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This Concept Map, created with IHMC CmapTools, has information related to: Chronic Heart Failure, Adult Chronic Heart Failure (HF) Nursing Diagnoses 1. Decreased Cardiac Output related to (r/t) decreased cardiac contractility secondary to cardiac muscle changes 2. Impaired Gas Exchange r/t alveolar-capillary membrane changes secondary to fluid accumulation in the alveoli 3. Excess Fluid Volume r/t compromised regulatory mechanisms secondary to decreased cardiac output 4. Ineffective Tissue Perfusion r/t interrupted blood flow secondary to decreased cardiac output 5. Activity Intolerance r/t imbalance of oxygen supply and demand secondary to decrease in cardiac muscle contractility (Swearingen, 2008), Adult Chronic Heart Failure (HF) Risk Factors Age 65 or older Male gender African American Obesity Diabetes Coronary artery disease Hypertension Myocardial infarction Familial history of HF (National Institute of Health, 2014), Adult Chronic Heart Failure (HF) Heart Compensation 1. Heart chambers enlarge 2. Cardiac muscle mass increases 3. The heart pumps faster 4. Blood vessels narrow 5. Blood is diverted away from less important organs (American Heart Association, 2015a), Adult Chronic Heart Failure (HF) Pharmacological Therapy Angiotensin converting enzyme inhibitors Beta-blockers Angiotensin receptor blockers Candesartan Spironolactone Eplerenone Diuretic therapy Digoxin Hydralazine and isosorbide dinitrate (National Institute of Health, 2014), Adult Chronic Heart Failure (HF) Health Promotion Prescribed medications Smoking cessation Daily weighing Fluid and sodium restrictions Avoidance of alcohol and caffeine Heart Heathy diet Stress Management Adequate rest Influenza and pneumonia vaccinations Monitoring blood pressure Cardiac Rehabilitation (Agency for Healthcare Research and Quality, 2015) (American Heart Association, 2015b), Adult Chronic Heart Failure (HF) Outcomes Short-Term- The patient understands and teaches heart failure concepts back to nurse by hospital discharge. Intermediate- The patient's symptoms are relieved and controlled by following health promotion guidelines. Long-Term- The patient has an improved quality of life, decrease in hospital re-admissions, and slowing of cardiac failure, Prescribed medications Smoking cessation Daily weighing Fluid and sodium restrictions Avoidance of alcohol and caffeine Heart Heathy diet Stress Management Adequate rest Influenza and pneumonia vaccinations Monitoring blood pressure Cardiac Rehabilitation (Agency for Healthcare Research and Quality, 2015) (American Heart Association, 2015b) Why is this important? Prescribed medications help to control symptoms and increase functioning of the heart. Smoking increases heart rate and blood pressure and increases blood coagulability. Weight gain of three or more pounds in one day or five or more pounds in one week indicates worsening HF. Daily weighing should be done at the same time each morning. Fluid and sodium restrictions help to decrease fluid accumulation and fluid overload. Moderate alcohol intake is recommended- no more than one to two drinks for men and one drink for women. Coffee is recommended in moderation of one to two cups. Coffee increases blood pressure and heart rate. Heart healthy diet supports a healthy heart and is low in saturated fats, trans fat, cholesterol, and sodium. Stress management helps to decrease anxiety and encourage positive coping. When resting, sitting with head of bed elevated can assist with easier breathing. Influenza and pneumonia can be very dangerous for HF patients. Vaccines can prevent patients from contracting the illnesses. Blood pressure can be monitored at home and charted in a notebook to keep track in addition to physician office monitoring. Cardiac rehab helps HF patients to participate in a structured physical rehabilitation. (American Heart Association, 2014b), Adult Chronic Heart Failure (HF) Manifestations Shortness of breath/Dyspnea Chronic coughing Edema in lower extremetries and abdomen Fatigue or Lightheadedness Anorexia Tachycardia (American Heart Association, 2015c), Age 65 or older Male gender African American Obesity Diabetes Coronary artery disease Hypertension Myocardial infarction Familial history of HF (National Institute of Health, 2014) Leads to Adult Chronic Heart Failure (HF), 1. Heart chambers enlarge 2. Cardiac muscle mass increases 3. The heart pumps faster 4. Blood vessels narrow 5. Blood is diverted away from less important organs (American Heart Association, 2015a) which causes Shortness of breath/Dyspnea Chronic coughing Edema in lower extremetries and abdomen Fatigue or Lightheadedness Anorexia Tachycardia (American Heart Association, 2015c), Adult Chronic Heart Failure (HF) Diagnostics 1. Brain natriuretic peptide (BNP) or N terminal-pro-BNP levels 2. Electrocardiogram 3. Echocardiography 4. Chest x-ray 5. Full blood count, fasting blood glucose, serum urea and electrolytes, urinalysis, and thyroid function 6. Cardiac catheterization 7. Stress test (Agency for Healthcare Research and Quality, 2015)