CHF HF

Congestive Heart Failure CHF Nursing Diagnosis Care Plan

Congestive Heart Failure HF CHF Nursing Diagnosis Care Plan Pathology and NCLEX Review

Congestive heart failure (CHF), also called as heart failure (HF) is a chronic cardiac condition wherein there is a reduction in the capacity of the heart to sufficiently pump blood throughout the body. This causes the body to have a lower oxygen supply than what it requires. In turn, the patient with CHF usually has fatigue, shortness of breath, and a limited ability to exercise or use the stairs.

CHF can affect either both sides of the heart or just one side. The three types of CHF are biventricular, left-sided, and right-sided heart failure. In left-sided heart failure, the left ventricle becomes enlarged (hypertrophy) and becomes dilated together with the left atrium in order to compensate for the increased pressure.

Right-sided heart failure usually happens after left-sided heart failure. Pooling of blood in the left heart chambers causes an increase in pressure, impairing the normal blood drainage from the lungs to the left atrium. The pressure in the pulmonary veins increases, causing the right ventricle to compensate by pumping more vigorously.

In time, the cardiac muscles of the right chambers wear down, causing right-sided heart failure. Failure of both sides of the heart is called biventricular heart failure.

Congestion is one of the common features of heart failure, thus the term “congestive heart failure” is still used by many medical professionals.

Signs and Symptoms of Heart Failure

  • Dyspnea (shortness of breath) upon exertion or lying down
  • Jugular vein distention (JVD)
  • Fatigue and reduced ability to exercise
  • Peripheral edema (swelling of limbs, ankles, and feet)
  • Pulmonary edema
  • Ascites (swelling of the abdominal cavity)
  • Irregular and/or rapid heartbeat
  • Cough and wheezing – may come with white or blood-tinged sputum
  • Nausea and lack of appetite
  • Decreased level of alertness and concentration
  • Increased urinary frequency at night
  • Chest pain if the HF is caused by myocardial infarction (heart attack)

Causes of Heart Failure

  1. Myocardial Infarction (heart attack) and Coronary Artery Disease (CAD). These are the most common causes of heart failure. Fat buildup on the arterial walls leads to the reduction of blood flow, resulting to cardiac arrest.
  2. Hypertension. Having a high blood pressure causes the heart to work harder than normal in order to facilitate the blood circulation throughout the body. This makes the cardiac muscles stiffer and/or weaker, leading to heart failure.
  3. Alcohol, tobacco, and drug abuse. The toxic effects of alcohol, nicotine, and drugs (e.g. cocaine) may lead to the damage of the cardiac muscles known as cardiomyopathy.
  4. Congenital heart defects. Faulty heart chambers or valves at birth can directly affect the functionality of the heart.
  5. Other heart conditions. Viral infections such as COVID-19 may cause inflammation of the cardiac muscles known as myocarditis.
  6. Chronic diseases. HIV, diabetes, arrythmias, and thyroid problems may lead to heart failure.
  7. Certain medications. Non-steroidal inflammatory drugs (NSAIDS), several anaesthesia drugs, chemotherapy agents, and some antihypertensives puts a person at a higher risk for heart problems which may eventually lead to heart failure.

Complications of Heart Failure

  1. Kidney damage. A reduction of blood flow from the heart to the kidneys may result to reduce capacity of the kidneys to remove toxic waste. If left untreated, this may lead to kidney failure which may require the patient to undergo dialysis.
  2. Liver damage. Fluid build up may result to an increased pressure to the liver. If left untreated, this may result to liver damage known as scarring.
  3. Other cardiac issues. Heart failure may result to faulty heart valves and arrythmias if there is an increased pressure in the heart or enlargement of the heart.

Diagnostic Tests for Heart Failure

  1. Physical examination – crackles heard upon auscultation, signs of edema upon inspection
  2. Blood tests – CBC, biochemistry, N-terminal pro-B-type natriuretic peptide (NT-proBNP)
  3. Imaging – Chest X-Ray, Echocardiogram, CT scan, MRI, coronary angiogram (insertion of a catheter and injecting a dye for visualization)
  4. Electrocardiogram
  5. Stress test – letting the patient walk on a treadmill while attached to an ECG machine
  6. Myocardial biopsy – insertion of a biopsy cord in a vein in the neck or groin to take heart muscle tissue samples

Treatment for Heart Failure

  1. Medications. Several medications are used in combination to treat heart failure. These include:
  2. Angiotensin-converting enzyme (ACE) inhibitors – promotes vasodilation of the blood vessels, lowering the pressure and improving the blood flow (e.g. lisinopril and enalapril).
  3. Beta blockers – reduces heart rate and blood pressure (e.g. bisoprolol and carvedilol).
  4. Angiotensin II receptor blockers – similar to ACE inhibitors and can be used if the patient does not tolerate ACE inhibitors (e.g. losartan and valsartan).
  5. Digitalis or digoxin – improves the contraction of heart muscles, regulate heart rhy and reduces heartbeat.
  6. Inotropes – to improve the function of the heart to pump blood in severe heart failure.
  7. Diuretics – to facilitate elimination of excess fluid in the body through urination (e.g. furosemide and spironolactone).
  8. Inotropes. These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.
  • Surgical interventions. These include coronary bypass surgery, heart valve repair or replacement, and heart transplant. It may also involve the insertion of medical devices such as implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and ventricular assist devices (VADs).
  • Lifestyle changes. A crucial part of the treatment plan for a patient with heart failure is to change several habits that are linked to the disease. These include smoking cessation, blood pressure control, diabetes management, dietary changes, stress management, exercise and increase in physical activity.

Nursing Care Plans for Heart Failure

  1. Nursing Diagnosis: Decreased Cardiac Output related to increased preload and afterload and impaired contractility as evidenced by irregular heartbeat, heart rate of 128, dyspnea upon exertion, and fatigue.

Desired outcome: The patient will be able to maintain adequate cardiac output.

InterventionsRationales
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess breath sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds of crackles/rales are important signs of heart failure. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
Administer the cardiac medications, and diuretics as prescribed.  To alleviate the symptoms of heart failure and to treat the underlying condition.  
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value of at least 94%.
Educate patient on stress management, deep breathing exercises, and relaxation techniques.Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels.
  • Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressures as evidenced by shortness of breath, SpO2 level of 85%, and crackles upon auscultation.

Desired Outcome: The patient will have improved oxygenation and will not show any signs of respiratory distress.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target of at least 94%.
Encourage small but frequent meals.To avoid abdominal distention and diaphragm elevation which lead to a decrease in lung capacity.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.

Other nursing diagnoses:

  • Excess Fluid Volume
  • Activity Intolerance
  • Deficient Knowledge

References:

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Link

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Link

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