Congestive Heart Failure Case Study
Congestive Heart
Failure
Christina Cabrera
Mayra Cortez
Serina Markham
Irina Peters
Prevalence & incidence of CHF
Mortality Rate: 4.1%
5.1 million people in the US have CHF
National Cost is $32 billion each year
550,000 are diagnosed each year.
Congestive heart failure (CHF):
Clinical Presentation
Also known as Heart Failure
Impaired cardiac pumping and/or filling action
Associated with
Cardiovascular diseases
Chronic hypertension
Coronary artery disease
Myocardial infarction
Right Sided Heart
Failure
Left Sided Heart
Failure
Signs:
Murmurs
Jugular Venous
Distention
Edema
Weight Gain
Increased Heart Rate
Ascites
Anasarca
Hepatomegaly
Symptoms:
Fatigue
Anxiety, Depression
Dependent Edema
Anorexia, GI Bloating
Nausea
Signs: …show more content…
Pleural Effusion
Increased Heart Rate
Alternating speed of pulses PaO2, PaCO2
Crackles
S3 & S4 heart sounds
Restlessness,
Confusion
Symptoms:
Weakness, Fatigue
Dyspnea
Shallow respirations
Dry, hacking cough
Nocturia
Frothy, pink sputum
Congestive heart Failure: Pathophysiology &
Etiology
Pathophysiology
Etiology
Abnormal mechanism of cardiac output Children- Underlying congenital cardiac defect: cardiomyopathies, dysrhythmias, infections (endocarditis, myocarditis), tumors, atrial septal defects, ventricular septal defects, common AV canal defect, patent ductus arteriosus in Adults
Preload/Afterload
Myocardial contractility
Classification of Failure
Systolic- inability of the heart to effectively pump
Decrease in left ventricle ejection fraction Diastolic- inability for ventricles to relax and fill during diastole
Decreased stroke volume, cardiac output and venous engorgement
Primary Causes
Underlying cardiac diseases (ex: CAD,
Cardiomyopathy)
Precipitating Causes
Anemia, pulmonary disease, hypervolemia Impact of CHF during childhood
Respiratory-Related
Energy
Symptoms
Levels are decreased
Decreased
appetite
Diaphoresis
Failure
to gain weight
Abnormal
cardiac rhythms
Edema
Chronic
Abdominal Pain related to poor circulation & decreased perfusion
Impact of CHF on adults on The
Health care system
The most costly health problem in the
United States
The most common cause of hospitalization in the Medicare population
Increasing number of patients with CHF due to advances in the treatment and early interventions
Length of stay can increase which becomes more expensive. Average is 6.5 days.
Outpatient heart failure management programs contribute to improved patient outcomes
Integrated and innovative approach to the management of heart failure patients
Impact of CHF in Adults on the
Nursing Practice
Comorbidity of chronic conditions can influence the nursing plan of care as well as timing and intensity of therapies.
Education and counseling are essential aspects of CHF patients care
Team approach
Implementation of therapeutic plan of care
Impact of CHF
Mental & Emotional Impact
Isolation which can lead to depression
Decreased self esteem
Lack of social support is a heavy burden
Need proper referrals for healthy outcome
Ability to Cope with Stress
“Self-talks” and deep breathing exercises are effective for management of anxiety
Guided imagery
Meditation or yoga
Support groups/meetings
Impact of CHF
Economic Impact
Occupational Considerations
& Hazards
Common reason for hospitalization in the elderly
Heavy lifting can be taxing
$32 billion a year in costs
Shortness of breath will make ambulating long distances difficult
20% of patients readmitted within 30 days
Medicare costs are $1.9 billion annually
Hot and humid environments or exposure to inhaled chemicals can exacerbate shortness of breath
Impact of CHF
Sexual
Sexual dysfunction can be affected d/t neurovascular, neurologic, vascular and endocrine system problems
Treatment can affect sexual response
Erectile dysfunction
Prenatal Care & Child
Bearing
Impact of CHF
Physical Impact
Shortness of breath/fatigue
Fluid retention
Weakened heart muscles
Substance Abuse Tendencies
Smoking
Alcoholic beverages
Anti-anxiety medications
Struggles with daily activities
Walking, playing sports
Decreased quality of life
Care plan for CHF
Nursing Diagnosis: Activity Intolerance related to fatigue secondary to cardiac insufficiency as evidenced by shortness of breath and patient complaints of weakness.
Patient Goal: Patient will establish a balance of rest and activity to decrease episodes of fatigue that may severely impact lifestyle choices.
Outcomes: Patient will have fewer days of reported fatigues as measured by self report from baseline.
Interventions:
Adjust patient’s daily activities and reduce intensity level. Stop activities that cause adverse physiological changes: Rationale: To prevent overexertion and strain.
