NURSE-UN 1435 Lecture Notes - Lecture 7: Volume Overload, Respiratory Acidosis, Cardiac Catheterization
15 Oct 2018
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15. CHF
1) General
a) Most common reason for hospitalization for people >65
b) African Americans are affected more often due to more risk factors
c) Common among older adults
i) Use of drugs may contribute to
ii) Long term use of NSAIDs for arthritis or other chronic pain
(1) Fluid & Na+ retention
(2) Peripheral vasoconstriction→toxicity of diuretics an ACE inhibitor
iii) Use of Lactose used for diabetes causes fluid and Na+ retention
2) Risk factors
a) Primary risk factors
i) CAD
ii) Advancing age
b) Contributing risk factors
i) Hypertension
ii) Diabetes
iii) Tobacco use
iv) Obesity
v) High serum cholesterol
3) Etiology
a) Reflects an inadequacy of heart pumping so that the heart fails to maintain the circulation of
blood to the rest of the body
b) Result of:
i) Impaired cardiac functioning
ii) Excessive workload demands
c) Usually a complication of another cardiopulmonary condition
d) Various compensation mechanisms maintain CO (some of which may aggravate the
condition)
4) Characteristics
a) Ventricular dysfunction
b) Reduced exercise tolerance
c) Diminished quality of life
d) Shortened life expectancy
5) Pathogenesis
a) Most common precipitating factor: MI
b) When heart cannot maintain pumping capability: CO or SV (less blood from the L
ventricle)
i) Less blood reaches the various organs
ii) cell function
iii) Fatigue and lethargy
iv) Mild acidosis develops
v) SNS activated→HR and vasoconstriction to maintain pressure and perfusion
c) Backup and congestion develop as coronary demands for O2 and Glu are not met
i) Output from ventricle < the inflow of blood
ii) Congestion in venous circulation draining into the affected side of the heart
6) Left-sided CHF
a) Left ventricle weekend and can’t empty→CO
b) renal bf→stimulates the RAAS to maintain bp
c) Blood backs up to the pulmonary vein
i) High pressure leads to pulmonary congestion or edema
d) Symptoms
i) Left forward failure
(1) Fatigue
