Tuesday, November 29, 2022

Nursing Diagnosis For Congestive Heart Failure

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Congestive Heart Failure Nursing Diagnosis

Congestive Heart Failure (CHF) Treatment, Management, Nursing Interventions & Medications Part 2

Congestive heart failure is a condition in which the heart is unable to pump blood effectively. This can lead to shortness of breath, fluid accumulation in the lungs, and edema of the legs or other parts of the body. The nurses role in caring for patients with CHF is to monitor for signs and symptoms related to congestive heart failure and provide interventions aimed at preventing complications from developing.

What Is Congestive Heart Failure

Heart failure is a chronic, progressive condition. It occurs when the heart is unable to pump effectively and produce enough cardiac output to successfully perfuse the rest of the bodys tissues and organs. An individual can have right-sided or left-sided heart failure as well as systolic or diastolic heart failure.

Left-sided heart failure is also known as Congestive Heart Failure . In CHF, the heart is either unable to contract completely or fill completely during relaxation. It can lead to an inadequate amount of blood pumping out of the heart. Thereby, backing up into the right side and then ultimately to the lungs and throughout the body causing congestion.

Systolic heart failure means the heart is not able to contract completely and affects its ability to pump blood out of the heart.

Diastolic heart failure means the heart is unable to relax fully between heartbeats and allows the appropriate amount of blood into the ventricle.

In this post, well formulate a sample nursing care plan for a patient with Congestive Heart Failure based on a hypothetical case scenario.

Nursing Diagnosis For Complete Heart Block

Cardiovascular system: K14.2,K40.7

Nursing Diagnosis Code: Nursing diagnosis code: 10338: NANDA-I code: K14.2, K40.7

Pain: CHF is usually diagnosed based on observed signs and symptoms of the disease/condition and diagnostic tests such as blood tests, EKGs to evaluate the electrical activity in the heart, and cardiac catheterization to assess blockages affecting blood flow from the heart. Patients with CHF often experience pain throughout their bodies due to poor circulation. However, this is not always a defining characteristic of CHF.

Signs & Symptoms: This may include the potential for long-term changes in mental status, anxiety, and depression.

Trauma: CHF is usually diagnosed based on observed signs and symptoms of the disease/condition and diagnostic tests such as blood tests, EKGs to evaluate the electrical activity in the heart, and cardiac catheterization to assess blockages affecting blood flow from the heart. Patients with CHF often experience pain throughout their bodies due to poor circulation. However, this is not always a defining characteristic of CHF.

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How To Prevent Complications Of Coronary Artery Disease

If you have confirmed that you have CAD, your doctor may recommend medicines to help treat or prevent the disease from getting worse.

The blood-thinning medicine aspirin prevents clotting in your arteries. It helps reduce the chance of a heart attack or stroke because it keeps atheromatous plaque from sticking to the lining of your arteries.

If you have diabetes and CAD, the possibility of a heart attack or death is much greater. Fortunately, with careful control of blood glucose, it may be possible to reduce these risks.

People who have cardiovascular disease should avoid certain medicines that can cause bleeding in the blood vessels of the brain or gastrointestinal tract. These medicines include aspirin, ibuprofen, and naproxen unless your doctor says its OK to take them.

Smokers should stop smoking because it can lead to heart disease. If you have CAD and smoke, quitting will reduce your risk of death by 50% or more in the first 20 years after giving up cigarettes.

A healthy lifestyle can also help you prevent the complications of CAD. These include:

-Eating fruits, vegetables, and a low-fat diet

-Exercising for 30 minutes daily

-Not drinking excessive amounts of alcohol

-Controlling your weight

Complications Of Heart Failure

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  • Kidney damage. A reduction of blood flow from the heart to the kidneys may result to reduce capacity of the kidneys to remove toxic waste. If left untreated, this may lead to kidney failure which may require the patient to undergo dialysis.
  • Liver damage. Fluid build up may result to an increased pressure to the liver. If left untreated, this may result to liver damage known as scarring.
  • Other cardiac issues. Heart failure may result to faulty heart valves and arrythmias if there is an increased pressure in the heart or enlargement of the heart.
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    Examples Of Medicines That Are Used In Treating Cad

    ACE inhibitors help relax blood vessels, so more blood flows to your heart. There are several types of ACE inhibitors.

