Nursing care in patients with Congestive Heart Failure

Inception Report

NURSING IN PATIENTS WITH CONGESTIVE HEART FAILURE

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UNDERSTANDING
Congestive heart failure is a condition where the heart can no longer pump enough blood to meet body needs circulation for tissue metabolism in certain circumstances, whereas in cardiac filling pressure is still high.

CAUSES OF HEART FAILURE

1. Causes of heart failure are classified as follows:
2. Myocardial dysfunction (myocardial failure).
3. Expenses excessive pressure - systolic loading (systolic overload).
4. Excessive volume load - loading diastolic (diastolic overload).
5. Impaired filling (input resistance).
6. Increased metabolic needs - increasing need for excess

LEFT HEART FAILURE SYMPTOMS:
Complaints of body feeling weak, tired, palpitations, shortness of breath, cough, anorexia, and sweating cold, cough and / or coughing up blood, decreased kidney function.

RIGHT HEART FAILURE SYMPTOMS:
Edema, anorexia, nausea, ascites, abdominal pain.

FUSE
Hypertension, myocardial, pulmonary embolism, infection, arrhythmia, anemia, febrile, emotional stress, pregnancy / delivery, infusion / transfusion.

PATHOPHYSIOLOGY
Each obstacle in the flow direction (forward flow) in the circulation will cause the dam to flow in reverse direction (backward congestion). Barriers flux (forward failure) will cause the symptoms of failure in the system backward flow of blood circulation. Cardiac compensatory mechanisms in heart failure is the way the body to maintain blood circulation to meet tissue metabolic needs. Compensatory mechanisms that occur in heart failure are: ventricular dilation, ventricular hypertrophy, increased sympathetic stimulation in the form of tachycardia and peripheral vasoconstriction, elevation of plasma catecholamine levels, retention of salt and fluid loss and increase oxygen ekstraksi by the network.
When the heart of the right and the left together in a state of failure due to interruption of blood flow and the presence of dams, it would appear the signs and symptoms of heart failure on systemic circulation and pulmonary circulation. This is called Congestive Heart Failure (CHF).

LABORATORY EXAMINATION:
There is no specific test that can diagnose heart failure (T. Santoso, heart failure 1989). Laboratory tests are needed to determine the extent to which heart failure has been disturbing the functions of other organs such as liver, kidney and others.

EXAMINATION OF OTHER SUPPORT:
A. Radiology:

• The image of the lung hili thick and wide, getting to the edge density decreases.
• Field lung spots because of pulmonary edema.
• Pulmonary venous distension.
• Hidrothorak.
• Enlargement of the heart, Cardio-thoragic ratio increased.

B. ECG:
Can be found in the primary abnormality of the heart (ischemia, ventricular hypertrophy, rhythm disturbances) and signs of acute trigger factors (myocardial infarction, pulmonary embolism).

C. Echocardiography:
For detection of functional and anatomical disorders that cause heart failure.

D. Cardiac Catheterization:
In left heart failure is obtained (VEDP) 10 mmHg or pulmonary arterial wedge pressure> 12 mmHg in the resting state. Cardiac output is lower than 2.7 lt/mnt/m2 body surface area.

MANAGEMENT
According to the priority is divided into 4 categories:

1. Improving myocardial contraction / perfusion systemic.
2. Lowering the volume of excess fluid.
3. Post Op prevent complications.
4. Surgical treatment (Komisurotomi).
5. Health education regarding disease, prognosis, medications and prevention of recurrence.

ad. 1 Improving myocardial contraction / perfusion systemic:

