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Congestive Heart Failure

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CHF
Impaired cardiac pumping
Associated with long-standing HTN and CAD
CHF Risk Factors
CAD
Age
Hypertension
Obesity
Cigarette smoking
Diabetes mellitus
High cholesterol
African American descent
Left sided failure
Most common form
Blood backs up through the left atrium into the pulmonary veins
Pulmonary congestion and edema
Causes of Left Sided Failure
HTN
Cardiomyopathy
Rheumatic heart disease
CAD
Right sided failure
Backward flow to the right atrium and venous circulation
Results from diseased right ventricle
Primary cause is left-sided failure
Clinical Manifestations of RSF
Ascites
Peripheral edema
Hepatomegaly
RUQ pain
Splenomegaly
JVD
Anorexia
Clinical Manifestations of LSF
DOE/PND
SOB
Rales
Cough
Oliguria/nocturia
Confusion/anxiety
Tachycardia
Fatigue
Pale, cool, clammy skin
Complications of CHF
Pleural effusion
Arrhythmias
Left ventricular thrombus
Hepatomegaly
CHF Diagnostics
Chest x-ray
ECG
Hemodynamic assessment
Lytes, BUN, creatinine, UA
BNP
Stress testing
Nursing Diagnoses
Activity intolerance
Excess fluid volume
Disturbed sleep pattern
Impaired gas exchange
Anxiety
Noncompliance
Pharmacologic management
ACEI
ARBs
Combo: hydralazine/isosorbide dinitrate
Beta-blockers
Diuretics
Digoxin
Ca++ channel blockers
Patient teaching
Medication regimen
Dietary restrictions
Daily weights
Physical activity
Smoking cessation
S/S of worsening HF
Pulmonary edema
Abnormal accumulation of fluid in the lungs.
May be in the interstitial space or alveoli
Can occur d/t MI or exacerbation of HF
S/S Pulomonary edema
Agitation, restless, anxious
Pale or cyanotic
Cold, clammy skin
Severe dyspnea/suffocation feeling
Tachypnea
Pink frothy sputum
Pulse weak & rapid
JVD
Incessant coughing