Heart Failure [Congestive Heart Failure (CHF)] overview | Nursing Diagnosis for Heart Failure
Heart failure is a condition in which the heart can no longer pump enough blood to the rest of the body. In congestive heart failure, the heart is unable to pump sufficient blood to maintain adequate circulation. This results in a backup of blood and the extra pressure may cause accumulation of fluid into the lungs. Heart failure is primarily due to problems with ventricular pumping action of the cardiac muscle, which may be caused by diseases such as myocardial infarctions (heart attacks), endocarditis (infection in the heart), hypertension (high blood pressure), or valvular insufficiency.
When disease affects primarily the left side of the heart, the blood will back up into the lungs. When disease affects primarily the right side of the heart, the systemic circulation may be overloaded. When the heart failure becomes significant, the whole circulatory system may be compromised.
Hallmark Signs and Symptoms| Nursing Diagnosis for Heart Failure [Congestive Heart Failure (CHF)]
- Extra heart sounds (normal heart sounds were described in the beginning):
- S3: Soft sound caused by vibration of the ventricular wall caused by rapid filling. Heard after S2 heart sound. Heard over the apex of the left ventricle, fourth intercostal space along the mid-clavicular line. Best heard when patient lies on left side. Usually indicates heart failure.
- S4: Vibration of valves and the ventricular walls during the second phase of ventricular filling when the atria contract. Heard before S1, in the same location as S3, usually due to a “stiff heart.”
- Murmur: Sounds of turbulence caused by blood flow. Heard anywhere around the heart.
- Congestive heart failure
- Fatigue
- Syncope
- Chest pain
Prognosis of Heart Failure | Nursing Diagnosis for Heart Failure [Congestive Heart Failure (CHF)]
- Medications can help the heart to pump more efficiently. Some medications are used for disease management; others are used for symptom control. Monitoring dietary intake of sodium and fluids can also help with symptom control. Heart failure is the main complication of heart disease, produced by an abnormality of pumping function. The heart is unable to carry blood effectively to meet metabolic needs. The resulting problems include acute left ventricular dysfunction usually due to arrhythmias and myocardial infarction, and chronic failure due to fluid overload, usually in valvular heart disease. Heart failure is a compromise of any of the following:
- Contractility of the muscle
- Heart rate
- Ventricular preload
- Ventricular afterload While most hearts can tolerate some changes in the above items, some diseased, older hearts may not be able to do so; heart failure results. Treatment results of early disease are usually good. Long-term prognosis can be variable, depending on the severity of the disease and associated conditions.
Hallmark Signs and Symptoms| Nursing Diagnosis for Heart Failure [Congestive Heart Failure (CHF)]
- Early:
- Basilar rales from fluid overload
- Nocturia
- Exertional dyspnea
- Fatigue
- Positive hepatojuglar reflux from liver congestion
- S3 heart sound
- Mid:
- Cough
- Orthopnea
- Discomfort in right upper abdomen due to hepatomegaly
- Cardiac rales
- Edema
- Cardiomegaly
- Late:
- Anasarca—generalized edema from ineffective pump function
- Frothy or pink sputum from capillary permeability
Nursing Diagnosis for Heart Failure: Interpreting Test Results and Treatment
Interpreting Test Results and Treatment | Nursing Diagnosis for Heart Failure
- B-type natriuretic peptide—elevated levels in CHF; produced when the ventricles are stretched.
- EKG may show signs of ischemia (T-wave inversion), tachycardia, or extrasystole (extra beats).
- CBC may show anemia—Hgb less than 12 in female, less than 14 in male; HCT; less than 3 times the Hgb.
- Chemistry may show renal problems, electrolyte disturbance.
- Chest x-ray.
- Left-sided heart failure:
- Pulmonary congestion because of accumulation of fluid in the lungs.
- Enlarged left ventricle (LVH) because of the increased stress on the heart to pump blood.
- Right-sided heart failure:
- Pulmonary congestion because of accumulation of fluid in the lungs.
- Accumulation of fluid in the pleural cavity (pleural effusion).
- Enlarged heart (cardiomegaly) because of the increased stress on the heart to pump blood.
Treatment of Heart Failure | Nursing Diagnosis for Heart Failure
Treatment is aimed at the underlying disease, i.e. ischemia, valve defects, arrhythmias. Excreting volume with diuretics, supplemental oxygen, use of medications to reduce workload of heart muscle, peripheral vascular resistance (afterload), and venous return to the heart (preload) may all be used. Dietary indiscretions may be a contributing factor, i.e. too much salt, too many calories.
- Administer diuretics for symptom control resulting in patient comfort by reducing blood volume.
- Furosemide, bumetanide, metolazone, hydrochlorothiazide, spironolactone — be aware of electrolyte imbalance—these medications may alter the K+ level.
- Administer ACE inhibitors to decrease afterload.
- Captopril, enalapril, lisinopril.Administer beta blockers, which help to raise ejection fraction, and decrease ventricular size.
- Administer inotrope to strengthen myocardial contractility:
- Digoxin.
- Administer vasodilator to reduce preload, relieve dyspnea:
- nitroprusside, nitroglycerin ointment.
- Administer anticoagulants in patients with severe heart failure, as they have a propensity to develop thrombus and emboli; those with concurrent atrial fibrillation will also need anticoagulation.
- Reduce fluids as fluid overload is a causative factor in CHF.
- High Fowler’s position to ease breathing and enhance diaphragmatic excursion.
- Supplemental oxygen to meet increased demand of myocardium.
- Low-sodium diet to prevent additional fluid retention.
Nursing Diagnosis for Heart Failure and Nursing Interventions
Most Common Nursing Diagnosis for Heart Failure
- Impaired gas exchange
- Decreased cardiac output
- Excess fluid volume
Nursing Interventions for Heart Failure
- Monitor vital signs and look for changes.
- Record fluid intake and output—weigh daily to assess for fluid overload.
- Position patient in semi-Fowler’s position to ease breathing.
- Administer oxygen as ordered because it helps to decrease workload of heart.
- Tell the patient:
- Eat foods low in sodium to avoid fluid retention. (For these patients, there is no such thing as “low-salt” cold cuts.)
- Raise legs when sitting to lessen dependent edema.
- Call the physician, nurse practitioner, or physician assistant if experiencing fluid retention, such as a weight gain of several pounds in 1 to 2 days.
Further reading about nursing diagnosis for heart failure:
- ncbi.nlm.nih.gov (about heart failure)
- Wikipedia.org
This is a sample of nursing diagnosis for heart failure.
