Tanta university

Faculty of nursing
Administration department.
Fourth year , first semester

In-service Education Program

Prepared by
Mohamed Tarek El Sayed Mostafa

Under supervision
A.L/Nahed Yassin

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 In-service Education Program
Title: Congestive Heart failure Section: Cardiology department

Date: 25-26/11/2023 Group: B2 Study online

Length: 2 days T.L.name: Mohamed Tarek

Duration: 4 hours No of staff: 17

Goal:
to increase knowledge and skills of nursing staff about Congestive Heart failure

Objectives:
At the end of program the nurses will be able to:

• Define Congestive Heart failure correctly.

• Explain pathophysiology of Congestive Heart failure briefly.
• List causes of Congestive Heart failure completely.
• Mention signs and symptoms of Congestive Heart failure correctly
• Mention risk factors of Congestive Heart failure correctly
• State types of Congestive Heart failure clearly.
• Identify diagnostic tests and studies of Congestive Heart failure briefly.
• Explain treatments for Congestive Heart failure correctly.
• Demonstrate nursing intervention for Congestive Heart failure clearly.
• State complications of Congestive Heart failure briefly.
• Express feeling concern of individual about program.

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 Pretest
 Define Congestive Heart failure ?
 Express pathophysiology of Congestive Heart failure?
 List causes of Congestive Heart failure.?
 Mention signs and symptoms of Congestive Heart failure?
 Mention risk factors of Congestive Heart failure?
 Demonstrate complications of Congestive Heart failure ?
 State types of Congestive Heart failure ?
 Identify diagnostic tests and studies of Congestive Heart failure?
 Explain treatments for Congestive Heart failure?
 Discuss nursing intervention for Congestive Heart failure ?

First day
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 Day: 25/11/2023 Section :Cardiology department

Time: 12:30 pm place: conference room

Duration: 2h No. of staff attendance: 17

Outlines:
A. Definition of Congestive Heart failure
B. Pathophysiology of Congestive Heart failure
C. Causes of Congestive Heart failure.
D. Signs and symptoms of Congestive Heart failure
E. Complications of Congestive Heart failure
F. Risk factors of Congestive Heart failure

A. Definition of Congestive Heart failure

Congestive heart failure is a long-term condition that
happens when your heart can’t pump blood well enough to
give your body a normal
supply.

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B. Pathophysiology of Congestive Heart failure
Heart failure develops when there are changes to the structure of the heart
muscle and it can't pump blood as efficiently as it should. When this happens
blood can back up and fluid may build up in the lungs or arms and legs, indicating

congestive heart failure

C. Causes of Congestive Heart failure.

• Coronary artery disease and/or heart attack.
• Cardiomyopathy (genetic or viral).
• Heart issues present at birth (congenital heart disease).
• Diabetes.
• High blood pressure (hypertension).
• Arrhythmia.
• Kidney disease.
• A body mass index (BMI) higher
than 30.
• Tobacco and recreational drug use.
• Alcohol use.
• Medications such as cancer drugs
(chemotherapy).

D. Signs and symptoms

• Shortness of breath.
• Waking up short of breath at night.
• Chest pain.
• Heart palpitations.
• Fatigue when you’re
active.

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 • Swelling in your ankles, legs and abdomen.
• Weight gain.
• Need to urinate while resting at night.
• A dry, hacking cough.
• A full (bloated) or hard stomach.
• Loss of appetite or upset stomach (nausea).

F. Complications of Congestive Heart failure.

❖ Hypotension
❖ Kidney failure
❖ Infections from frequent hospital visits that involve central IVs.

E. Risk factors of Congestive Heart failure

• Being older than 65.
• Using tobacco products, cocaine or alcohol.
• Having an inactive (sedentary) lifestyle.
• Eating foods that have a lot of salt and fat.
• Having high blood pressure.
• Having coronary artery disease.
• Having a heart attack.
• Having a family history of congestive heart failure.

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 Second day

Day: 26/11/2023 Section :Cardiology department

Time: 12:30 pm place: conference room

Duration: 2h No. of staff attendance: 17

Outlines:
• Types of Congestive Heart failure
• Diagnostic tests and studies of Congestive Heart failure.
• Treatments for Congestive Heart failure.
• Nursing intervention for Congestive
Heart failure.
• Complications of Congestive Heart
failure.

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1. Types of Congestive Heart failure
❖ Left-sided heart failure
❖ Right-sided heart failure
❖ High-output heart failure. This is a rare type of congestive heart failure.

2. Diagnostic tests and studies of Congestive Heart failure.

Your healthcare provider will ask you about your symptoms and medical history.
They may ask you about:
❖ Other health conditions you have.
❖ A family history of heart disease or sudden death.
❖ Your use of tobacco products.
❖ How much alcohol you drink.
❖ Any history of chemotherapy and/or radiation.
❖ The medications you take.
❖ You’ll also have a physical exam. Your provider will look for signs of congestive heart
failure and diseases that may have made your heart muscle weak or stiff.

