Congestive Heart Failure

Chronic, progressive illness called congestive heart failure (CHF) impairs the ability of the heart muscles to pump blood. Although "heart failure" is frequently used as a blanket term, CHF refers particularly to the stage when fluid accumulates around the heart and impairs its ability to pump. When ventricles are unable to adequately pump blood to the body, CHF develops. Blood and other fluids eventually pool inside the lungs, liver, abdomen, lower extremities, and dependent area. CHF can be fatal, necessitating immediate treatment.

Causes of Heart Failure

Classification of Heart Failure

• Systolic vs. diastolic
• High output vs. low output
• Acute vs. chronic
• Right sided vs. left sided
• Forward vs. backward

Pathophysiology

• Regardless of the precipitating event, the shared pathophysiologic condition that sustains the development of heart failure is incredibly complex.
• Every level of structure, from the subcellular to the interconnections between organs, has compensatory mechanisms.
• Heart failure only occurs when this network of adaptations is overloaded.

Signs and Symptoms

New York Heart Association Functional Classification

• Class I: No symptoms when engaging in routine activity
• Class II: Restricting physical activity just a little. At rest comfortable, but with routine exercise suffers from exhaustion, palpitations, dyspnea, or angina
• Class III: A clear restriction on exercise. Comfortable during rest, but less intense exercise causes tiredness, palpitations, dyspnea, or anginal discomfort.
• Class IV: Unable to engage in any type of physical activity without pain. Even at rest, heart insufficiency symptoms could be present.

Diagnosis

• Patient History
• Laboratory and Diagnostic Tests
• Echocardiography
• Physical Examination
• Blood work
• Chest x-ray
• ECG

Management of Heart Failure

• Improving myocardial 'pump' performance:
  • Digitalis
  • Dopamine and dobutamine- facilitate myocardial contractility and enhance stroke volume
• Reducing myocardial work load:
  • Diuretics - ↓preload
  • Vasodilators - ↓afterload e.g. isosorbide dinitrate, hydralazine etc. nitroglycerine,
  • ACE inhibitors- suppress RAAS-↑renal blood flow & ↓ renal vascular resistance- dieresis
• Diet - ↓Na (2-4gm/day), limit fluid
• Cardiac resynchronization therapy increases the patient's (heart) efficiency by changing lifestyle e.g. rest, exercise, ↓ weight, quit smoking, goal setting etc
  • Create realistic goal: Encourage patients to create their own objectives, such as going grocery shopping or going straight to the mailbox.
  • Encourage them to take part in activities like regular follow-ups and daily weight checks, for example.

Nursing Diagnosis

• Cardiac output causes RT to drop cardiac arrhythmia, failure.
• Extra fluid volume RT a lower GFR, a lower dysrhythmia cardiac output, a higher ADH, and sodium and water retention.
• RT fluid in alveoli, poor gas exchange, or pulmonary congestion.
• Risk of reduced peripheral tissue perfusion is high RT Vasoconstriction and reduced cardiac output.
• High risk for cardiac output-related activity intolerance.
• High likelihood of weakened skin integrity Fear of the uncertain results reduces functional capacity.
• Drug toxicity risk for damage.

Nursing Interventions

• Monitor respiratory status and provide adequate ventilation (when progress to pulmonary edema):

  • Administer 02 therapy
  • Maintain the patient in semi or high Fowler's position
  • Monitor ABGS
  • Assess for breath sounds, noting any changes

• Provide physical and emotional rest:

  • As a result, evaluate your level of anxiety.
  • Remain in bed and engage in only light activities.
  • Maintain a calm, easygoing atmosphere.
  • Nursing care should be planned around rest periods.

• Increase cardiac output:

  • As directed, provide digitalis, vasodilators, and diuretics, and keep an eye on the results.
  • ECG, vital signs, daily weight, CVP, electrolytes, and peripheral edema should all be watched for.
  • Keep accurate I&O and daily measure abdominal girth As directed, provide a diet low in sodium.
  • Administer assiduous skin care.

• Provide teaching:

  • Self-monitoring of daily weight and S&S of CHF is necessary.
  • Name, function, dosage, frequency, and side effects of a medical regimen.
  • Prescribed eating schedule.
  • To prevent fatigue, set aside time for rest.