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Congestive Heart Failure : What your patients need to know. Lisa M. Kappers, RN, BSN Alverno College MSN Program Patient Care Coordinator – Infusion Therapy Center, WFSI – All Saints. Tutorial Instructions.

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congestive heart failure what your patients need to know

Congestive Heart Failure: What your patients need to know.

Lisa M. Kappers, RN, BSN

Alverno College MSN Program

Patient Care Coordinator – Infusion Therapy Center, WFSI – All Saints

tutorial instructions
Tutorial Instructions
  • Use the buttons at the bottom of each slide to navigate through the tutorial or follow the special instructions on certain slides.
  • The “Home” button will bring you back to the beginning.
tutorial outcomes
Tutorial Outcomes
  • At the end of this tutorial you will be able to:
    • Teach your patients about the pathophysiology of CHF.
    • Teach your patients about the importance of a low sodium diet.
    • Teach your patients how to “live” with CHF.
in order to complete this tutorial
In order to complete this tutorial:
  • You should know the basic pathophysiology of normal cardiac function and normal respiratory function. If you need to review, the links below will take you to tutorials on:
  • Path of blood flow Cardiac Cycle Blood pressure Respiratory System
  • To return from these tutorials, click the back button on your browser.
let s review the basics
Let’s review the basics.
  • Which side of the heart pumps blood to the lungs?
    • Right
    • Left
great job
Great Job!
  • The right side of the heart pumps blood to the lungs.
  • Click on our friend to move forward.
sorry
Sorry.
  • Remember, the left side of the heart pumps blood to the peripheral circulatory system.
  • Click on our friend to try again.
which part of the respiratory system is directly responsible for gas exchange
Which part of the respiratory system is directly responsible for gas exchange?
  • A. Trachea
  • B. Larynx
  • C. Alveoli
try again
Try Again.
  • The trachea is part of the lower airway but is not directly responsible for gas exchange. Click the duck to try again.
try again1
Try Again.
  • The larynx is responsible for air flow in and out of the lungs as it is a part of the upper airway. It is not responsible for gas exchange.
  • Click the gator to try again.
great job1
Great Job!
  • The alveoli are thin sacs at the end of the bronchioles which are directly responsible for gas exchange.
now that we ve reviewed the basics let s talk about chf
Now that we’ve reviewed the basics, let’s talk about CHF.
  • Remember, the basics are essential in order to complete this tutorial. If you need to review, return to the provided links at the beginning of the tutorial.
let s define congestive heart failure
Let’s define congestive heart failure.
  • Heart failure is defined by the ACC/AHA as a disorder where the ventricle is prohibited from filling with or ejecting blood (2005). There are many different clinical signs of heart failure.
right sided heart failure
Right-Sided Heart Failure
  • Right sided heart failure occurs when the heart can not move the blood from the periphery into the pulmonary system. This causes blood to back up into the peripheral venous system.
  • (Porth, 2004)
what symptoms are caused by right sided heart failure
What symptoms are caused by right-sided heart failure?
  • Peripheral edema
  • Dyspnea
  • Ascites
  • Hypoxia
  • Anorexia
slide16

You are correct!When the right side of the heart can not move blood from the peripheral system to the pulmonary system, peripheral edema occurs.

  • Click here to pick another symptom Click here to move forward
slide18
In right sided heart failure, the blood can not move from the peripheral system to the pulmonary system. This does not cause hypoxia.
  • Click here to return to question
slide19

Good job!When blood can not be moved from the peripheral system to the pulmonary system, fluid builds up in the abdominal cavity causing ascites.

  • Click to return to question Click to move forward
excellent fluid in the abdomen can push on the organs causing nausea and anorexia
Excellent!Fluid in the abdomen can push on the organs causing nausea and anorexia.
  • Click to return to question
  • Click to move forward
left sided heart failure
Left-Sided Heart Failure
  • Left-sided heart failure occurs when the blood from the pulmonary system can not be pumped into the peripheral system. This causes the blood to back up into the pulmonary vasculature.
  • (Porth, 2004)
what symptoms would you observe with left sided heart failure
What symptoms would you observe with left-sided heart failure?
  • Hypoxia
  • Dependent edema
  • Cough with frothy sputum
  • Orthopnea
  • Jugular vein distention
fabulous
Fabulous!!
  • Hypoxia occurs due to the pulmonary congestion caused by left-sided heart failure.

Click here to return to questionClick here to move forward

oops sorry
Oops, sorry.
  • Dependent edema occurs when the blood from the peripheral vasculature can not move forward during right-sided heart failure.

Click here to return to question

great job2
Great job!
  • The cough occurs due to the congestion in the pulmonary vasculature.

