Define congestive heart failure. Discus Pathophysiology of CHF. Explain clinical manifestations of CHF. Identify therapeutic management of CHF. Discus nursing considerations of CHF. Explain clinical manifestations of rheumatic fever. Identify therapeutic management of rheumatic fever. Discus nursing considerations of rheumatic fever.

 Is inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.

 Right sided failure The right ventricle is unable to pump blood effectively into the pulmonary artery Resulting in Increased pressure in the right atrium and systemic venous circulation Hypertension Causes Hepatosplenomegaly and edema

 In left sided failure The left ventricle is unable to pump blood into the systematic circulation Resulting in Increased pressure in the left atrium and pulmonary veins Lungs become congested with blood Causing Pulmonary pressure and pulmonary edema

Systemic venous congestion Pulmonary congestion Impaired myocardial function Weight gain Hepatomegaly Peripheral edema Ascites Neck vein distention (children). Tachypnea Dyspnea, cyanosis Exercise intolerance Orthopnea Cough, hoarseness, wheezing Tachycardia Sweating urine output Fatigue Weakness, restlessness Anorexia Pale, cool extremities Weak peripheral pulse

1. Clinical symptoms  Tachypnea and tachycardia at rest  Dyspnea, activity intolerance (during feeding in infants).  Weight gain. 2. A chest X ray (Cardiomegaly). 3. E C G

1. Improve cardiac function ( increase contractility). Through administration of digitalis glycosides The beneficial effects of digitalis are:  Increase cardiac output.  Decrease heart size.  Decrease venous pressure.  Relief of edema.

2. Remove accumulated fluid and sodium.  Administration of diuretics  Fluid and sodium restriction 3. Decrease cardiac workload  Limiting physical activity (bed rest).  Treating any infections  Reducing the effort of breathing ( semi fowler position).  Using medication to sedate an irritable child. 4. Improve tissue oxygenation

 Hospitalized  Positioning  Monitored cardiac and respiratory function  Pulse oximeter  Urine output and serum electrolytes are evaluated.

1. Assist in measures to improve cardiac function  Calculating and administrating the correct dosage of digoxin.  The child’s apical pulse is always checked before administering digoxin.  Not given if the pulse is below 90 b/m in infants and young children. Or below 70b/m in older children.

Observing for signs of digoxin toxicity  Nausea  Vomiting  Anorexia  Bradycardia

 Give digoxin at regular intervals.  Do not mix it with other foods or fluids (inaccurate intake of drug).  If a dose is missed more than 4 hours has, withhold the dose and give the next dose at the regular time, if less than 4 hours give the missed dose.  If the child vomits do not give a second dose.  Do not increase or double the dose for missed dose.  In case of accidental overdose of digoxin call the nearest poison center immediately.

2. Decrease cardiac demands (workload)  Uninterrupted period of sleep.  Minimize disturbing the infant (changing bed linen, bathing).  The child is fed when hungry.  Because infants with CHF tire easily and may sleep through feeding, smaller feedings every 3 hours may helpful.  Avoid crying

 Temperature carefully monitored ( hypothermia or hyperthermia increase the need of oxygen).  Skin breakdown from edema is prevented with change of position every 2 hours ( from side to side within semi fowler position).

3. Reduce respiratory distress  Careful assessment.  Positioning and oxygen administration.  Respirations are counted for full minute.  Protected from infections.  Good hand washing.

4. Maintain nutritional status Infant do not have the energy to do extra work even feeding.  The nurse seeks measures to enable the infant to feed easily without excess fatigue and to increase the caloric density of the formula.  The infant should be rest before feeding.  A 3-hour feeding schedule works.

 Infants should be feed in a semi upright position.  Gavage feeding for infant with feeding difficulties.  A large nipple opening, decreases the energy expenditure of the infant while sucking.

5. Assist in measures to promote fluid loss.  Record fluid intake and output and monitors body weight.  Diuretics should be given early in the day.  If potassium losing diuretics are given, the nurse encourage foods high in potassium.  Fluid restriction. 6. Support child and family.

 Is an inflammatory disease that occurs after infection with group AB hemolytic streptococcal Pharyngitis.  It is involves the joints, skin, brain, serous surfaces and heart.  The most significant complication of RF is Rheumatic heart diseases.

 Previous infection with group A- streptococcal infection. Prevention or treatment of group A streptococcal infection prevents RF.

 Major manifestations:  fever and arthralgia  recent streptococcal infections.  Tested for streptococcal antibodies ( elevated of antistreptolysin-O (ASLO).

Major manifestations. 1. Carditis  Tachycardia out of proportion of fever.  Cardiomegaly.  Chest pain. 2. Polyarthritis  Swollen, hot, red, painful joints.  Favors large joints (knees, elbows, hips, shoulders, wrists).

3. Erythema marginatum  Nonpruritic  Affects trunk and extremities (inner surfaces). 4. Chorea  Sudden aimless, irregular movements of extremities.  Involuntary facial grimaces.  Speech disturbances.

5. Subcutaneous nodes  Nontender swelling.  Located over bony prominences. 6. Supporting evidence  Positive throat culture

Goals  Eradication of hemolytic streptococci.  Prevention of permanent cardiac damage.  Palliation of the other symptoms.  Prevention of recurrences of RF.

 Penicillin is the drug of choice. Erythromycin  Salicylattotes control inflammatory process especially in the ( joints and reduce fever).  Prophylactic treatment against recurrence of RF (monthly IM injections of benzathine penicillin G).  Followed medically for at least 5 years.

 Encourage adherence to the therapeutic plan.  Providing rest and adequate nutrition.  If Carditis is present, activity restrictions.  Prevention, primarily in screening school age children for sore throats caused by group A streptococci.  Throat culture screening programs.