Congestive Heart
Failure
[Link] Anto
Vice Principal-clinical
Child Health Nursing
Central objective
Students will be able to acquire knowledge
regarding congestive heart disease and apply
this knowledge in the clinical field with a
positive attitude
Specific Objectives:-
Students will be able to
define congestive heart failure
explain the aetiology of CHF
describe the Pathophysiology
List down the Signs and symptoms
Explain the Diagnosis
Enumerate the Treatment
describe theNursing care
Conclusion
Congestive cardiac failure
Inability of the heart to pump an adequate amount of blood
to the systemic circulation at normal filling pressure to meet
the metabolic demands of the body.
Etiology
Secondary to structural abnormalities
Volume overload- Lt to Rt intracardiac shunts
Pressure overload -obstructive lesions such as
coarctation of the aorta
Reduced myocardial contractility
Hypoxia, rheumatic fever,
Hypovolaemia,
Cardiomyopathies,
myocarditis,
hypoglycaemia,
hypocalcaemia
High cardiac output demands –
systemic sepsis
Tachyarrhythmia,
bradyarrhythmias
Supraventricular tachycardia,
Atrial flutter
Complete heart block
pathophysiology
After load (pressure load)
,preload(Lt-Rt shunt)
Contractility
filling &ventricular dilation
contractility& CO
If abnormalities are not corrected
Heart muscles damaged
Decrease the CO
Reduced Blood supply to the kidneys
Na & water retention
Fluid overload
Increased workload of the heart
Congestion in the pul:&systemic circulations
The S\S Of CHF divided into3 groups
Pathophysiology
CHF
Sympathetic nervous system
[Link] of cholinergic fibers, 2. increased rate &force
Sweating of contractionn
Tachycardia
Especially on the scalp
[Link] Vascular tone
Peripheral vasoconstruction Blood flow to kidneys
venous return Production of renin,aldosterone&
ADH
pulmonary vascular resistance
Na & water retention
systemic vascular resistance
Blood volume(preload)
afterload
Systemic & pulmonary venous
engorgement
blood flow to limbs
Long term effect-increased preload & after load–
chamber dilation- myocardial hypertrophy,
Progressive CHF
Heart compensates by stretching and enlarging the vent
ricles and increasing the HR
As long as it maintains adequate output no S/S heart fail
ure
Pathophysiology
Lt HF
Due to various Etiological factors
Lt V unable to pump blood….systemic circulation
Increased pressure in Lt A & pul:veins.
Lungs become congested with blood
Elevated Pul: pressure &pul :edema.
Rt HF
due to various Etiological factors
RV unable to pump blood….Pul:artery
Increased pressure in Rt A & systemic venous
circulation
systemic venous HT
Hepatosplenomegaly& occasionally edema
CHF –s\s in Children
Impaired myocardial function
Tachycardia,
fatigue,
weakness,
restless,
pale,
cool extremities,
decreased BP,
decreased urine output
Pulmonary congestion
Tachypnea,
dyspnea,
respiratory distress,
exercise intolerance,
Systemic venous congestion
Peripheral and periorbital edema,
weight gain,
ascites,
hepatomegaly,
neck vein distention
Left CHF/Pulmonary
Congestion
Lt CHF/Pulmonary Congestion-S/S
19
diagnosis
History …s\s
Physical examination
Chest X-ray….cardiomegaly,pul:blood flow
ECG…V hypertrophy
Echo…detect the defect
Congestive Heart Failure
Goal :-
Improve cardiac function
Decrease fluid load
Decrease cardiac demand
Improve tissue oxygenation
Decrease oxygen consumption
Nursing care
1) Improve cardiac function
Digitalis glycosides—Digoxin.05mg\ml(1000mcg=1mg)
Watch dosage (mcg, mg, mL, etc) Infants rarely get > 1cc
Apical pulse BEFORE administration (HOLD IF <90 infants, <70 child)
Narrow toxicity range (0.8 – 2)
S/S- anorexia, N/V, dizziness, diarrhea, HA
TEACH PARENTS!
+Inotropic Drugs (slow HR & increase contractility)
Vasodilators & others (reduce afterload)
Angiotensin converting enzyme inhibitors---captopril
Digoxin:-
Regular interval-8am-8pm
Adm:side of the mouth
Do not mix with food
If vomits do not give 2nd dose
Observe S\S toxicity - anorexia, N/V, dizziness,
diarrhea,
Keep in safe place
Treat the over dose
2) Decrease fluid load
Diuretics (reduce preload
Lasix
K+ suppliments
Daily weights, I/O, E-lytes
3)Decrease cardiac demand
Provide for rest periods
Positioning
Organized care
Sedation
CHF Nursing Care
4) Improve tissue oxygenation
Provide Oxygen as necessary
Hood, mask, NC
Orient child to equipment
Nutrition
6-8 small meals
If formula, need increased calories
Nursing diagnosis:-
Decreased cardiac output r\t myocardial
dysfunction
Excess fluid volume r\t decreased cardiac
contractility
Impaired gas exchange r\t pul: venous congestion
Risk for infection r\t pul:congestion
Imbalanced nutrition less than body
requirement r\t increased metabolic demand
Anxiety r\t prognosis
Nsg care
ICU care
Emotional support
Observe digoxin toxicity
Bp
Uninterrupted sleep
Feeding & calories
Temperature
Position..45 angle
Fluid restriction
Support child & family
Interventions:-
Relieving respiratory distress
Promoting activity tolerance
decreasing risk of infection
reducing anxiety & fear
Family education
Reference:-
Botto LD. Correa A. Erickson JD. Racial and temporal variations
in the prevalence of heart defects. Pediatrics. 107(3):E32, 2001
Mar.
Botto LD. Mulinare J. Erickson JD. Occurrence of congenital
heart defects in relation to maternal mulitivitamin use. American
Journal of Epidemiology. 151(9):878-84, 2000 May 1.
Ferencz C. On the birth prevalence of congenital heart disease.
Journal of the American College of Cardiology. 16(7):1701-2,
1990 Dec.
Fixler DE. Pastor P. Chamberlin M. [Link]. Trends in congenital
heart disease in Dallas County births. 1971-1984. Circulation.
81(1):137-42, 1990 Jan.
Grabitz RG. Joffres MR. Collins-Nakai RL. Congenital heart
disease: incidence in the first year of life. The Alberta Heritage
Pediatric Cardiology Program. American Journal of
Epidemiology. 128(2):381-8, 1988 Aug.
Thank you
