interventions for patients with heart failure are also reviewed.

1. NURS 5263 Introduction to Chronic Heart Failure

2. Student Resources Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medical-surgical nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins. Chapter 26: Assessment of Cardiovascular Function Chapter 30: Management of Patients with Complications from Heart Disease

3. Objectives Explain normal and abnormal pathophysiology of the heart in relation to chronic heart failure. Differentiate between left and right sided heart failure. Discuss current medical treatments for patients with heart failure. Discuss common teaching principles related to heart failure. Utilize the nursing process as a framework for care in patients with heart failure. Demonstrate competent and compassionate nursing care for the heart failure patient.

4. Stroke Volume The amount of blood pumped by the ventricles per beat. Average resting SV is 60-80 ml (2 Ounces) per beat.

5. Cardiac Output CO – the amount of blood pumped by the heart in 1 minute. Normal CO = 5 Liters per min CO = Heart rate X stroke volume The entire blood volume passes through the heart every minute

6. Starling’s Law of the Heart The greater the stretch of the myocardial fibers, the stronger the force of the contraction.

7. Inotropic effect Positive inotropic effect – increase stroke volume by increasing the force of contraction without stretching the fibers. Digitalis Negative Inotropic Effect – decrease in contraction

8. Congestive Heart Failure Heart is unable to pump adequate amount of blood to meet metabolic needs CHF describes the accumulation of blood and fluid in organs and tissues from impaired circulation.

9. http://www.cdc.gov/dhdsp/library/fs_heart_failure.htm

10. HF Video

11. Preload The amount of blood presented to the ventricles just before systole. Blood volume - stretches cardiac muscle fibers Ventricular compliance – the elasticity or amount of give when blood enters ventricle. Ventricular hypertrophy = decreased ventricular compliance

12. Afterload The amount of resistance to the ejection of blood from the ventricle. Resistance caused by tension in aorta and systemic vessels.

14. Contractility The force of contraction Catecholamines – released by SNS, increases contractility and stroke volume MI = myocardial cell damage = decreased contractility = HF

15. Test Your Knowledge Stroke Volume of the heart is determined by: The degree of cardiac muscle strength. The intrinsic contractility of the cardiac muscle. The pressure gradient against which the muscle ejects blood during contraction. All of the above

16. Heart Failure The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients

18. Compensatory Mechanisms: Ventricular dilation Muscle fibers stretch.. Increase contractile force Increases cardiac output / blood pressure Eventually inadequate …overstretched/overstrained Ventricular hypertrophy Increase in muscle mass Hypertrophic muscle has POOR contractility Increased SNS stimulation First mechanism triggered LEAST EFFECTIVE mechanism Increased workload causes increased demand for O2

21. Chronic Heart Failure Risk Factors: *HYPERTENSION Diabetes Cigarette smoking Obesity High cholesterol level

22. What conditions might contribute to HF? Slide 119

23. Hypertension Tachydysrhythmias Valvular disease Cardiomyopathy Renal failure

24. Hypertension, tachydysrhythmias, valvular disease, cardiomyopathy, and renal failure reduce C/O by: 1. 2. 3.

25. Chronic Heart Failure Types of CHF: Usually manifested by biventricular failure One ventricle may precede the other Prolonged strain …. causes remaining side to fail

26. Left-Sided Heart Failure Results from LV dysfunction Blood backs up into LEFT atrium Pulmonary congestion and edema

27. Left Sided CHF What are the Signs & Symptoms?

28. S & S Left Sided HF Pulmonary symptoms Cough, may have frothy sputum SOB Orthopnea Crackles on auscultation Tachycardia Extra Heart Sound - S3

29. S3 Heart Sound Audio

30. Lung Sounds – Crackles Audio

31. Pulmonary Edema

32. Acute Pulmonary Edema Pulmonary edema : Severe dyspnea, orthopnea Tachycardia, pallor Blood tinged frothy sputum Wheezing, crackles Bubbling respirations Acute anxiety, apprehension, restlessness Diaphoresis cold clammy skin Cyanosis Nasal faring Use of accessory muscles Tachypnea Hypocapnia evidenced by muscle cramps, weakness, dizziness

34. Right-Sided Failure What is #1 Cause? Results from diseased right ventricle Blood backs up into right atrium and venous circulation S & S:

35. S & S Right Sided Failure Peripheral edema Hepatomegaly Splenomegaly Vascular congestion in GI tract Jugular venous distention ABD distention (ascites) from portal hypertension

36. Cor Pulmonale

38. Test Your Knowledge When collecting subjective data, the nurse could expect that the client who is developing left-sided congestive heart failure would describe having: a. to sleep in a reclining chair b. intolerance for fatty foods c. tight fitting shoes d. to urinate frequently

39. Test Your Knowledge All of the following are clinical manifestations of right-sided heart failure except: Hepatomegaly Jugular vein distention Ascites Orthopnea

40. Ejection Fraction The percentage of blood the LV ejects when it contracts Normal = 55% - 65% Mild reduction= 45-55% Moderately reduced = 35-45% Severely reduced = < 35%

41. BNP Brain (B-Type) Natriuretic Peptide Helps regulate BP and fluid volume Secreted from the ventricles in response to increased preload Used to diagnose and monitor HF > 51.2 pg/mL = mild HF > 1000 pg/mL = severe HF

42. Managementof CHF and Pulmonary Edema Reduce the heart’s workload Improve cardiac output How do we do that?

43. Drug Therapy for Chronic HF Goals: Identification of TYPE of HF and underlying cause Correction of Na+ and water retention Reduction of cardiac workload Improvement of cardiac contractility

44. Drug Categories for Treating CHF Drug Categories for Treating HF Standard TX: Diuretics ACE inhibitors Beta Blockers Other drugs used: Cardiac Glycosides (Positive inotropic drugs)[Digoxin] Vasodilator drugs[Nitroprusside] Nonglycoside inotropic Agents (Dobutrex) See Brunner pgs 952-956

45. Review HF Medication Therapy Handout

46. Test Your Knowledge A client admitted with heart failure who is taking a thiazide diuretic has been ordered to receive furosemide (Lasix). What side effect of these medications should the nurse be alert for? a. Hypertension b. Headache c. Bradycardia d. Arrhythmias

47. Test Your Knowledge The treatment of cardiac failure is directed at: Decreasing oxygen needs of the heart Increasing CO by strengthening muscle contraction and decreasing PVR Reducing the amount of circulating blood volume All of the above

48. Test Your Knowledge The physiologic effect of an angiotensin converting enzyme inhibitor in the management of congestive heart failure includes which of the following: (Mark all that apply) a. Decrease peripheral vascular resistance (PVR) b. Decrease in heart rate c. Increase myocardial contractility d. Decrease in afterload

49. Nursing Diagnoses for HF Name some Nursing Diagnoses for HF

50. Nursing Interventions for Patient with HF

51. Test Your Knowledge If a client with left sided heart failure experiences paroxysmal nocturnal dyspnea, which one of the following would be most appropriate to add to the plan of care? a. Place the client on an alternating pressure mattress b. Use several pillows to support the head and thorax c. Administer oxygen per nasal cannula at bedtime d. Cough forcefully to expectorate accumulated secretions

53. Resources Lehne, R.A., Pharmacology For Nursing Care, 7th Edition, 2010, Elsevier Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medical-surgical nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins.