Congestive Cardiac Failure and Its Medical Management
The objective of management in congestive heart failure is to eradicate or minimize those factors which precipitate the disease. It is also aimed at strengthening the heart to cope with the stress and to reduce sodium and water retention.
Drugs
1. Diuretics
2. Cardiac glycosides
3. Mild hypnotics
4. Electrolytes supplement
5. Expectorants
1. Diuretics: Diuretics such as Chlorothiazide 0.5gm-2gm is given daily to help the body get rid of excess fluid and the sodium stored in the tissues.
Examples of other diuretics that can be used include:
- Furosemide (Laxis) 40-80mg daily
- Ethacrynic acid (Edecrin) 80-200mg daily
- Hydrochlorothiazide (Esidrix, hydrodiuril) 25-100mg daily
Nursing responsibilities while administering diuretics
i. Diuretics should be administered before noon to prevent nocturia
ii. Patient should be told that the diuretics would make him urinate frequently and in high amounts too.
iii. Weigh patient daily to be sure that weight loss is not rapid. Daily weight loss of 4Ibs or above is dangerous.
iv. Maintain intake and output record. Ensure patient is not dehydrated.
v. Observe patient for signs of adverse reactions. Signs to check out for include muscle cramps, weakness, fatigue, confusion, dizziness, light-headedness, abdominal distension, perspiration, anorexia, etc
vi. Check patient's vital signs especially the BP, for signs of hypotension.
2. Cardiac glycosides: Digitalis such as Tab Digoxin (Lanoxin, Davoxin) 0.5mg stat, then 0.25mg tds. Digitalis helps the ventricles to contract effectively and empty their blood. They also help to improve myocardial contraction and slow down the heart rate. A high dose of digitalis is usually given initially in order to accumulate a therapeutic amount of the drug in the body. This is known as digitalization. This is then followed by minimal amount of maintenance doses.
Examples of other Digitalis include:
i. Digitoxin - Digitalizing dose = 1.2mg- 1.5mg in divided doses
ii. Digitalis - Digitalizing dose = 1-1.5g p.o in divided doses, maintenance dose is 0.1 - 0.2g
iii. Gitalin (Gitaligin) - Digitalizing dose = 4-6mg. Maintenance dose is 0.25 - 0.5mg daily.
Nursing responsibilities when administering Digitalis
i. Take extra care to read the labels on digitalis drugs because all digitalis preparations have similar names but different strength and dosages e.g. Digitalis, Digoxin, Digitoxin
ii. Take the patient's apical pulse for one full minute you administer a dose of digitalis
iii. Take careful note of the rate and rhythm of the pulse and chart accordingly
iv. Drug should be withheld if the heart rate is very rapid, below 60, or irregular. Inform the doctor.
v. Don't administer drug if there are severe symptoms of digitalis toxicity.
3. Mild hypnotics: E.g. Sodium Amytal may be given for the first 2-3 nights to make the patient sleep comfortably.
Tranquilizers/Analgesics may also be administered to the patient to relieve anxiety and pain.
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4. Expectorant: Expectorant is given to help patient expectorate the sputum from the lungs. Expectorants that contain substances capable of causing respiratory depression should be avoided in order not to worsen the respiratory distress.
5. Electrolyte supplement: Hypokalaemia (usually a complication of potassium-depleting diuretics) is prevented by administering potassium chloride. Liquid potassium supplement can be given, but must be diluted in water or fruit juice before being taken in order to minimize gastric irritation.
The objective of management in congestive heart failure is to eradicate or minimize those factors which precipitate the disease. It is also aimed at strengthening the heart to cope with the stress and to reduce sodium and water retention.
Drugs
1. Diuretics
2. Cardiac glycosides
3. Mild hypnotics
4. Electrolytes supplement
5. Expectorants
1. Diuretics: Diuretics such as Chlorothiazide 0.5gm-2gm is given daily to help the body get rid of excess fluid and the sodium stored in the tissues.
Examples of other diuretics that can be used include:
- Furosemide (Laxis) 40-80mg daily
- Ethacrynic acid (Edecrin) 80-200mg daily
- Hydrochlorothiazide (Esidrix, hydrodiuril) 25-100mg daily
Nursing responsibilities while administering diuretics
i. Diuretics should be administered before noon to prevent nocturia
ii. Patient should be told that the diuretics would make him urinate frequently and in high amounts too.
iii. Weigh patient daily to be sure that weight loss is not rapid. Daily weight loss of 4Ibs or above is dangerous.
iv. Maintain intake and output record. Ensure patient is not dehydrated.
v. Observe patient for signs of adverse reactions. Signs to check out for include muscle cramps, weakness, fatigue, confusion, dizziness, light-headedness, abdominal distension, perspiration, anorexia, etc
vi. Check patient's vital signs especially the BP, for signs of hypotension.
2. Cardiac glycosides: Digitalis such as Tab Digoxin (Lanoxin, Davoxin) 0.5mg stat, then 0.25mg tds. Digitalis helps the ventricles to contract effectively and empty their blood. They also help to improve myocardial contraction and slow down the heart rate. A high dose of digitalis is usually given initially in order to accumulate a therapeutic amount of the drug in the body. This is known as digitalization. This is then followed by minimal amount of maintenance doses.
Examples of other Digitalis include:
i. Digitoxin - Digitalizing dose = 1.2mg- 1.5mg in divided doses
ii. Digitalis - Digitalizing dose = 1-1.5g p.o in divided doses, maintenance dose is 0.1 - 0.2g
iii. Gitalin (Gitaligin) - Digitalizing dose = 4-6mg. Maintenance dose is 0.25 - 0.5mg daily.
Nursing responsibilities when administering Digitalis
i. Take extra care to read the labels on digitalis drugs because all digitalis preparations have similar names but different strength and dosages e.g. Digitalis, Digoxin, Digitoxin
ii. Take the patient's apical pulse for one full minute you administer a dose of digitalis
iii. Take careful note of the rate and rhythm of the pulse and chart accordingly
iv. Drug should be withheld if the heart rate is very rapid, below 60, or irregular. Inform the doctor.
v. Don't administer drug if there are severe symptoms of digitalis toxicity.
3. Mild hypnotics: E.g. Sodium Amytal may be given for the first 2-3 nights to make the patient sleep comfortably.
Tranquilizers/Analgesics may also be administered to the patient to relieve anxiety and pain.
4. Expectorant: Expectorant is given to help patient expectorate the sputum from the lungs. Expectorants that contain substances capable of causing respiratory depression should be avoided in order not to worsen the respiratory distress.
5. Electrolyte supplement: Hypokalaemia (usually a complication of potassium-depleting diuretics) is prevented by administering potassium chloride. Liquid potassium supplement can be given, but must be diluted in water or fruit juice before being taken in order to minimize gastric irritation.