Identify activity needs versus desires to evaluate appropriateness for patient.
Rationale: Patient is unable to ambulate to restroom but desires to run a marathon.
Encourage the patient to maintain a positive attitude. Rationale: To enhance a sense of well being
Community Resources
American Association of Cardiovascular and Pulmonary Rehabilitation
(AACVPR), www.aacvpr.org
The Mended Hearts. www.mendedhearts.otg.
Mended Little Hearts. www.mendedlittlehearts.org.
Congestive Heart Failure Online Support Group.
http://www.mdjunction.com/congestive-heart-failure
A community of patients, family members and friends dedicated to dealing with Congestive Heart Failure, together.
Adult Congenital Heart Association (ACHA). http://www.achaheart.org/
This non-profit organization reaches out to adults living with CHF through the association educational and advocacy events, media outreach and website.
ACHA offers information directly to patients and families, and provides materials and services through health-professional members.
References
Boston Children’s Hospital. (2014).Congestive Heart Failure Symptoms and Causes. Retrieved from
http://www.childrenshospital.org/health-topics/conditions/c/congestive-heart- failure/symptoms-and causes
Congestive Heart Failure. (n.d.). Retrieved November 16, 2014, from
http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/CongestiveHeart- Failure_UCM_307111_Article.jsp
Grady, K. L., Dracuo, K., Kennedy, G. (2000). Team Management of Patients with Heart Failure. Retrieved November 16, 2014 from http://circ.ahajournals.org/content/102/19/2443.1.full Heart Failure Fact Sheet. (2013, December 3). Retrieved November 16, 2014, from
http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm
Lewis, S.L., Dirksen, S.R. (2011). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (8th ed, pp.797-817),
St. Louis, MO: Elsevier Mosby.
McKinney, E. S., James, S.R. (2013). Maternal-Child Nursing (4th ed). St. Louis, MO: Elsevier Mosby
Richardson, L. (2003). Psychosocial Issues in Patients With Congestive Heart Failure. Progress in Cardiovascular Nursing, 19-27.
Retrieved November 16, 2014, from
http://www.medscape.com/viewarticle/451763_3
Wilkinson, A. (2002, November 1). Living with Advanced Congestive Heart Failure: A Guide for Family
Caregivers. Retrieved November 16, 2014, from http://www.medicaring.org/educate/download/chfbookfinal.pdf
Failure
Christina Cabrera
Mayra Cortez
Serina Markham
Irina Peters
Prevalence & incidence of CHF
Mortality Rate: 4.1%
5.1 million people in the US have CHF
National Cost is $32 billion each year
550,000 are diagnosed each year.
Congestive heart failure (CHF):
Clinical Presentation
Also known as Heart Failure
Impaired cardiac pumping and/or filling action
Associated with
Cardiovascular diseases
Chronic hypertension
Coronary artery disease
Myocardial infarction
Right Sided Heart
Failure
Left Sided Heart
Failure
Signs:
Murmurs
Jugular Venous
Distention
Edema
Weight Gain
Increased Heart Rate
Ascites
Anasarca
Hepatomegaly
Symptoms:
Fatigue
Anxiety, Depression
Dependent Edema
Anorexia, GI Bloating
Nausea
Signs: …show more content…
Pleural Effusion
Increased Heart Rate
Alternating speed of pulses PaO2, PaCO2
Crackles
S3 & S4 heart sounds
Restlessness,
Confusion
Symptoms:
Weakness, Fatigue
Dyspnea
Shallow respirations
Dry, hacking cough
Nocturia
Frothy, pink sputum
Congestive heart Failure: Pathophysiology &
Etiology
Pathophysiology
Etiology
Abnormal mechanism of cardiac output Children- Underlying congenital cardiac defect: cardiomyopathies, dysrhythmias, infections (endocarditis, myocarditis), tumors, atrial septal defects, ventricular septal defects, common AV canal defect, patent ductus arteriosus in Adults
Preload/Afterload
Myocardial contractility
Classification of Failure
Systolic- inability of the heart to effectively pump
Decrease in left ventricle ejection fraction Diastolic- inability for ventricles to relax and fill during diastole
Decreased stroke volume, cardiac output and venous engorgement
Primary Causes
Underlying cardiac diseases (ex: CAD,
Cardiomyopathy)
Precipitating Causes
Anemia, pulmonary disease, hypervolemia Impact of CHF during childhood
Respiratory-Related
Energy
Symptoms
Levels are decreased
Decreased
appetite
Diaphoresis
Failure
to gain weight
Abnormal
cardiac rhythms
Edema
Chronic
Abdominal Pain related to poor circulation & decreased perfusion
Impact of CHF on adults on The
Health care system
The most costly health problem in the
United States
The most common cause of hospitalization in the Medicare population
Increasing number of patients with CHF due to advances in the treatment and early interventions
Length of stay can increase which becomes more expensive. Average is 6.5 days.