3. Treatments for Congestive Heart failure.

Your treatment will depend on the type of heart failure you have and, in
part, what caused it. Medications and lifestyle changes are part of every
heart failure treatment plan. Your healthcare provider will talk to you
about the best treatment plan for you.
There’s no cure for heart failure. As congestive heart failure gets worse,
your heart muscle pumps less blood to your organs, and you move
toward the next stage of heart failure. Since you can’t move backward
through the heart failure stages, the goal of treatment is to keep you
from moving forward through the stages or to slow down the
progression of your heart failure.
Stage A treatment
Treatment for people with Stage A heart failure includes:

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• Regular exercise, such as walking every day.
• No tobacco products.
• Treatment for high blood pressure (medication, low-sodium diet, active
lifestyle).
• Treatment for high cholesterol.
• No alcohol or recreational drugs.
• Angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II
receptor blocker (ARB) if you have coronary artery disease, diabetes,
high blood pressure or other vascular or cardiac conditions.

Stage B treatment
Treatment for people with Stage B heart failure includes:
• Treatments for Stage A.
• Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II
receptor blocker (ARB) if your EF is 40% or lower.
• Beta-blocker if you’ve had a heart attack and your EF is 40% or lower (if
you aren’t already taking one).
• Aldosterone antagonist if you’ve had a heart attack or if you have an EF
of 35% or less.
• Possible surgery or intervention as a treatment for coronary artery
blockage, heart attack, valve disease (valve repair or replacement) or
congenital heart disease.
Stage C treatment
Treatment for people with Stage C HFrEF includes:
• Treatments from Stages A and B.
• Beta-blocker.
• Aldosterone antagonist.
• Sodium-glucose transport 2 inhibitors (SGLT2i).
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• Hydralazine/nitrate combination if other treatments don’t stop your
symptoms and you’re African American.
• Medications that slow your heart rate if your heart rate is faster than 70
beats per minute and you still have symptoms.
• A diuretic (“water pill”) if symptoms continue.
• Restriction of sodium (salt) in your diet.
• Weight tracking every day. Tell your healthcare provider if you gain or
lose more than 4 pounds.

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Possible fluid restriction.

• Possible cardiac resynchronization therapy (biventricular
pacemaker).
• Possible implantable cardiac defibrillator (ICD) therapy.
If the treatment improves or stops your symptoms, you still need to
continue treatment to slow the progression to Stage D.

Stage D treatment
Treatment for people who have Stage D heart failure includes
treatments for Stages A, B and C. In addition, it includes evaluation for
more advanced treatment options, including:
• Heart transplant.
• Ventricular assist devices.
• Heart surgery.
• Continuous infusion of inotropic drugs.
• Palliative or hospice care.
Stages C and D with preserved EF
Treatment for people with Stage C and Stage D heart failure and
preserved EF (HFpEF) includes:
• Treatments for Stages A and B.
• Medications for the treatment of medical conditions that can cause
heart failure or make it worse, such as atrial fibrillation, high blood
pressure, diabetes, obesity, coronary artery disease, chronic lung
disease, high cholesterol and kidney disease.
• Diuretic (“water pill”) to reduce or relieve symptoms.
It’s very important for you to manage your other health conditions,
such as:

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 •

• Diabetes.
Kidney disease.
• Anemia.
• High blood pressure.
• Thyroid disease.
• Asthma.
• Chronic lung disease.
Some conditions have signs and symptoms similar to congestive heart
failure. If you have new or worsening nonurgent symptoms, tell your
healthcare provider.

4. Nursing intervention for Congestive Heart failure.

The nursing care plan for patients with HF should include

• Relieving fluid overload symptoms
• Relieving symptoms of anxiety and fatigue
• Promoting physical activity
• Increasing medication compliance
• Decreasing adverse effects of treatment
• Teaching patients about dietary restrictions
• Teaching patient about self-monitoring of symptoms
• Teaching patients about daily weight monitoring
• Initiating Interventions for Decrease in Cardiac Output
• Monitoring Diagnostic Procedures and Laboratory Studies •
Administering Medication and Providing Pharmacological
Interventions
• Maintaining or Improving Respiratory Function
• Managing Fluid Volume and Electrolyte Imbalance

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• Providing Perioperative Nursing Care

• Managing Acute Pain and Discomfort
Promoting Adequate Tissue Perfusion and Managing Decreased
Cardiac Tissue Perfusion
• Promoting Optimal Nutritional Balance and Adherence to
LowSodium Diet
• Maintaining Skin Integrity & Preventing Pressure Ulcers
• Managing Decreased Tolerance to Activity and Fatigue
• Reducing Anxiety, Fear and Improving Coping

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 Post test
• Define Congestive Heart failure ?
• Explain pathophysiology of Congestive Heart failure?
• List causes of Congestive Heart failure.?
• Mention signs and symptoms of Congestive Heart failure?
• Mention risk factors of Congestive Heart failure?
• Express Stages of Congestive Heart failure?
• State types of Congestive Heart failure ?
• Identify diagnostic tests and studies of Congestive Heart failure?
• Explain treatments for Congestive Heart failure?
• Discuss nursing intervention for Congestive Heart failure ?
• Demonstrate complications of Congestive Heart failure ?
• Express feeling concern. Congestive Heart failure ?

Signature :
Mohamed Tarek

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