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Nursing Care Plan for Congestive Heart Failure

Congestive Heart Failure


Heart failure (HF) often called congestive heart failure (CHF) is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests. Treatment commonly consists of lifestyle measures (such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes) and medications, and sometimes devices or even surgery.

Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. The term "heart failure" is sometimes incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure.

The symptoms of congestive heart failure vary among individuals according to the particular organ systems involved and depending on the degree to which the rest of the body has "compensated" for the heart muscle weakness.
  • An early symptom of congestive heart failure is fatigue. While fatigue is a sensitive indicator of possible underlying congestive heart failure, it is obviously a nonspecific symptom that may be caused by many other conditions. The person's ability to exercise may also diminish. Patients may not even sense this decrease and they may subconsciously reduce their activities to accommodate this limitation.
  • As the body becomes overloaded with fluid from congestive heart failure, swelling (edema) of the ankles and legs or abdomen may be noticed. This can be referred to as "right sided heart failure" as failure of the right sided heart chambers to pump venous blood to the lungs to acquire oxygen results in buildup of this fluid in gravity-dependent areas such as in the legs. The most common cause of this is longstanding failure of the left heart, which may lead to secondary failure of the right heart. Right-sided heart failure can also be caused by severe lung disease (referred to as "cor pulmonale"), or by intrinsic disease of the right heart muscle (less common)
  • In addition, fluid may accumulate in the lungs, thereby causing shortness of breath, particularly during exercise and when lying flat. In some instances, patients are awakened at night, gasping for air.
  • Some may be unable to sleep unless sitting upright.
  • The extra fluid in the body may cause increased urination, particularly at night.
  • Accumulation of fluid in the liver and intestines may cause nausea, abdominal pain, and decreased appetite.

Nursing Assessment for Congestive Heart Failure

a. Identity

b. Food or liquid
Symptoms:
  • Loss of appetite
  • Nausea and vomiting
  • Swelling of the extremities
  • Diit high salt or fat, sugar and caffeine

c. Elimination
Symptoms:
  • Decreased urination, dark urine
  • Urination at night
  • Diarrhea or constipation

d. Activity / rest
Symptoms:
  • Fatigue or tiredness constantly throughout the day
  • Insomnia
  • Chest pain with activity

e. Circulation
Symptoms:
  • History of hypertension
  • Cardiac surgery
  • Anemia
  • Endocarditis

f. Ego integrity
Symptoms:
  • Anxiety, worry and fear
  • Stress-related illnesses

g. Comfort
Symptoms:
  • Chest pain, acute or chronic angina
  • Muscle pain

h. Respiratory
Symptoms:
  • Dyspnea on exertion, while sitting or sleeping with multiple pillows

i. Social interaction
Symptoms:
  • Decreased participation in usual social activities

j. Security
Symptoms:
  • Changes in mental function
  • Loss of strength or muscle tone
  • skin blisters

Nursing Diagnosis for Congestive Heart Failure

Decreased cardiac output related to
  • Changes in myocardial contractility or inotropic changes.
  • Changes in frequency, rhythm, cardiac conduction.
  • Structural changes. (eg, valve abnormalities, ventricular aneurysm)

Activity intolerance related to
  • Weakness, fatigue.
  • Changes in vital signs, presence of dysritmia.
  • Dyspnea.
  • Pale.
  • Sweating.

Excess fluid volume related to
  • The decline in glomerular filtration rate (decrease in cardiac output) or increased production of ADH and sodium and water retention.

Risk for impaired skin integrity related to
  • Bed rest.
  • Edema, decreased tissue perfusion.

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