Monday, March 26, 2012

Nursing Management and Diagnosis for CHF

Definition :

A state of pathophysiological abnormalities in cardiac function resulting in heart failure to pump blood to meet the metabolic needs of tissues and or ability only if accompanied by elevation of left ventricular filling pressure.

Etiology :
A. mechanical abnormalities
  • Increased burden of the central (aortic stenosis), peripheral (systemic hypertension)
  • Increase in volume load (initial load increase)
  • Obstruction of the ventricular filling (stenosis mitralis / trikuspidalis)
  • Pericardial tamponade
  • Restriction endocardium / myocardium
  • Ventricular aneurysm.
B. Abnormalities of the myocardium
1. Primary
  • Cardiomyopathy
  • Myocarditis
  • The metabolic abnormalities
  • Toxicity (alcohol, cobalt)
2. Dis-dynamic abnormalities, secondary
  • K (-) O2
  • The metabolic abnormalities
  • Inflammation
  • Systemic Diseases
  • COPD
C. Changes in heart rhythm
  • Cardiac arrest
  • Fibrillation
  • Tachycardia / bradycardia
  • Electric Asinkroni
Signs and symptoms of CHF

1. Left heart failure
  • Fatigue
  • Weak
  • Cyanosis
  • Dyspnea
  • Cough
  • Orthopnea
  • Anorexia
  • Tachypnea
  • The first heart sound decreases
  • Wet crackles pleural effusion
2. Right heart failure
  • Weight loss
  • Ankle edema
  • Abdominal distention
  • Pain subkostal
  • Pulsation neck region
  • Jaundice
  • Tired
  • Edema, ascites
  • Increased jugular venous pressure
Complication
  • Cardiac asthma? due to bronchospasm occurs at night or in the activity
  • Non-productive cough due to lung congestion
  • Haemoptysis
  • Dysphagia due to distension of the pulmonary venous atrium or
  • Containment of systemic veins - JVP increased
  • Hepatomegaly
  • Peripheral edema
  • Ascites and anasarka
  • Increase in body weight due to water retention and sodium
  • Peripheral vasoconstriction? release of body heat (-)
  • Abnormalities of liver function, prothrombin time emanjangan light.

Nursing Management of CHF

Goal :
- Reducing the workload of the heart
- A third of selective manipulation of the main determinants of myocardial function, namely:
  • the initial load
  • the load end
  • contractility
- Achieve the desired clinical response

Guidelines:
1. Limitation of physical activity
  • Avoid strenuous work
  • Stop the heavy exercise
2. sodium restriction
3. digitalis glycosides
4. diuretics
  • Diuretics
  • Potassium-sparing diuretics
5. vasodilator
6. inotropic agents
7. specific actions:
  • Consideration tranpalntasi
  • Assisted circulation:

Nursing Diagnosis for CHF
  1. Decreased cardiac output related to mechanical factors (preload, afterload, contractility)
  2. Impaired gas exchange related to alveolar capillary membrane due to increased pulmonary capillary pressure
  3. Changes in nutritional status: less than body requirement related to the absorption of nutrients secondary to decreased cardiac output.
  4. Activity intolerance related to decreased cardiac output.

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