Click here to return to question Click here to move forward

great thinking
Great thinking!
  • Orthopnea occurs when the patient is reclined and the blood from the peripheral vasculature settles in the pulmonary system.

Click here to return to question Click here to move forward

let s think about this
Let’s think about this.
  • Jugular vein distention occurs when blood backs up in the peripheral vasculature. This happens during severe right-sided heart failure.

Click here to return to the question

chronic heart failure
Chronic Heart Failure
  • Chronic heart failure is a combination of right and left heart failure. The right and left ventricles must maintain an equal output. Persistent left sided failure can lead to right sided failure. (Porth, 2004)
hypertension
Hypertension
  • There are two types of hypertension: primary and secondary.
  • Primary hypertension accounts for 90 – 95% of all cases and does not result from another disease process.
  • Secondary hypertension is the direct cause of a primary disease process such as renal disease.
  • (Porth, 2004)
slide31
Uncontrolled hypertension increases the workload of the left ventricle by increasing the pressure against which the heart must pump. The left ventricle hypertrophies or thickens, decreasing ejection fraction and putting the patient at risk for CHF.
  • (Porth, 2004)
slide32
Hypertension is a risk factor for all major cardiovascular disorders such as atherosclerosis, stroke, heart failure, coronary artery disease, and peripheral artery disease.
  • (Porth, 2004)
atherosclerosis and coronary artery disease
Atherosclerosis and Coronary Artery Disease
  • Atherosclerosis is defined as fatty lesions developing in the intimal lining of the aorta, coronary arteries, and the large arteries that supply blood to the brain.
slide35

Hypertension

Click to see how comorbidities

might fit together.

Vessel Wall

Damage

Coronary

Artery

Disease

Atherosclerosis

Myocardial

Infarction

Ventricular

Dysfunction

CHF

how bad is joe s chf
How bad is Joe’s CHF?
  • There are different classification systems:
  • New York Heart Association
  • American College of Cardiology/ American Heart Association guidelines
new york heart association classification
New York Heart Association classification
  • Based on the ability to function
  • Level I – No symptoms, no activity limits
  • Level II – Mild symptoms, slight limits, comfortable at rest
  • Level III – Moderate limited activity, comfortable only at rest
  • Level IV – Severe restrictions, symptomatic at rest
  • (Porth, 2004)
acc aha heart failure guidelines
ACC/AHA Heart Failure Guidelines
  • Based on risk factors, ventricular remodeling, and progressive symptoms
  • Stage A - High risk for HF, no structural heart disease, no symptoms
  • Stage B – Structural heart disease, no symptoms
  • Stage C – Structural heart disease with prior or current symptoms
  • Stage D – Refractory HF
  • (Hunt et al, 2005)
joe becomes very short of breath and presents to the emergency room
Joe becomes very short of breath and presents to the emergency room:
  • 56 YEAR OLD MALE
  • Hx: diabetes, CAD, HTN
  • C/O SOB, “light headed”
admitted by dr heart
Admitted by Dr. Heart
  • Diagnosis: CHF
  • Physician orders:
    • Chest XRAY
    • Chemistry panel, BNP, CBC
    • EKG
    • Echocardiogram
    • 2 gram sodium diet
    • Activity as tolerated
for the next three days you monitor joe
For the next three days you monitor Joe:

Daily weight

Intake and output

Blood sugars

Vital signs

Activity level

dr heart discharges joe and tells you to do patient education prior to discharge
Dr. Heart discharges Joe and tells you to do patient education prior to discharge.

What do you teach?

what do we teach
What do we teach?

Medications and side effects

slide45

Which classification of medications promotes the excretion of fluid, reduces preload, and operates at an optimal part of the Frank-Starling curve?

Diuretics

Beta blockers

Digitalis

ACEinhibitors

great job3
Great Job!!

Click here

slide48

Which group of drugs increase the force and strength of ventricular contraction, decreases heart rate, and increases diastolic filling time?

Diuretics

Beta blockers

Digitalis

ACEinhibitors

which group of drugs interferes with the raa pathway
Which group of drugs interferes with the RAA pathway?

Diuretics

Beta blockers

Digitalis

ACEinhibitors

great job4
Great Job!!

Click here

slide54
Which group of drugs decrease left ventricular dysfunction associated with the sympathetic nervous system?

Diuretics

Beta blockers

Digitalis

ACEinhibitors

very good
Very good!

Click here

sorry1
Sorry.

