Congestive Cardiac Failure and Its Medical Management

The objective of management in congestive heart failure is to eradicate or reduce those variables which precipitate the illness. It is also aimed at strengthening the heart to cope with the pressure and to lower sodium and water retention.

Drugs
1. Diuretics
two. Cardiac glycosides
three. Mild hypnotics
4. Electrolytes supplement
five. Expectorants

1. Diuretics: Diuretics such as Chlorothiazide .5gm-2gm is given every day to help the body get rid of excess fluid and the sodium stored in the tissues.
Examples of other diuretics that can be made use of contain:
- Furosemide (Laxis) 40-80mg day-to-day
- Ethacrynic acid (Edecrin) 80-200mg daily
- Hydrochlorothiazide (Esidrix, hydrodiuril) 25-100mg daily

Nursing responsibilities though administering diuretics
i. Diuretics must 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 everyday to be sure that weight loss is not rapid. Day-to-day weight loss of 4Ibs or above is harmful.
iv. Sustain intake and output record. Make sure patient is not dehydrated.
v. Observe patient for signs of adverse reactions. Signs to check out for incorporate muscle cramps, weakness, fatigue, confusion, dizziness, light-headedness, abdominal distension, perspiration, anorexia, and so on
vi. Check patient's crucial signs in particular the BP, for signs of hypotension.

2. Cardiac glycosides: Digitalis such as Tab Digoxin (Lanoxin, Davoxin) .5mg stat, then .25mg tds. Digitalis helps the ventricles to contract successfully and empty their blood. They also assist to strengthen myocardial contraction and slow down the heart rate. A high dose of digitalis is typically given initially in order to accumulate a therapeutic quantity of the drug in the body. This is identified as digitalization. This is then followed by minimal quantity of upkeep doses.

Examples of other Digitalis involve:
i. Digitoxin - Digitalizing dose = 1.2mg- 1.5mg in divided doses
ii. Digitalis - Digitalizing dose = 1-1.5g p.o in divided doses, upkeep dose is .1 - .2g
iii. Gitalin (Gitaligin) - Digitalizing dose = four-6mg. Maintenance dose is .25 - .5mg everyday.

Nursing responsibilities when administering Digitalis
i. Take added care to read the labels on digitalis drugs considering all digitalis preparations have comparable names but distinctive strength and dosages e.g. Digitalis, Digoxin, Digitoxin
ii. Take the patient's apical pulse for 1 full minute you administer a dose of digitalis
iii. Take cautious note of the rate and rhythm of the pulse and chart accordingly
iv. Drug should be withheld if the heart rate is rather rapid, below 60, or irregular. Inform the doctor.
v. Do not administer drug if there are severe symptoms of digitalis toxicity.

three. Mild hypnotics: E.g. Sodium Amytal might be given for the initial 2-3 nights to make the patient sleep comfortably.
Tranquilizers/Analgesics could also be administered to the patient to relieve anxiety and pain.

four. Expectorant: Expectorant is given to help patient expectorate the sputum from the lungs. Expectorants that include substances capable of causing respiratory depression ought to be avoided in order not to worsen the respiratory distress.

5. Electrolyte supplement: Hypokalaemia (often 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 prior to getting taken in order to minimize gastric irritation.