    Some examples are:

    Calcium channel blockers help control blood pressure by relaxing blood vessels and lowering heart rate. Examples include:

    Diuretics remove excess water, salt, and minerals from your body, helping it to lower blood pressure and giving you more energy. Examples include:

    • Hydrochlorothiazide Chlorothiazide
    • Spironolactone Amiloride HCl

    Beta-blocker + Diuretic medicines effectively treat high blood pressure and help prevent a second heart attack. This combination is also effective in treating chest pain and improving exercise tolerance.

    Angiotensin-converting enzyme inhibitors + Beta-blockers are very effective treatments for CAD patients who have had a heart attack or have congestive heart failure and high blood pressure.

    Coronary artery bypass graft surgery is used to treat severe coronary heart disease. This procedure involves moving a healthy vein from your leg or chest wall and using it to bypass the narrowed section of an artery in the heart muscle, restoring blood flow around the blockage.

    Nursing Assessment For Deficient Knowledge

    Assessment Rationale
    Assess the patients knowledge regarding causes, treatment, and follow up care to heart failure. This information provides data regarding knowledge of the patient about heart failure. It helps to plan educational sessions for the patient and family members.
    Discuss with the patient and relatives about the disease and find out the existing misconceptions regarding treatment and care. Finding out misconceptions and Clearing them out from the mind also guide future interventions.

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    How To Conduct Electrocardiogram To Diagnose Heart Failure

    Step 1: The patient will lie down or sit down if theyre too weak to stand.

    Step 2: The doctor will place electrodes on the patients chest to check for electrical activity in the heart. These electrodes are placed over each of the hearts four chambers, and one electrode is also placed on their back .

    Step 3: The doctor will apply a small amount of gel to each electrode and also put the back electrode in place.

    Step 4: The doctor will turn on the EKG machine and read its printout for irregularities that may indicate heart failure. Depending on what is found, they may refer you to a specialist who can do further tests.

    Epidemiology Of Heart Failure

    Congestive Heart Failure (CHF) Pathophysiology, Nursing, Treatment, Symptoms | Heart Failure Part 1

    Heart failure is mostly found in elderly patients . About 2% to 3% of the United States Of America population are affected by Heart failure, of which 10% are male and 8% are female. According to a CDC report, around 6.3 million heart failure patients were there in 2018. USA government-issued 379,800 death certificates mentioning death cause as heart failure.

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    Ineffective Cerebral Tissue Perfusion

    May be related to:tissue ischemia, reduction or interruption of blood flow, vasoconstriction, hypovolemia, shunting, depressed ventricular function, dysrhythmias, conduction defects.

    As evidenced by:abnormal hemodynamic readings, dysrhythmias, decreased peripheral pulses, cyanosis, decreased blood pressure, shortness of breath, dyspnea, cold and clammy skin, decreased mental alertness, changes in mental status, oliguria, anuria, sluggish capillary refill, abnormal electrolyte, hypoxia, ABG changes, chest pain, ventilation perfusion imbalances, changes in peripheral resistance, impaired oxygenation of myocardium, ECG changes in S-T segment, T wave, U wave, palpitations.

    Types Of Heart Failure

    There are two types of heart failure depending on the type of underlying disease that has caused it.

    1. Congestive Heart Failure results from an inability of the left ventricle to fill with blood upon relaxation and a diminished stroke volume . This produces increased pressure in the left ventricle and pulmonary vascular bed.

    2. Restrictive Cardiomyopathy is caused by the loss of heart muscle, usually because of a disease or an injury.

    The pathophysiology of cardiomyopathy is different from that of congestive heart failure in that it does not involve the left ventricle. Also, with cardiomyopathy, there is a decreased ventricular compliance, and the stiffness of the heart muscle increases.

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    Risk For Ineffective Cardiac Tissue Perfusion Related To Decreased Perfusion Of Oxygen And Nutrients To Body Tissues

    Ineffective Cardiac Tissue Perfusion Related to Decreased Perfusion of Oxygen and Nutrients to Body Tissues

    Risk for ineffective cardiac tissue perfusion related to decreased perfusion of oxygen and nutrients to body tissues. Ineffective cardiac tissue perfusion may be a result of several factors: acute or chronic changes in heart function, autonomic nervous system dysfunction or failure, decreased systemic blood pressure, reduced venous return from the extremities , low cardiac output states , sustained tachycardia or bradycardia, respiratory acidosis and alkalosis. The patient with this condition is at increased risk for the development of other health problems such as pulmonary edema if compensatory mechanisms are not functioning well enough.

