Congestive Heart Failure (CHF) is a chronic, progressive condition where the heart is unable to pump blood effectively, leading to a buildup of fluid in the lungs, abdomen, liver, and lower extremities.
CHF is a common health issue, particularly among the elderly, and can lead to severe health complications if not managed properly.
Pathophysiology of Congestive Heart Failure (CHF)
CHF occurs when the heart’s ventricles are unable to pump sufficient blood to meet the body’s needs. This leads to fluid retention and congestion in organs and tissues. CHF is commonly caused by underlying conditions such as coronary artery disease, hypertension, and myocardial infarction.
Common Causes of CHF:
- Coronary artery disease
- Hypertension
- Diabetes
- Valve disorders
- Myocardial infarction (heart attack)
- Arrhythmias
Symptoms of CHF:
- Shortness of breath (dyspnea)
- Fatigue and weakness
- Swelling in legs, ankles, and feet (edema)
- Rapid or irregular heartbeat
- Persistent cough or wheezing
- Fluid retention leading to weight gain
Nursing Assessment for CHF
During the nursing assessment, it is crucial to gather subjective and objective data to identify the severity and progression of CHF.
Subjective Data:
- Patient reports of fatigue, shortness of breath, chest pain, or orthopnea.
- History of heart disease, hypertension, or diabetes.
- Difficulty sleeping flat due to breathing discomfort.
Objective Data:
- Observation of edema in extremities.
- Auscultation of lung sounds indicating crackles.
- Observation of jugular vein distention.
- Monitoring vital signs: tachycardia, hypertension, or hypotension.
- Lab results: Elevated BNP (B-type natriuretic peptide) levels, abnormal electrolytes, elevated creatinine or liver enzymes, and abnormal ECG findings.
Nursing Diagnoses for CHF
1. Decreased Cardiac Output related to impaired myocardial contractility
Related to: Myocardial dysfunction, hypertension, valvular disease
Evidenced by: Shortness of breath, fatigue, abnormal heart rate, hypotension, decreased peripheral pulses
Goals:
- Patient will demonstrate improved cardiac output as evidenced by stable heart rate, normal blood pressure, and reduced fatigue.
- Patient will report increased energy levels and ability to perform daily activities without fatigue or shortness of breath.
Nursing Interventions:
- Monitor vital signs: Check blood pressure, heart rate, respiratory rate, and oxygen saturation regularly to assess cardiac function.
- Administer medications as prescribed: Administer diuretics to reduce fluid overload, ACE inhibitors to improve cardiac output, and beta-blockers to reduce the heart’s workload.
- Assess for signs of fluid overload: Monitor weight daily, assess for edema, and auscultate lung sounds for crackles.
- Educate patient and family: Teach about low-sodium diet, fluid restrictions, and the importance of adhering to the medication regimen.
Expected Outcomes:
- Patient will maintain stable cardiac output, as evidenced by regular heart rate, blood pressure within normal range, and absence of edema.
- Patient will experience reduced fatigue and report improved tolerance to physical activity.
2. Impaired Gas Exchange related to pulmonary congestion
Related to: Accumulation of fluid in the lungs
Evidenced by: Shortness of breath, orthopnea, crackles on lung auscultation, oxygen saturation < 90%
Goals:
- Patient will maintain oxygen saturation levels above 92% and demonstrate normal respiratory rate.
- Patient will report decreased dyspnea and improved ability to engage in physical activity.
Nursing Interventions:
- Monitor respiratory status: Check oxygen saturation, respiratory rate, and depth regularly.
- Administer supplemental oxygen as prescribed: Ensure patient is receiving the appropriate level of oxygen therapy.
- Positioning: Elevate the head of the bed to facilitate lung expansion and ease breathing.
- Monitor fluid status: Keep track of fluid intake and output, and administer diuretics as prescribed to reduce pulmonary congestion.
Expected Outcomes:
- Patient will demonstrate improved oxygenation, with oxygen saturation levels above 92% and absence of crackles in the lungs.
- Patient will experience less shortness of breath and be able to perform activities of daily living with ease.
3. Activity Intolerance related to decreased cardiac output
Related to: Inability of the heart to pump sufficient blood to meet the body’s needs
Evidenced by: Fatigue, dyspnea on exertion, increased heart rate with minimal activity
Goals:
- Patient will report increased tolerance to activity and demonstrate the ability to perform daily activities without experiencing fatigue or shortness of breath.
Nursing Interventions:
- Assess patient’s tolerance to activity: Monitor response to activity by checking heart rate, blood pressure, and respiratory status before, during, and after activity.
- Encourage gradual increase in activity levels: Provide support for progressive ambulation or participation in a cardiac rehabilitation program.
- Plan rest periods: Encourage frequent rest periods during activity to prevent overexertion.
Expected Outcomes:
- Patient will gradually increase activity levels, demonstrating improved exercise tolerance and decreased symptoms of fatigue and dyspnea.
Patient Education and Discharge Planning
Educating the patient and their family is vital for long-term management of CHF. Key topics to include:
- Medication adherence: Stress the importance of taking prescribed medications (diuretics, ACE inhibitors, beta-blockers) as instructed.
- Dietary changes: Encourage a low-sodium diet to help prevent fluid retention.
- Weight monitoring: Teach the patient to weigh themselves daily and report any sudden increases to the healthcare provider.
- Fluid restriction: Advise on appropriate fluid intake to prevent fluid overload.
- Lifestyle modifications: Encourage smoking cessation, regular physical activity, and limiting alcohol intake.
References:
- American Heart Association. (2024). Heart Failure. Retrieved from https://www.heart.org/en/health-topics/heart-failure
- Mayo Clinic. (2024). Congestive Heart Failure: Symptoms and Causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
- NurseStudy.net. (2022). Congetive Heart Failure (CHF) Nursing Diagnosis and Care Plan. Retrieved from https://nursestudy.net/chf-nursing-diagnosis/