Pathophysiology of Heart Failure

In case of heart failure, the body has several adaptations, both in the heart and systemically. If both ventricular stroke volume is reduced, therefore the emphasis contractility or afterload was increased, the volume and end-diastolic pressure in the two chambers of the heart increased. This will increase the length of myocardial fibers end-diastolic, systolic rise time becomes shorter. If this condition persists, ventricular dilatation occurs. Cardiac output at rest can still be good, but the increase in diastolic pressure that lasts longer / chronicle will spread to both the atrium and the pulmonary circulation and the systemic circulation. Finally, capillary pressure will increase which will lead to transudation of fluid and edema arising systemic or pulmonary edema. Decrease in cardiac output, especially if associated with a reduction in arterial pressure or decreased renal perfusion, will activate several neural and humoral systems. Increased activity of the sympathetic nervous system will stimulate myocardial contraction, heart rate and veins; recent changes that will increase central blood volume, which in turn increase the preload. Although these adaptations are designed to increase cardiac output, adaptation itself can interfere with the body. Therefore, tachycardia and increased myocardial contractility can stimulate the occurrence of ischemia in patients with coronary artery disease earlier and increased preload may worsen pulmonary congestion.

Activation of the sympathetic nervous system will also increase peripheral resistance; adaptation designed to maintain perfusion to vital organs, but if activation is increased instead will decrease the flow to the kidneys and tissues. Peripheral vascular resistance may also be a major determinant of ventricular afterload, so that excessive sympathetic activity can improve the function of the heart itself. One important effect is a decrease in cardiac output decreased renal blood flow and filtration rate decreased glomerolus, which will cause sodium and fluid retention. Sitem renin - angiotensin - aldosterone system will also be activated, leading to increased peripheral vascular resistance and penigkatan selanjutnta left ventricular afterload as sodium and fluid retention. Heart failure is associated with increased levels of arginine vasopressin in the circulation increases, which also is vasokontriktor and inhibiting the excretion of fluids. In heart failure increased atrial natriuretic peptide due to increased atrial pressure, which indicates that here there is resistance to the effects of natriuretic and vasodilator.

Nursing Diagnosis for Congestive Heart Failure - CHF related to

Nursing Diagnosis for CHF - Congestive Heart Failure

1 Decreased Cardiac Output
related to

• changes in left ventricular contractility,
• rhythm frequency changes,
• electrical conduction

2. Ineffective Tissue Perfusion
related to

• decrease in cardiac output
• tissue hypoxemia,
• acidosis and,
• the possibility of thrombus or emboli.

3. Ineffective Airway Clearance
related to

• decrease in lung volume,
• hepatomegaly,
• splenomegaly

4. Activity Intolerance
related to

• imbalance between myocardial oxygen supply and demand of the body, the ischemic / necrotic myocardial tissue

5. Excess Fluid Volume
related to

• Systemic fluid overload,
• interstitial fluid permeation in the systemic secondary to decreased cardiac output, right heart failure

6. Imbalanced Nutrition: Less Than Body Requirements
related to

• anorexia,
• dyspnoea,
• nausea, vomiting,
• side effects of drugs,
• sputum production

7. Sleep pattern disturbance
related to

• paroxysmal nocturnal disease,
• hospitalization,
• crowded

8. Anxiety
related to

• fear of death,
• decline in health status,
• crisis situations,
• changes in consciousness.

Nursing Assessment for Congestive Heart Failure

Nursing Assessment for Congestive Heart Failure

1. Activity / rest
Symptoms: fatigue / tiredness throughout the day, insomnia, chest pain with activity, dyspnea at rest.
Symptoms: Anxiety, mental status changes such as lethargy, changes in vital signs of activity.

2. Circulation
Symptoms: history of hypertension, acute myocardial infak, previous episodes of Chronic Heart Failure, heart disease, cardiac surgery, endocarditis, anemia, septic shock, swelling in the legs, feet, abdomen.
Signs: blood pressure; may be low (pump failure), pulse pressure; may be narrow, heart rhythm; dysrhythmias, cardiac frequency; Tachycardia, apical pulse; PMI may spread and change in an inferior position to the left, heart murmurs; S3 (gallops) is diagnostic, S4 may, occur, S1 and S2 may be weakened, systolic and diastolic murmur, Color: blue, pale gray, cyanotic, nail backs; pale or cyanotic with a filling, capillary slow, Liver; enlargement / can be palpated, breath sounds ; crackles, rhonchi, edema; may be dependent, general or pitting especially on the extremities.

c. Ego integrity
Symptoms: Anxiety, worry and fear. Stress-related illness / financial concerns (job / cost of medical care).
Signs: A variety of behavioral manifestations, such as anxiety, anger, fear and irritability.

d. Elimination
Symptoms: Decreased urination, dark colored urine, nighttime urination (nocturia), constipation / diarrhea.

e. Food / fluid
Symptoms: Loss of appetite, nausea / vomiting, significant weight gain, swelling of the lower extremities, clothes / shoes feel tight, high-salt diet / food that has been processed and the use of diuretics.
Symptoms: rapid weight gain and abdominal distension (ascites) and edema (general, dependent, stress and pitting).

f. Hygiene
Symptoms: fatigue / weakness, fatigue during activities of self care.
Signs: Appearances indicate negligence personal care.

g. Neurosensory
Symptoms: weakness, dizziness, fainting episodes.
Symptoms: Lethargy, tangled thought, oriented, behavioral changes and irritability.

h. Pain / Comfort
Symptoms: Chest pain, acute or chronic angina, upper right abdominal pain and muscle pain.
Signs: No quiet, insecure, narrow focus and behavior to protect themselves.

i. Breathing
Symptoms: Dyspnea on exertion, sleeping, sitting or with several pillows, cough with less / no sputum formation, history of chronic disease, use of rescue breathing.
Signs: Respiratory: tachypnea, shallow breathing, use of accessory respiratory muscles. Cough: Dry / loud / or non productive cough may be continuous with / without sputum formation. Sputum; Perhaps blood Flushed, pink / frothy (pulmonary edema). Breath sounds; may not be heard. Mental function; may decrease, anxiety, lethargy. Skin color; Pallor and cyanosis.

j. Security
Symptoms: Changes in mental function, loss of strength / muscle tone, skin abrasions.

k. Social interaction
Symptoms: Decreased participation in social activities are wont to do.

l. Learning / teaching
Symptoms: use / forgot to use heart medications, such as calcium channel blockers.
Symptoms: Evidence of lack of success to increase.

