Congestive Heart Failure is a serious chronic condition affecting over 6 million Americans over the age of 20 according to the American Heart Association (AHA). The two biggest contributing factors are that the population is aging and advances in medicine has made survival from heart attacks much more plausible. The quality of life for those who have CHF is not necessarily good. The survival rate is poor with about 50% of those diagnosed dying within the first five years. It contributes to nearly 300,000 deaths per year. Show
CHF does not discriminate between genders and can affect people of all ages from children to the elderly. The incidence does increase with age. African Americans are 1.5 times more likely to develop CHF than Caucasians. CHF is the most common admitting diagnosis for patients over 65. In this age group, 1/5 of all hospitalizations will list CHF as the primary or secondary diagnosis. The financial burden on healthcare is greatly impacted by CHF with almost 900,000 hospitalizations each year and more than 11 million physician visits each year. All hospitalizations for all forms of cancer combined don’t equate to this. Contributing factors and co-morbidities Contributing factors include chronic lung disease, coronary artery disease, genetic or inherited diseases such muscular dystrophy, HTN, regurgitant valvular decease, cardiac rate or rhythm disease such as bradycardia, alcohol abuse, myocardial damage due to toxins or drug abuse, and viral infections. Other conditions such as obesity, anemia, renal disease, COPD and diabetes especially with co-morbid cardiac disease that are not well-managed can contribute to cardiac disorders and lead to CHF. Patients diagnosed with CHF have an increased risk of developing other co-morbid chronic diseases such as atrial fibrillation, diabetes, chronic kidney disease, dementia and cognitive decline, depression, sleep disorder breathing, and venous thromboembolism. Prevention is key and careful management of the disease is essential. Patients who already have hypertension or diabetes are at greater risk of developing CHF. Managing HTN is of prime importance in preventing as well as managing CHF. Guidelines suggest an optimal blood pressure less than 130/80. Basic types of CHF There are two basic types of CHF. One is a diastolic failure and the other is a systolic failure. They both result from a syndrome caused by either a functional or a structural inability of the heart’s ventricles to eject or fill with blood in sufficient amounts to meet the body’s metabolic demands. Further categorization of CHF has become inconsistent and somewhat controversial. A firm understanding of cardiac function is essential to truly understanding CHF. Acute versus chronic CHF are the most widely used and understood terms. CHF is a progressive disease characterized by declining cardiac function. This decline adversely affects quality of life. Most people don’t know they have CHF initially. Symptoms include edema, dyspnea, Cheyne-Stokes respirations, paroxysmal nocturnal dyspnea, rales, fatigue, hepatomegaly, orthopnea, and jugular vein distention. These can be symptoms of many other conditions. Nursing considerations for CHF patients When nursing care pathways were first being developed, CHF was one of the very first to be enacted. Patient education is key to preventing and managing CHF. Nurses need to keep up to date with best practices and treatments and can do so through continuing education courses for nurses. This helps ensure they have the knowledge and information on how to prioritize patients as a nurse or how to make a difference for patients. Like any other illness or chronic disease, patients need to have a basic understanding of CHF including the signs and symptoms, the co-morbid diseases, the reasons to manage symptoms, what and when to report to healthcare providers to avoid exacerbation and possible hospitalization and how to improve their outcomes and quality of life. This starts with basic instruction in the anatomy and physiology of the disease, medication regimen, diet and exercise considerations. Daily weights are a necessary part of managing CHF along with consistency in taking medications. A weight gain of 2 or more pounds in one day can mean an exacerbation. Patients need to understand the parameters to report to their physician and the importance of getting a response. Ask when they might expect to hear back. Patients need medication information and education. Even patients who may have been taking the same medications for an extended period of time should not be assumed to know what they’re taking and why. It’s not at all uncommon to encounter a patient who thinks her pills are just vitamins the doctor gave her or is easily convinced her “little white pills” (digoxin) can be taken for chest pain every 5 minutes x 3 – confusing it with nitroglycerin and creating a possible medical emergency from toxic levels of digoxin on top of the chest pain incident! Timing of diuretics is important. If the patient doesn’t take them early in the day, he/she may be up late urinating frequently and this becomes a reason to be non-compliant. It’s also important to have adequate intake of fluids and sometimes a potassium supplement is needed. These can be unpleasant and there are varieties which are more palatable. Edema is another common symptom of CHF and needs to be managed by limiting sodium intake. But does your patient understand that bacon contains large amounts of sodium? Or does he think he can use it to flavor his food in lieu of salt?! Does your patient understand how to read food labels and calculate sodium contents? Elevating lower extremities while sitting also helps to decrease the edema. The patient needs to understand why this is necessary and how it helps. The legs need to be elevated higher than the heart level. A reclining chair will help but lying on the bed for 20-30 minutes might work better. They need to try each and perhaps alternate them. Fatigue and shortness of breath are common with CHF and can make a serious dent in activities and quality of life. Learning tips and techniques for energy conservation can make a huge difference. Remind patients to comply. The sudden increase in any symptoms such as weight gain, shortness of breath, fatigue, chest pain, heart rate, etc. should be reported to the healthcare provider for instructions in modification of medications or other regimens to prevent an exacerbation requiring hospitalization. By helping patients understand the disease process and comply with necessary daily regimens, nurses can help patients improve outcomes and their quality of life. This also helps reduce the financial burden on patients as well as the overall health care system. Learn more about nursing interventions and postoperative complications.