Click here

common side effects that your patient should be aware of
Common side effects that your patient should be aware of:
  • Diuretics: excessive urination, hypotension & dizziness, hypokalemia
  • Beta Blockers: fatigue, impotence, bradycardia, dizziness & hypotension
  • ACE Inhibitors: Excessive urination, angioedema, electrolyte imbalance, dizziness & hypotension
  • Digitalis: bradycardia, toxicity
slide58
Medications such as diuretics can alter the levels of electrolytes such as potassium within the blood. Nutrition can be an important factor in maintaining a balance for the patient with CHF.
nutrition
Nutrition
  • Low Sodium Diet
    • Define “What is a low sodium diet?”
      • 2000 milligrams or less per 24 hours
    • How to read food labels.
      • Low sodium means 140mg or less per serving

Patients must also monitor their daily fluid intake.

how does sodium work
How does sodium work?
  • Sodium enters the body through the GI tract and is excreted primarily by the kidneys. Water follows sodium.
  • (Porth, 2004)
high sodium foods
High sodium foods
  • Canned foods
  • Ham, bacon, sausage
  • Deli meats and hot dogs
  • Prepared mixes, frozen dinners, seasoning packages
  • Salad dressings
  • Fast foods
how does potassium work
How does potassium work?
  • Potassium regulates the electrical membrane potentials controlling the contractility of skeletal, cardiac, and smooth muscles. Hypokalemia causes EKG changes and ventricular arrythmias. Hyperkalemia can cause ventricular fibrillation and cardiac arrest.
  • (Porth, 2004)
what about potassium
What about potassium?
  • Some diuretics cause potassium loss.
    • Loop diuretics
    • Thiazide diuretics
    • Thiazide-like diuretics

Also, excessive vomiting/diarrhea.

Potassium excess is typically caused by renal insufficiency or failure.

do you know which foods are rich in potassium
Do you know which foods are rich in potassium?
  • Click on the foods rich in potassium.
vegetables
VEGETABLES !!!
  • You are correct but did you pick them all? Click our friend to move forward or click the question mark to choose another.
fruit
FRUIT!!
  • Great job but did you get them all? Click on our friend to move forward or click the question mark to return to the question.
turkey fish beef
Turkey, fish, & beef!!
  • Great job! Click on our friend to move forward or click the question mark to return to the question.
candy
Candy??
  • Did you really mean that? Click our friend to return to the question.
potato chips
Potato chips??

Did you make a mistake? Click our friend to return to the question.

the kidneys regulate electrolytes
The kidneys regulate electrolytes.
  • The function of the kidneys

are to filter the blood and

maintain fluid and

electrolyte balance. The

kidneys produce 1.5 liters

of urine per day. (Porth, 2004)

slide71
Teach patients to observe their urinary output daily. If they notice it decreasing and their weight

increasing, they should

notify their doctor.

when do i call the doctor
When do I call the doctor?
  • Weight gain > 2 lbs. in 24 hours
  • Trouble sleeping
  • Shortness of breath
  • Dry cough
  • Increased swelling in abdomen or extremities
  • Fatigue
slide73

Congestive heart failure affects and is affected by multiple body systems. With your increased understanding comes an improved foundation for patient education and improved patient outcomes.

thank you
THANK YOU!

Thank you for completing this tutorial. I hope it has provided you with information to use when educating your CHF patients.

Good Luck!

references
References
  • Hunt, S.A., Abraham, W.T., Chin, M.H., Feldman, A.M., Francis, G.S., Ganiats, T.G., Jessup, M., Konstam, M.A., Mancini, D.M., Michl, K., Oates, j.A., Rahko, P.S., Silver, M.A., Stevenson, L.W., & Yancy, C.W. (2005). ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). American College of Cardiology Web Site. Available at: http://www.acc.org/clinical/guidelines/failure//index.pdf.
  • Porth, C.M. (2004). Essentials of pathophysiology: Concepts of altered health states. Philadelphia, PA: Lippincott Williams & Wilkins.
  • Clark, P.C., & Dunbar, S.B. (2003). Family partnership intervention: A guide for a family approach to care of patients with heart failure. AACN Clinical Issues: Advanced Practice in Acute Critical Care, 14(4), 467-476.
  • Images retrieved from Microsoft Office Clip Art.
  • Bowne, P. S., 2004. Path of Blood Flow Tutorial. Retrieved April 27, 2007 from http://faculty.alverno.edu/bowneps/pathofbloodflow/pathmap.htm.
  • Bowne, P., 2004-2006. PATHO Interactive Physiology Tutorials. Retrieved May 11, 2007 from http:// faculty.alverno.edu/bowneps/cardiaccycle/cardiaccycle1map.htm.
  • Bowne, P., 2004-2006. PATHO Interactive Physiology Tutorials. Retrieved May 11, 2007 from http://faculty.alverno.edu/bowneps/bp/bpindex.htm.
  • Sheffield, S., (2007). Get Body Smart-The respiratory system – Anatomy & physiology. Retrieved May 11, 2007 from http://getbodysmart.com/ap/respiratorysystem/menu/menu.html.