    Nursing Intervention In Semi

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    • The patients family should be educated regarding the target goal, the underlying cause of the heart failure, and signs of toxicity with medications. It is also important to teach them about medications and their activities and the signs of toxicity, as this will lead to more effective medication management.
    • Teaching about medications and their activities: It is important to teach the patient, and family members/ loved ones about heart disease, especially congestive heart failure, as this will lead to a proper understanding of their pharmacological needs. It is also important to teach them about medications and their activities and the signs of toxicity, as this will lead to more effective medication management.

    The patients family should be educated regarding the target goal, underlying cause for procedures such as pericardiocentesis, and complications. It is also important to teach them about medications and their activities and the signs of toxicity, as this will lead to more effective medication management.

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    How To Improve Symptoms Of Cad

    Although CAD has no cure, proper treatment can cause the disease to remain stable or even improve over time.

    Treatment may include medicines, lifestyle changes, and surgery to repair a damaged heart valve or replace an artery narrowed or blocked by atheromatous plaque.

    Treatment begins with diagnostic tests that determine which arteries and veins are affected by CAD and its severity.

    These tests help your doctor identify which medicines may be right for you and allow your doctor to choose the best treatment option.

    Examples of tests include Blood tests to check the amounts of fats and blood sugar in your bloodstream

    Angiogram, a procedure that uses X-rays and dye injected into an artery in the groin or arm to produce an image of the arteries

    Echocardiogram, an ultrasound that uses sound waves to create images of the heart and blood vessels.

    Once these diagnostic tests have been done, your doctor will be able to determine the best treatment for you.

    Chf Nursing Care Plan 3

    Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Congestive Heart Failure as evidenced by patients verbalization of I want to know more about my new diagnosis and care

    Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of congestive heart failure and its management.

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    Nursing Intervention Of Heart Failure Patients In Emergency Department

    • Elicit Cardiac History and Physical Assessment
    • Auscultation of all four cardiac sounds for rate, rhythm, and quality. . Then auscultate for murmur grade 1 to 6 .
    • Palpation for LV hypertrophy by feeling the sternum and observing for sharp, deep systolic murmur in apex beat.
    • Check pulse oximetry heard 100% on room air .
    • Teaching: It is important to teach the heart failure patient and family members/ loved ones about the disorder, its prognosis, and the cause of disease projections in addition to reassurance for available treatment modalities. It is also important to teach them about medications and their activities and the signs of toxicity, as this will lead to more effective medication management.

    Risk For Fluid Volume Excess

    Congestive Heart Failure (CHF) for Nursing & NCLEX

    May be related to: increased sodium and water retention, decreased organ perfusion.

    As evidenced by: edema, weight gain, intake greater than output, increased blood pressure, increased heart rate, shortness of breath, dyspnea, orthopnea, crackles , oliguria, jugular vein distention, pleural effusion, specific gravity changes, altered electrolyte levels.

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    Health Teaching And Health Promotion

    Nursing care plans for patients with HF must include patient education to improve clinical outcomes and reduce hospital readmissions. Patients need education and guidance on self-monitoring of symptoms at home, medication compliance, daily weight monitoring, dietary sodium restriction to 2 to 3 g/day, and daily fluid restriction to 2 L/day. In addition, patients with HF need aggressive treatment for underlying risk factors and the potential triggers for HF exacerbations. Modifiable risk factors include diabetes mellitus, hypertension, obesity, nicotine use, alcohol use disorder, and recreational drug use, especially cocaine. Patients with sleep apnea and HF should be encouraged to use continuous positive airway pressure therapy as uncontrolled sleep apnea can also increase HF-associated morbidity and mortality.

    What Are The Reducing Risk Factors For Coronary Artery Disease

    Coronary artery disease is the buildup of fatty deposits, also known as plaque, on the walls of your hearts arteries. The accumulation of plaque narrows or blocks blood vessels that supply blood to the heart muscle and reduces blood flow.

