CONGESTIVE CARDIAC FAILURE
Congestive Cardiac Failure is a condition in which the heart is unable to pump adequate amount of blood to meet the metabolic needs of the body's tissues.
Risk Factors: Overt CAD, advancing age, HT, DM, smoking, obesity, high cholesterol levels, proteinuria
Causes
Disorders of heart muscle the heart, CHDMI, HT, valvular heart is decreased contractile properties of the heart. E.g. Myocardial Infarction, Hypertension, Valvular Disease, Congenital Heart Disease, Cardiomyopathies, Dysrhythmia.
Others-
1. Pulmonary embolism, chronic lung disease,
2. Haemorrhage and anaemia.
3. Chrome renal disease also
4. Anaesthesia and surgery
5. Transfusions/infusions
6. Drug induced
7. Physical and emotional stress
8. Excessive Na intake
Pathophysiology
When failure First begins, Left ventricular fails to eject sufficient amount of blood compensatory mechanism.
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Maintains perfusion. When these mechanism fail, amount of blood remaining in left ventricular at end of diastole increases.
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Increase residual blood
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Decrease ventricle's capacity to receive blood from Left atrium
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Left atrium dilate and hypertrophy (inability to eject blood)
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Inability to receive full amount of incoming blood from pulmonary veins.
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Left atrial pressure increase
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Pulmonary edema
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Increased pressure in pulmonary vascular system
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Right ventricular dilates and hypertrophy (to meet increase workload)
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[When right ventricular fails] engorgement of venous system.
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Congestion in GIT, liver, viscera, kidneys, legs and sacrum,
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Right ventricular failure.
Clinical Manifestations
Left Ventricular Failure: Dyspnoea, Cheyne - stroke respiration, cough and hacking productive and frothy, blood-tinged sputum, orthopnoea; paroxysmal/nocturnal dyspnoea, acute pulmonary edema, fear, wheezing, sweating, nasal flaring. Cardiac Asthma
Right Ventricular Failure: liver enlargement, abdominal pain, anorexia, nausea, dependent edema, jugular vein distension, anasarca (late sign generalized edema upper extremity, genital area, thoracic and abdominal walls)
Anxious, frightened, depressed.
Diagnostic Investigation
1. Clinical manifestation, patient's history.
2. Chest x-ray.
3. ABG
4. Pulse oximetry.
5. Liver enzyme-liver failure
6. Increase BUN and Creatinine
7. ECG, Echocardiogram
Medical Management
1. High fowler's position- decreases pulmonary venous congestion and relieves dyspnoea
2. Maintain legs [in dependent position] - do not elevate - increase venous return.
3. Administer oxygen - relieves hypoxia and dyspnoea.
4. Bronchodilators - for severe bronchospasm.
5. Digitalis increase ventricular contractility, increase ventricular emptying and increase cardiac output.
Assess for digitalis toxicity s/s anorexia, nausea, vomiting, diarrhoea, abdominal cramps, headache, fatigue, lethargy, depression, restlessness, irritability, drowsiness, convulsions, aphasia, memory loss, bradycardia, halo vision, flashes of lights, photophobia, blurring, diplopia.
6. Dopamine and dobutamine facilitates Myocardial contractility
7. Diuretic therapy enhance renal excretion of Na and H₂O S. Vasodilators-dilate veins and arterioles decrease BP
8. Vasodilators- dilate veins and arterioles
9. Salt 2 to 4gms/day
10. Provide rest-decreases physical and emotional stress.
11. Mild sedative-promote rest and overcomes anxiety.
12. Passive leg exercise prevents venous stasis.
Nursing Management
1. Assess vital signs every 15 mins client's condition.
2. Monitor for dysrhythmias
3. Administer oxygen- improves tissue hypoxia.
4. Monitor urine output hourly, note for colour and volume oliguria decreased renal perfusion.
5. Assess mental status QH-for cerebral perfusion.
6. Provide rest.
7. Small frequent, meals, because large meals - increase myocardial workload.
8. Monitor Intake/Output.
9. Provide fowler's position facilitates breathing.
10. Frequent oral care if breathing through mouth.
11. Monitor weight daily response to diuretic therapy.
12. Low salt diet-2-4 gm/day.
13. Fluid restriction.
14. Encourage turning, coughing and deep breathing clear airway and facilitate oxygen delivery
15. Monitor ABG and pulse oximetry renal hypoxia acidosis.
16. Monitor peripheral pulse
17. Note colour and temperature of skin.
18. Keep extremities warm - -promotes vasodilation. Formation of clot
19. Watch for signs of thrombophlebitis - decrease venous return.
20. Active range of motion exercise decrease venous pooling.
21. Provide skin care.
22. Provide calm environment for psychological rest.
23. Explain routine regimens and management.
24. Provide emotional support-patient and family
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