congestive heart failure
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Running Head: CONGESTIVE HEART FAILURE
Congestive Heart Failure
Adrianne Bazo
Montana Tech Nursing Department
NURS 1566 Core Concepts of Adult Nursing
March 14, 2008
Noel Mathis RN, BSN, MSN
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Congestive Heart Failure
Congestive heart failure occurs when there is a malfunction in the
pumping action of either the left ventricle, right ventricle, or both
which causes blood to pool in the pulmonary arteries and/or veins. This
pooling causes pulmonary congestion (fluid build up in the lungs),
reduced cardiac output, increased strain on the heart, decreased
efficiency of the heart muscle contraction, reduced stroke volume,
increased heart rate, and hypertrophy; leading to increased risk of
cardiac arrest and a decreased blood supply to the rest of the body.
Since blood is the oxygen/nutrient supply to the cells, the effects of
CHF are systemic.
Risk factors for developing CHF are disorders that increase cardiac
workload and disorders that disrupt the pumping ability of the heart.
Examples of such diseases are, CAD, cardiomyopathy, acute
myocardial infarction, disease of the heart valves, fluid volume
overload hypertension, COPD, pulmonary hypertension, and anemia.
My patient had triple bypass surgery six years ago, so the cause of her
CHF is most likely from acute myocardial infarction.
The diagnosis of CHF is primarily made from a composite of patient
history, physical exam, laboratory studies, and radiographs. Lab
studies that indicate CHF are, low serum sodium and Hct from
hemodilution and inadequate oxygen levels in the arteries from poor
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pulmonary perfusion. The effects of CHF cause reduced renal funciton
producing elevated blood urea nitrogen and creatinine levels.
The treatment of CHF is directed on decreasing the effects of the
underlying causes. Pharmaceuticals are used to decrease excess fluid
(diuretics), and improve cardiac output (ACE inhibitors, Beta-
adrenergic blockers, inotropics, and nitrates). Nonpharmaceutical
interventions to decrease cardiac workload and increase myocardial
oxygenation include intra-aortic balloon pump, ventricular assist
devices, and biventricular pacing. Also a diet low in sodium is
recommended.
My patient presents with peripheral edema, low SaO2 oxygenation,
rales heard in the lower 2/3 of the posterior lungs, shortness of breath,
low Hct (30.5), high total carbon dioxide, high Lactate dehydrogenase
(778), and high natriuretic peptide (823). Lactate dehydrogenase and
natriuretic peptide are indicators of tissue damage and degree of heart
failure.
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