Heart Failure 2

• Right-sided heart failure


  Results in fluid buildup in the body
• Causes of right-sided heart failure


  • Coronary Artery Disease (60% of heart failure patients have this)
  • Ischemia
  • Heart muscle disease
  • Systemic or pulmonary hypertension
  • Valvular heart disease
• Signs and symptoms of right-sided heart failure


  • dyspnea
  • fatigue
  • fluid retention
  • pulmonary edema
  • reduced exercise ability
  • persistent cough/wheezing with white/pink phlegm
  • nocturia
  • abdomen swelling
  • sudden weight gain
  • lack of appetite/nausea
• Left-sided heart failure


  Results in fluid buildup in the lungs
• Cough may be misdiagnosed as COPD or asthma because AT FIRST it may be a dry cough. Later it may become moist with pink, frothy sputum
• Systolic heart failure


  Left ventricle loses ability to contract normally so can't pump blood out into circulation
• Diastolic heart failure


  Left ventricle loses ability to stretch (becomes stiff) can't fill during resting period
• Causes of left-sided heart failure


  • Hypertension
  • Coronary heart disease
  • Cardiomyopathy
  • Heart valve disorder
  • Renal dysfunction
• Right-sided heart failure


  The right ventricle is too weak to pump blood into the lungs, causing blood to back up and cause fluid buildup in the rest of the body
• Assessment and diagnostics for heart failure


  • Echocardiogram
  • CXR
  • ECG
  • BUN, creatinine, liver function, thyroid stimulating hormone, CBC, BNP, routine UA
• BNP (B-type natriuretic peptide)


  Less than 125 is normal. High numbers (over 450 for those under 50 and over 900 for those over 50) is an indication patient is currently having an exacerbation of heart failure. High levels=sign of high cardiac filling pressure
• Management goals for heart failure


  • Relieve symptoms
  • Improve functional status and quality of life
  • Extend survival
• Preload


  The degree of stretch during diastole (the period of ventricular filling (reduces amount of blood the blood has to pump)
• Afterload


  The amount of resistance to ejection of blood from the ventricle
• Interventions for heart failure


  • Head of bed up
  • Oxygen
  • Push the -ides medications (furosemide) and morphine
  • End sodium and fluid
• By decreasing amount of fluid in patient body it decreases blood volume which decreases the work the heart has to do
• Lifestyle changes for heart failure


  • Restrict sodium
  • Avoid smoking (including passive smoke), excessive fluid and alcohol intake
  • Weight reduction if needed
  • Regular exercise
  • Teach to recognize s/s to report to a hcp
• Medications for heart failure


  • Ace Inhibitors
  • Beta Blockers
  • Diuretics
• Types of diuretics

  • Loop
  • Osmotic
  • Thiazide
• Geriatric considerations in heart failure


  • Atypical s/s: fatigue, weakness, somnolence
  • May not c/o dyspnea
  • Decreased renal function
  • Urinary urgency and frequency may be stressful
• Assessment of heart failure


  • Don't just look at change in physical status, but emotional too
  • Health history, focusing on s/s of heart failure
  • Ask about the number of pillows they have to use for sleep
  • Ability to participate in ADLs
  • Understanding of HF, self management strategies, ability and willingness to adhere to strategies
  • Assess for hypoxia
  • Jugular vein distention
  • Edema
  • I&O
  • Daily weight
  • Restlessness, anxiety, confusion, change in level of consciousness
  • Skin color
  • Respiratory rate, effort
• Activity recommendations for heart failure

  • Bed rest for acute exacerbations
  • Encourage regular physical activity; 30-45 minutes a day when able
  • Exercise training
  • Pacing of activities
  • Wait 2 hours after eating for physical activity
  • Avoid activities to extreme cold, hot or humid weather
  • Modify activities to conserve energy
  • Positioning; elevation of HOB to facilitate breathing and rest
• Fluid overload management


  • Assess for s/s of fluid overload
  • Daily weight
  • I&O
  • Diuretic therapy, timing of diuretics
  • Fluid intake; fluid restriction
  • Maintenance of sodium restriction