Question

Disease teaching

TOPIC:           Congestive Heart Failure (CHF)

Write the following summary of the disease, making sure to include all of the points below. Your lesson should include:

• Pathophysiology of the disease: In your own words, write the pathophysiology of the disorder and relate the clinical manifestations of each back to the pathophysiology based on the information you taught your peer.

• Clinical manifestations of the disease (at least two assessment findings)

• Two nursing diagnoses: Discuss 2 nursing diagnoses common to patients and the interventions you chose for each diagnosis.

• Treatment plan (at least two interventions: intraprofesional and nursing care) and the rationale for interventions

• Four patient teaching points for this disease: Include the disease, the treatment plan, and the evaluation of the effectiveness of your teaching.

Answer 1

1. Pathophysiology of Congestive cardiac failure

In heart failure heart may not provides tissues with adequate blood for metabolic needs,and cardiac related elevation pulmonary or systemic venous pressure may result in organ congestion.This will result from abnormalities of systolic or diastolic function or both,change in cardiomyocyte function cardiac structural defects,and high metabolic demands.

Systolic heart failure-The LV contracts poorly and empties inadequately leading to increased diastolic volume,pressure,and decreased ejection fraction.many defects in energy utilization,energy supply,electro physiologic functions,and contractile element interaction occur, with abnormalities in intracellular calcium modulation.

Predominant systolic dysfunction is common in heart failure due to myocardial infraction,,myocarditis,and dilated cardiomyopathy.Systolic dysfunction may affect the LV or RV ;LV failure often leads to RV Failure

Diastolic heart failure-LV filling is impaired resulting in increased LV end diastolic pressure at rest or during exertion.Global contractility and thus ejection fraction remain normal.Marked restriction to LV filling can cause inappropriately low LV end diastolic volume and thus causes low cardiac output and systemic symptoms.Elevated left atrial pressure can cause pulmonary hypertension and pulmonary congestion.

LV failure-In LV failure cardiac out put decreases and pulmonary venous pressure increases.When the pulmonary capillary pressure exceeds the oncotic pressure of plasma proteins,the fluids extravasates from the capillaries in to the interstitial space and alveoli,and increasing the work of breathing.Marked fluid accumulation in the alveoli alters the ventricular perfusion. De oxygenated pulmonary arterial blood pasess through poorly ventilated alveoli,decreasing systemic arterial oxygenation and causing dyspnea.

RV failure-Due to right ventricular dysfunction,systemic venous pressure increases,causing fluid extravasation and edema in independent tissues and abdominal viscera fluid accumulation in the peritoneal cavity causes ascites..Rv failure commonly causes moderate hepatic dysfunction,increase in bilirubin,Pt,and hepatic enzymes.Chronic venous congestion in the viscera can cause anorexia,malabsorption,protein losing enteropathy,chronic Gl blood loss,and bowel infection.

CLINICAL MANIFASTATIONS

• shortness of breath
• Fatigue and weakness
• swelling of legs,ankles and feet,abdomen
• rapid weight gain
• irregular heart beat

NURSING DIAGNOSIS

Decreased cardiac output related to altered myocardial contractility evidenced by increased heart rate,changes in BP,extra heart sound and decreased urine out put

Outcome-Patient will display vital signs with in acceptable limits,reporrts decreases episodes of dyspnea

Nursing intervention

• Auscultate apical pulse,assess heart rate rhythm,document dysrhythmia-Tachycardia usually present to compensate decreased ventricular contractility
• Note heart sounds-S1,S2 may be weak due to diminished pumping action
• Encourage rest and assist in physical care-To improve the efficiency of cardiac contractions and decreases the myocardial oxygen demand
• Provide quite environment,explain therapeutic management,help to avoid stressful situation-Psychological rest helps to reduce the emotional stress
• Provide bedside commode.Have the patient avoid activities causing a vasovagal response during defecation-to reduce vagal stimulation and tachycardia
• Elevating legs avoiding pressure under knee-To decrease venous stasis and reduce the incidence of thrombus formation.

2.activity intolerance related to imbalance between oxygen supply and demand evidenced by weakness and fatigue,dyspnea,pallor,diaphoresis.

Outcome-Participate in desired activities,meet own self care needs,acieve measurable increase in activity tolerance.

Nursing interventions

• Check the vital signs before and immediately after an activity-orthostatic hypotesion can occur with activity
• Document the cardio pulmonary response to activity-Inability to increase stroke volume during activity may cause immediate increase in heart rate and oxygen demands
• Assess for other causes of fatigue-Fatigue is a side effect of some medications
• Evaluate accelerating activity intolerance-May denote increase in cardiac decompensation rather than over activity
• Provide assistance with self care activities-Meet the patients personal care needs with out undue myocardial stress
• Assist the patient in ROM exercises-To prevent deep vein thrombosis due to vascular congestion

TREATMENT PLAN

1. Diuretics-lasix,spironolactone-Block chloride reabsorption thus the reabsorption of sodium and water
2. Vasodialators-Nitro-dur,isordil-Incese cardiac output and reducing circulating volume
3. Arterial dialators-Hydralazine
4. Digoxin-increases the force of myocardial contraction

PATIENT EDUCATION

1. Expline about the disease process mangement and treatment plan
2. Advise to quit smoking
3. Engage in physical activity
4. Controll weight incase of obesity
5. Avoid use of alcohol
6. Pompt use of medications