Congestive Heart Failure CHF NCLEX Review and Nursing Care Plans CHF can affect either both sides of the heart or just one side. The three types of CHF are biventricular, left-sided, and right-sided heart failure. In left-sided heart failure, the left ventricle becomes enlarged (hypertrophy) and becomes dilated together with the left atrium in order to compensate for the increased pressure. Right-sided heart failure usually happens after left-sided heart failure. Pooling of blood in the left heart chambers causes an increase in pressure, impairing the normal blood drainage from the lungs to the left atrium. The pressure in the pulmonary veins increases, causing the right ventricle to compensate by pumping more vigorously. In time, the cardiac muscles of the right chambers wear down, causing right-sided heart failure. Failure of both sides of the heart is called biventricular heart failure. Congestion is one of the common features of heart failure, thus the term “congestive heart failure” is still used by many medical professionals. Signs and Symptoms of Heart Failure
Causes of Heart Failure
Complications of Heart Failure
Diagnostic Tests for Heart Failure
Treatment for Heart Failure
2. Surgical interventions. These include coronary bypass surgery, heart valve repair or replacement, and heart transplant. It may also involve the insertion of medical devices such as implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and ventricular assist devices (VADs). 3. Lifestyle changes. A crucial part of the treatment plan for a patient with heart failure is to change several habits that are linked to the disease. These include smoking cessation, blood pressure control, diabetes management, dietary changes, stress management, exercise and increase in physical activity. CHF Nursing DiagnosisCHF Nursing Care Plan 1Nursing Diagnosis: Decreased Cardiac Output related to increased preload and afterload and impaired contractility as evidenced by irregular heartbeat, heart rate of 128, dyspnea upon exertion, and fatigue. Desired outcome: The patient will be able to maintain adequate cardiac output.
CHF Nursing Care Plan 2Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressures as evidenced by shortness of breath, SpO2 level of 85%, and crackles upon auscultation. Desired Outcome: The patient will have improved oxygenation and will not show any signs of respiratory distress.
CHF Nursing Care Plan 3Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Congestive Heart Failure as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care” Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of congestive heart failure and its management.
CHF Nursing Care Plan 4Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
CHF Nursing Care Plan 5Nursing Diagnosis: Excess Fluid Volume related to decreased cardiac output and increased glomerular filtration rate (GFR) as evidenced by S3 heart sound, blood pressure level of 190/85, orthopnea, pitting edema of the ankles, and weight gain Desired Outcome: The patient will demonstrate a balanced input and output, and stabilized fluid volume
CHF Nursing Care Plan 6Nursing Diagnosis: Acute Pain related to decreased myocardial blood flow as evidenced by pain score of 10 out of 10, verbalization of pressure-like/ squeezing chest pain (angina), guarding sign on the chest, blood pressure level of 180/90, respiratory rate of 29 cpm, and restlessness Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
CHF Nursing Care Plan 7Nursing Diagnosis: Ineffective Breathing Pattern related to pulmonary congestion secondary to CHF as evidenced by shortness of breath, SpO2 level of 85%, cough, respiratory rate of 25 bpm, and frothy sputum Desired Outcome: The patient will achieve effective breathing pattern as evidenced by normal respiratory rate, oxygen saturation within target range, and verbalize ease of breathing.
With proper use of the nursing process, a patient can benefit from various nursing interventions to assess, monitor, and manage heart failure and promote client safety and wellbeing. Nursing ReferencesAckley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon Disclaimer:Please follow your facilities guidelines, policies, and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Please enable JavaScript Nursing Stat FactsThis information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. |