Nursing Care Plan for Congestive Heart Failure - CHF
Congestive Heart Failure (CHF)
Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs. This can result from :
- narrowed arteries that supply blood to the heart muscle — coronary artery disease
- past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle's normal work
- high blood pressure
- heart valve disease due to past rheumatic fever or other causes
- primary disease of the heart muscle itself, called cardiomyopathy.
- heart defects present at birth — congenital heart defects.
- infection of the heart valves and/or heart muscle itself — endocarditis and/or myocarditis
As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down.
Heart failure also affects the kidneys' ability to dispose of sodium and water. The retained water increases the edema.
Congestive Heart Failure Symptoms and Signs
The symptoms of congestive heart failure vary among individuals according to the particular organ systems involved and depending on the degree to which the rest of the body has "compensated" for the heart muscle weakness.
The early symptoms are often shortness of breath, cough, or a feeling of not being able to get a deep breath.
In addition, the three major symptoms of congestive heart failure are :
- exercise intolerance (a person may be unable to tolerate exercise or even mild physical exertion that he or she may have been able to do in the past);
- shortness of breath (you may have difficulty breathing (dyspnea), especially when active, or even at rest); and
- fluid retention and swelling (edema in the legs, feet, and ankles).
- Decreased cardiac out put related to structural defect, myocardial dysfunction. Ineffective breathing pattern related to pulmonary congestion.
- Anxiety related to threat to or change in health status resulting in inability to manage feelings of uncertainty and apprehension regarding the life-style changes.
- Disturbance of sleep pattern related to illness resulting in interrupted sleep caused by nocturnal dyspnea.
- Monitor vital signs every two to four hours including apical pulse, peripheral pulses, capillary refill, CVP and PAP if appropriate. Indicates change in cardiac status and potential for arrhythmias, compromised systemic venous flow.
- Monitor for heart sounds and breath sounds. Indications of recuced cardiac output caused by mechanical failure, pulmonary edema.
- Monitor electrolyte level of sodium increases and potassium decreases. Diuretic therapy may induce hypokalemia; decreased glomerular filtration rate (GFR) may cause hypernatremia; arrhythmias may be induced by potassium imbalances.
- Administer diuretic (hydrochlorothiazide, furosemide) while monitoring for electrolyte imbalances. Acts on distal tubule to increase water and potassium excretion or loop of Henle to promote excretion of sodium and chloride.
- Administer bronchodilator (theophylline). Dilates airways to facilitate breathing if dyspneic.
- Administer inotropic agents (digoxin, dopamine) while monitoring hemodynamic status. Increases cardiac output by increasing cardiac contractility.
- Administer oxygen therapy by cannula. Provides oxygen if hypoxic from decreased cardiac output or with ventilation perfusion imbalance from fluid in alveoli.
- Provide quite environment limiting stimuli. Stimuli and stress stimulate catecholamines and cardiac workload.
- Provide small meals six times per day. Reduces pressure on diaphragm and enhances chest expansion.
- Provide bed rest with head of bed elevated 30 to 60 degrees. Promotes lung expansion and decreases venous return.
- Perform deep breathing exercises, incentive spirometry ever two hours. Improves breathing and oxygen intake.