Diagnostic Examination for CHF

Diagnostic Examination for CHF

1. Thoracic X-ray: may reveal an enlarged heart, edema or pleural effusion which confirmed the diagnosis of CHF.

2. ECG: reveals tachycardia, ventricular hypertrophy and ischemia, an echocardiogram.

3. Laboratory examination: includes electrolytes, serum sodium levels revealed a low blood hemodilution that results from the presence of excess water retention, potassium, sodium, chloride, urea and blood sugar.

4. Sonogram (echocardiogram) to indicate the dimensions of ventricular enlargement, changes in the function / structure of the valve or area decreased ventricular contractility.

5. Cardiac catheterization: an indication of abnormal pressure and helps to distinguish right and left heart failure and valvular stenosis or insufficiency. Also assess patency of coronary arteries. Contrast agent is injected into the ventricles show abnormal size and ejection fraction / change in contractility.

6. Ultrasonography (USG): get an overview of free fluid in the abdominal cavity, and the picture of the liver and spleen enlargement. Enlarged liver and spleen is sometimes difficult to be checked manually when accompanied by ascites.

Sample of Nursing Care Plan for Heart Failure - Decreased Cardiac Output

Nursing Care Plan for Heart Failure 
 
Nursing Diagnosis : Decreased Cardiac Output 

NANDA Definition:

Inadequate blood pumped by the heart to meet metabolic demands of the body

Nursing Diagnosis:

Decreased cardiac output related to Altered heart rate and rhythm AEB bradycardia

characterized by:

• with pale conjunctiva, nail beds and buccal mucosa
• irregular rhythm of the pulse
• bradycardic
• pulse rate of 34 beats / min
• generalized weakness

Short-Term Objectives:
the patient Will Participate in activities That Reduced the workload of the heart.

Long-Term Objectives:
Will the patient be Able to display hemodynamic stability.

Nursing Interventions Decreased Cardiac Output Congestive Heart Failure:

1. Auscultation apical pulse; examine the frequency, the heart rhythm.
Rational: Usually tachycardia (even at rest) to compensate for the decrease in ventricular contractility.

2. Record the heart sounds.
Rational: S1 and S2 may be weak due to decreased pumping action. Gallop rhythm common (S3 and S4) is generated as the flow of blood to the porch of distension. Mur-mur may indicate incompetence / stenosis of the valve.

3. Palpation of peripheral pulses.
Rational: The decrease in cardiac output may show decreased radial artery, popliteal, dorsalis, pedis and posttibial. The pulse may disappear fast or irregular pulse to be palpable and alternan.

4. Monitor blood pressure.
Rational: In Congestive Heart Failure early, moderate or chronic blood pressure may increase. In Congestive Heart Failure-up body could no longer compensate and hypotension can not be normal again.

5. Assess against pale skin and cyanosis.
Rational: Pale, indicating reduced peripheral perfusion secondary to cardiac output adekutnya not; vasoconstriction and anemia. Cyanosis may occur as refrakstori Congestive Heart Failure. The area of ​​pain is often colored blue striped atu because of increased venous congestion.

6. Give supplemental oxygen by nasal cannula / mask and drugs as indicated (collaboration).
Rationale: Increased dosage of oxygen to the need to counter the effects of myocardial hypoxia / ischemia.

Activity Intolerance of CHF (Congestive Heart Failure)

Nursing Diagnosis for Congestive Heart Failure (CHF)

Activity Intolerance

related to imbalance between oxygen supply. General weakness, long bedrest / immobilized.

Characterized by:

• Weakness,
• fatigue,
• changes in vital signs,
• presence of dysrhythmias,
• dyspnea,
• pallor,
• sweating.

Goals / evaluation criteria:

Clients will participate in desired activities, meet self-care, achieve increased tolerance activity can be measured, evidenced by a decrease in weakness and fatigue.

Nursing Interventions Activity Intolerance related to Congestive Heart Failure (CHF) :

1. Check vital signs before and immediately after activity, especially when the client is using vasodilators, diuretics and beta blockers.
Rational: Orthostatic hypotension can occur with activity due to drug effects (vasodilation), the displacement of fluid (diuretics) or influence cardiac function.

2. Note the cardiopulmonary response to activity, note tachycardia, dysrhythmias, dyspnea sweaty and pale.
Rationale: Decrease / inability of the myocardium to increase the volume of activity during dpat sekuncup cause an immediate increase heart rate and oxygen demand is also increasing fatigue and weakness.

3. Evaluation of increased activity intolerant.
Rational: It can show increased activity of cardiac decompensation rather than excess.

4. Implementation of cardiac rehabilitation programs / activities (collaboration)
Rationale: Increasing gradual to avoid the activity of cardiac work / oxygen consumption is excessive. Strengthening and improvement of cardiac function under stress, if cardiac function can not be improved again.

Source : http://nursing-care-plan.blogspot.com/2011/12/nursing-diagnosis-activity-intolerance.html