• Bed rest / bed rest in semi-Fowler position
• Provide oxygen therapy as needed
• Provide medical therapy: digitalis to strengthen heart muscle contraction

ad.2 Lose excess fluid volume

• Provide medical therapy: diuretics to reduce fluid in the tissues
• Record intake and output
• Considering weight
• Restriction of salt / low salt diet

ad.3 Preventing complications

• Schedule a gradual mobilization according to client circumstances
• Prevent the occurrence of immobilization due to bed rest
• Changing sleeping positions
• Noting the adverse effects of Medica mentosa; digitalis poisoning
• Checking or monitoring ECG

ad.4 Surgical Treatment Komisurotomi
Only in the aorta due to infection of aortic regurgitation, aortic valve repair can be considered. While in aortic regurgitation due to other diseases should generally be replaced with artificial valves. Indications on the complaint shortness of breath that can not be overcome by treatment symptomatik. When ekhokardiografi showed left ventricular systole 55 mm, or 25% fractional shortning considered for surgery before heart failure arise.

ad.5 health education, in terms of disease, prognosis, drug use and preventing relapse

• Explaining the course of the disease and prognosis.
• Explaining the use of medications that are used, as well as providing drug administration schedule.
• Changing lifestyles / habits that one: smoking, stress, heavy work, drinking alcohol, foods high in fat and cholesterol.
• Explain about the signs and symptoms that contribute to heart failure, particularly those associated with fatigue, soon tired, palpitations, shortness of breath, anorexia, cold sweat.
• Advise to all controls on a regular basis even if no symptoms.
• Providing mental support; client to accept his situation is real / reality will itself well.

ASSESSMENT OF DATA

1. Activity and rest

• The existence of fatigue / exhaustion, insomnia, lethargy, lack of rest.
• chest pain, dyspnea at rest or during activity.

2. Circulation

• History of hypertension, valve disorders, cardiac surgery, endocarditis, anemia, septic shock, swelling in the legs, ascites, tachycardia.
• Dysrhythmias, atrial fibrillation, premature ventricular contraction.
• Sound S3 Gallop, the sound of CA, the presence of systolic or diastolic, murmur, increased JVP.
• Presence of chest pain, cyanosis, pale, ronchi, hepatomegaly.

3. Mental Status

• Anxiety, fear, anxiety, anger, iritabel / sensitive.
• Stress related to illness, financial social

4. Elimination

• Decrease in urine volume, urine is concentrated
• Nocturia, diarrhea and constipation

5. Food and fluid

• Loss of appetite, nausea, and vomiting
• In the lower limb edema, ascites

6. Neurology

• Dizziness, fainting, pain
• Lethargi, confusion, disorientation, iritabel

7. Comfort
Chest pain, chronic / acute angina

8. Respiration

• Dispnoe at the time of activity, takipnoe
• Sleeping and sitting, history of lung disease

9. Sense of security

• Changes in mental status
• Disorders of the skin / dermatitis

10. Social interaction
Reduced social activity

PRIORITY TREATMENT

• Increase myocardial contractility / systemic tissue perfusion.
• Lose excess fluid volume.
• Preventing Post op complications.
• Provides information about the tailor, prognosis, therapy and prevention of recurrence of disease.

TREATMENT DIAGNOSIS FREQUENTLY ARISING:

1. Decrease in cardiac output in relation to the decrease in myocardial contractility, characterized by:Increased heart rate, changes in blood pressure, decreased urine output, the S3 and S4, chest pain.
2. Limitations of activity in relation to the imbalance between supply and demand of oxygen, characterized by: weakness, fatigue, changes in vital signs, dysrhythmias, dispnoe, diaporesis
3. Disorders of fluid balance, more of the needs in relation to the decline in GFR, marked by: heart sounds 3, orthopnoe, oliguria, edema, weight change, hypertension, respiratory distress, abnormal breath sounds.
4. High risk of failure of gas exchange in relation to changes in alveolar capillary membrane by accumulation of fluid in the lung cavity.
5. Risk of damage to skin integrity about its continuity due to edema, decreased perfusion to the skin.
6. Lack of knowledge about diseases, conditions and treatment in relation to the lack of information is marked with: the patient asked the patient the wrong statement.