    One of the reasons for this behavior is that CAD involves a type of cholesterol called low-density lipoprotein . LDL, also known as bad cholesterol, is often referred to by doctors as the silent killer because it can build up in the walls of arteries and slowly narrow or block the arteries.

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    Nursing Diagnosis: Acute Cardiac Failure Cardiogenic Shock

    Nanda-I Diagnosis Code: Nursing diagnosis code: 10213: NANDA-I code: K33.208

    Signs & Symptoms: CHF is a condition where the heart fails to pump blood sufficiently throughout the body leading to vascular congestion and fluid accumulation in the lungs . This can lead to difficulty breathing, shortness of breath, fatigue, and ultimately death if not aggressively treated. Common signs of CHF include shortness of breath , fatigue, swelling, and weight gain in the abdominal region due to fluid retention. Cardiogenic shock signs and symptoms are similar to CHF, but they tend to be more severe, leading to a significantly increased risk for death within days or weeks if left untreated.

    Ineffective Airway Clearance Related To An Accumulation Of Secretions

    Heart Failure

    Patients with CHF may have difficulty breathing and shortness of breath. They may experience chest congestion, wheezing, dyspnea and/or feeling of impending suffocation. Ineffective airway clearance related to an accumulation of secretions can lead to a buildup of mucus in the lungs that make it difficult for oxygen to enter the bloodstream.

    When a patients blood flow is decreased due to heart failure, this causes less blood flow through the lungs and reduces their ability to breathe properly by clearing out excess fluid from the respiratory tract . This results in increased amounts of secretions such as sputum or phlegm which can be difficult or impossible for patients who have weakened respiratory muscles due to chronic injury caused by fluid accumulation within their lungs or bronchi .

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    What Are The Nanda Ii Nursing Diagnoses Involving Cardiac Function

    Acute cardiac failure: Cardiogenic shock. Circulatory overload: Due to fluid accumulation in the lungs , this can lead to shortness of breath, fatigue, and ultimately death if not aggressively treated. Cardiomyopathy: Defined as a disease/condition involving the muscular wall of the heart causing dysfunctions in pumping and circulating blood. CHF is one type of cardiomyopathy.

    Study Population And Sample

    The population consisted of hospitalized patients with heart failure over a period of 12 months , considering a simple random sampling selection and overall margin of error resulting in a maximum of n = 5%. Total sample size corrected by the size of the N population was calculated using the following formula: n=/1+1111 Callegari-Jacques SSM. Bioestatística: princípios e aplicações Porto Alegre: Artmed 2003.. The sample selected for this study respecting the inclusion and exclusion criteria included 70 patients. Therefore, the estimated ratios in this study are subject to maximum error of 8.75% and a 95% confidence level.

    The sample selection was non-probabilistic with an initial composition of 84 patients, but with four losses due to hospital discharge before the end of data collection, six losses due to death and two losses due to discontinuity by transfers. The final sample consisted of 72 patients followed for three weeks of hospitalization from the time of hospital admission.

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    Causes Of Heart Failure

  • Myocardial Infarction and Coronary Artery Disease . These are the most common causes of heart failure. Fat buildup on the arterial walls leads to the reduction of blood flow, resulting to cardiac arrest.
  • Hypertension. Having a high blood pressure causes the heart to work harder than normal in order to facilitate the blood circulation throughout the body. This makes the cardiac muscles stiffer and/or weaker, leading to heart failure.
  • Alcohol, tobacco, and drug abuse. The toxic effects of alcohol, nicotine, and drugs may lead to the damage of the cardiac muscles known as cardiomyopathy.
  • Congenital heart defects. Faulty heart chambers or valves at birth can directly affect the functionality of the heart.
  • Other heart conditions. Viral infections such as COVID-19 may cause inflammation of the cardiac muscles known as myocarditis.
  • Chronic diseases. HIV, diabetes, arrythmias, and thyroid problems may lead to heart failure.
  • Certain medications. Non-steroidal inflammatory drugs , several anaesthesia drugs, chemotherapy agents, and some antihypertensives puts a person at a higher risk for heart problems which may eventually lead to heart failure.
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