Congestive Heart Failure (CHF)

Congestive Heart Failure (CHF)

Definition: Condition in which heart is unable to pump sufficient blood to meet metabolic needs of the body. Result of inadequate cardiac output (CO) is poor organ perfusion and vascular congestion in pulmonary (left-sided failure) and systemic (right-sided failure) circulation. Incidence: Increases with age; ~1% of people >50 years old and ~10% of people _80 years old have CHF. Onset: With exception of acute and severe damage to myocardium, as in an AMI, CHF develops slowly, over a long period of time. Etiology: Most common cause is CAD. Other causes include MI, HTN, diabetes, congenital heart disease, cardiomyopathy, and valvular disease. Clinical Findings: Most common symptoms include fatigue, shortness of breath, and edema (vascular congestion in either the pulmonary or systemic circulation) in ankles or feet, in sacral area, or throughout body. Ascites may cause Pt to feel bloated and may compromise respiratory effort. Onset of symptoms may be rapid or gradual, depending on underlying etiology. Leftsided 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: Dependent edema, JVD, bounding pulses, oliguria, dysrhythmias, enlargement of the liver and/or spleen, increased CVP, and altered liver function tests. Nursing Focus ■ Encourage rest and help alleviate dyspnea by administering supplemental oxygen as ordered and elevating HOB 30–45 degrees. ■ In end-stage CHF, slightest activity can cause fatigue and shortness of breath; therefore, assist Pt with ADLs and eating as needed. Stage activities to conserve energy and decrease oxygen demand. ■ 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. ■ Monitoring for signs and symptoms of fluid overload, impaired gas exchange, activity intolerance, daily intake and output, and weight gain will help in 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 L/day and restrict sodium as ordered. ■ Teach Pt to weigh self at same time every day using same scale and report any weight gain >4 lb in 2 days. ■ Instruct 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 importance of reducing sodium intake. ■ Explain dosages, route, actions, and adverse reactions of meds.