Outpatient heart failure management programs contribute to improved patient outcomes
Integrated and innovative approach to the management of heart failure patients
Impact of CHF in Adults on the
Nursing Practice
Comorbidity of chronic conditions can influence the nursing plan of care as well as timing and intensity of therapies.
Education and counseling are essential aspects of CHF patients care
Team approach
Implementation of therapeutic plan of care
Impact of CHF
Mental & Emotional Impact
Isolation which can lead to depression
Decreased self esteem
Lack of social support is a heavy burden
Need proper referrals for healthy outcome
Ability to Cope with Stress
“Self-talks” and deep breathing exercises are effective for management of anxiety
Guided imagery
Meditation or yoga
Support groups/meetings
Impact of CHF
Economic Impact
Occupational Considerations
& Hazards
Common reason for hospitalization in the elderly
Heavy lifting can be taxing
$32 billion a year in costs
Shortness of breath will make ambulating long distances difficult
20% of patients readmitted within 30 days
Medicare costs are $1.9 billion annually
Hot and humid environments or exposure to inhaled chemicals can exacerbate shortness of breath
Impact of CHF
Sexual
Sexual dysfunction can be affected d/t neurovascular, neurologic, vascular and endocrine system problems
Treatment can affect sexual response
Erectile dysfunction
Prenatal Care & Child
Bearing
Impact of CHF
Physical Impact
Shortness of breath/fatigue
Fluid retention
Weakened heart muscles
Substance Abuse Tendencies
Smoking
Alcoholic beverages
Anti-anxiety medications
Struggles with daily activities
Walking, playing sports
Decreased quality of life
Care plan for CHF
Nursing Diagnosis: Activity Intolerance related to fatigue secondary to cardiac insufficiency as evidenced by shortness of breath and patient complaints of weakness.
Patient Goal: Patient will establish a balance of rest and activity to decrease episodes of fatigue that may severely impact lifestyle choices.
Outcomes: Patient will have fewer days of reported fatigues as measured by self report from baseline.
Interventions:
Adjust patient’s daily activities and reduce intensity level. Stop activities that cause adverse physiological changes: Rationale: To prevent overexertion and strain.
Identify activity needs versus desires to evaluate appropriateness for patient.
Rationale: Patient is unable to ambulate to restroom but desires to run a marathon.
Encourage the patient to maintain a positive attitude. Rationale: To enhance a sense of well being
Community Resources
American Association of Cardiovascular and Pulmonary Rehabilitation
(AACVPR), www.aacvpr.org
The Mended Hearts. www.mendedhearts.otg.
Mended Little Hearts. www.mendedlittlehearts.org.
Congestive Heart Failure Online Support Group.
http://www.mdjunction.com/congestive-heart-failure
A community of patients, family members and friends dedicated to dealing with Congestive Heart Failure, together.
Adult Congenital Heart Association (ACHA). http://www.achaheart.org/
This non-profit organization reaches out to adults living with CHF through the association educational and advocacy events, media outreach and website.
ACHA offers information directly to patients and families, and provides materials and services through health-professional members.
References
Boston Children’s Hospital. (2014).Congestive Heart Failure Symptoms and Causes. Retrieved from
http://www.childrenshospital.org/health-topics/conditions/c/congestive-heart- failure/symptoms-and causes
Congestive Heart Failure. (n.d.). Retrieved November 16, 2014, from
http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/CongestiveHeart- Failure_UCM_307111_Article.jsp
Grady, K. L., Dracuo, K., Kennedy, G. (2000). Team Management of Patients with Heart Failure. Retrieved November 16, 2014 from http://circ.ahajournals.org/content/102/19/2443.1.full Heart Failure Fact Sheet. (2013, December 3). Retrieved November 16, 2014, from
http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm
Lewis, S.L., Dirksen, S.R. (2011). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (8th ed, pp.797-817),
St. Louis, MO: Elsevier Mosby.
McKinney, E. S., James, S.R. (2013). Maternal-Child Nursing (4th ed). St. Louis, MO: Elsevier Mosby
Richardson, L. (2003). Psychosocial Issues in Patients With Congestive Heart Failure. Progress in Cardiovascular Nursing, 19-27.
Retrieved November 16, 2014, from
http://www.medscape.com/viewarticle/451763_3
Wilkinson, A. (2002, November 1). Living with Advanced Congestive Heart Failure: A Guide for Family
Caregivers. Retrieved November 16, 2014, from http://www.medicaring.org/educate/download/chfbookfinal.pdf