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Congestive Heart Failure (CHF)

Congestive heart failure, or heart failure, is a condition in which the heart is unable to
adequately pump blood throughout the body and/or unable to prevent blood from "backing
up" into the lungs.

In most cases, heart failure is a process that occurs over time, when an underlying condition
damages the heart or makes it work too hard, weakening the organ.

There are two basic problems in congestive heart failure:

• systolic dysfunction occurs when the heart can't pump enough blood to supply all
the body's needs
• diastolic dysfunction occurs when the heart cannot accept all the blood being sent
to it.

Many people have both systolic and diastolic heart failure.

CAUSES AND RISK FACTORS

Heart failure is a chronic, long-term condition, although it can sometimes develop suddenly.

The condition may affect only the right side or only the left side of the heart. These are
called right-sided heart failure or left-sided heart failure. More often, both sides of the heart
are involved.

Most common cause of heart failure is coronary artery disease (CAD), a narrowing of the
small blood vessels that supply blood and oxygen to the heart.

Heart failure can also occur when an infection weakens the heart muscle. Such a disorder is
called cardiomyopathy.

Other heart problems that may cause heart failure are:

• Congenital heart disease


• Heart attack
• Heart valve disease
• Some types of abnormal heart rhythms (arrhythmias)

Heart failure is most common in people over age 65, African Americans, and women.

Clinical manifestations:
a. Sweating
b. Weakness and fatigue
c. loss of appetite resulting in weight loss
d. Weight gain from edema, ascites and pleural effusion
e. Irritability
f. Pallor and Cyanosis
g. Dyspnea, tachypnea, orthopnea, wheezing, cough
h. Tachycardia and gallop rhythm
i. Hepatomegaly
j. Distended neck and peripheral veins.
Anatomy and Physiology
The Heart

Blood travels to:

Systemic
circulation
Superior and
Inferior vena Aorta
cava

Right
atrium Aortic valve

Tricuspid
Left ventricle
valve

Right
ventricle Mitral valve

Pulmonary
valve Left atrium

Pulmonary
artery Pulmonary
vein

Lungs

Deoxygenated blood Oxygenated blood


Pathophysiology

Heart muscle
Bacterial weakens
invasion

Tachycardia and
Myocardial
ventricular
hypertrophy
dilatation to

Decreased Decreased
renal cardiac output
perfusion

Increased
sodium
retention

Edema, weight
gain,
distended Fluid
neck and overload
peripheral
veins Dyspnea,
tachypnea,
Pleural orthopnea,
effusion cough
Nursing Management

1. Monitor for signs of respiratory distress

a. Provide pulmonary hygiene as needed

b. Administer oxygen as prescribed

c. Keep the head of the bed elevated

d. Monitor ABG values.

2. Monitor for signs of altered cardiac output, including

a. Pulmonary edema

b. Arrhythmias, including extreme tachycardia and bradycardia

c. Characteristic ECG and heart sound changes

3. Evaluate fluid status

a. Maintain strict fluid intake and output measurements

b. Monitor daily weights

c. Assess for edema and severe diaphoresis

d. Monitor electrolyte values and hematocrit level

e. Maintain strict fluid restrictions as prescribed

4. Administer prescribed medications which may include:

a. Antiarrhythmias to increase cardiac performance

b. Diuretics, to reduce venous and systemic congestion

c. Iron and folic acid supplements to improve nutritional status.

5. Prevent Infection

6. Reduce cardiac demands by scheduling nursing interventions to allow patient for rest

7. Promote adequate nutrition. Maintain a high-calorie, low-sodium as prescribed.

8. Promote optimal growth and development