Causes of Congestive Heart Failure (CHF)

Congestive Heart Failure Condition in which the heart is unable to pump sufficient blood to meet the metabolic needs of the body. The result of inadequate cardiac output (CO) is poor organ perfusion and vascular congestion in the pulmonary (left-sided failure) and systemic (right-sided failure) circulation.

Incidence: Increases with age; about 1% of people over the age of 50 have CHF and about 10% of people over the age of 80.

Onset: With the exception of acute and severe damage to the myocardium, as in an AMI, CHF develops slowly, over a long period of time.

Etiology: Most common cause is coronary artery disease (CAD). Other causes include myocardial infarction (MI), HTN, diabetes, congenital heart disease, cardiomyopathy, and valvular disease.

Clinical Findings:The most common symptoms include fatigue, shortness of breath, and edema (vascular congestion in either the pulmonary or systemic circulation) in the ankles or feet, in the sacral area, or throughout the body. Ascites may cause the Pt to feel bloated. Onset of symptoms may be rapid or gradual, depending on underlying etiology. Left-sided heart failure: Orthopnea, pulmonary edema, crackles or wheezes, dysrhythmias, tachycardia, tachypnea, dyspnea, anxiety, cyanosis, HTN (early CHF), low BP (late CHF), and decreased CO. Right-sided heart failure: Dependant edema, jugular venous distention (JVD), bounding pulses, oliguria, dysrhythmias, enlargement of the liver and/or spleen, increased central venous pressure (CVP), and altered liver function tests.

Nursing Focus
■ Encourage rest and help alleviate dyspnea by elevating the HOB 30°–45°.
■ In end-stage CHF, the slightest activity can cause fatigue and shortness of breath; therefore, assist the Pt with ADLs and eating as needed.
■ Restrict fluid intake (typically < 2 L/day) and sodium intake as ordered (typically 1500–2300 mg/day depending on severity of heart failure).
■ Assess vital signs before and after any level of increased activity.
■ Monitor for signs and symptoms of fluid overload, impaired gas exchange, activity intolerance, daily intake & output, and weight gain will help in the early detection of exacerbation.

Patient Teaching
■ Provide Pt with literature on CHF.
■ Teach Pt and family to monitor for increased shortness of breath or edema.
■ Teach Pt to limit fluids to 2 liters per day and restrict sodium as ordered.
■ Teach the Pt to weigh him- or herself at the same time every day using the same scale, and report any weight gain > 4 lb in 2 days.
■ Instruct the Pt to call for emergency assistance with acute shortness of breath or chest discomfort that is not relieved with rest.
■ Review fluid and dietary restrictions and stress the importance of reducing sodium intake.
■ Explain the dosages, route, actions, and adverse reactions of meds.