CHF
What is it?
- Cardiac Output is insufficient to meet the body’s perfusion demands
- ↑ Aldosterone & ↓ renal perfusion leads to fluid retention
- ↑ Sympathetic nervous system stimulation leads to ↑ cardiac workload
- ↑ Pressure in the pulmonary system = Left-Sided HF
- ↑ Pressure in the systemic system = Right-Sided HF
Risk Factors
Valve Disorders & Atrial fibrillation
Viral illnesses
Diabetes
Smoking & Alcohol
Obesity & Sleep Apnea
Diagnostic Tests
- Echocardiogram
- Chest X-ray (cardiomegaly)
- ↑ BNP (B-type natriuretic peptides)
- Cardiac stress test
Treatment
- Treat cause
- ACE inhibitors to ↓ preload/afterload
- Beta blockers to counteract Sympathetic nervous system (↓ heart rate and BP)
- Diuretics to ↓ fluids
- Digoxin to ↑ Cardiac output
- Acute heart failure: Dobutamine IV drip to ↑ contractility
Nursing Interventions: NCLEX Alert
- Semi/high fowlers to ↓ venous return. THIS IS THE PRIORITY ACTION. IT CAN BE DONE FAST
- Administer Oxygen (PRIORITY ABC)
- I & O let’s you know if the client is retaining fluids, but weight is the MOST accurate indicator of fluid balance.Â
- Daily weights before breakfast
- Report weight gain 2-3 lbs/day
- Assess lung sounds (does the client have water in their lungs?)Â
- Administer diuretics (furosemide)
- Monitor potassium levels
- ↑ K diet if on lasix (furosemide): dried fruit, bananas, oranges, & melons
- Administer ACE Inhibitors, beta blockers, and digoxin
- Monitor cardiac rhythm. Watch for atrial fibrillation
- Monitor digoxin levels
- Fluid restriction
- Diet: ↓ Na, ↓ fat, ↓ cholesterol, ↓ water.
- Balance rest/activity to decrease cardiac demands/oxygen demands.
- Gradually ↑ exercise
- Educate about medications
- Remember that hypokalemia potentiates digoxin toxicity.
- One important symptom of hypokalemia is muscle weakness.
NCLEX Alert: A lot of the questions on CHF are based on MAWDS. Teaching the client to stay active, to weight daily (report weight gain or 2-3 lbs/24 hours), to be compliant with meds, to follow low salt diet, and to recognize symptoms early to prevent an exacerbation.Â
Case Study
History
Vital Signs
Nurses Notes
Labs
Meds
History
A 76-year-old male client is admitted with shortness of breath x 2 days. The client states “I’m having trouble catching my breath and my legs get more swollen everyday.” The client has a history of Congestive Heart Failure, Diabetes Type 2, and MI 5 years ago with a stent placement to his RCA.Â
Vital Signs
Temp: 98.8º F, HR 99 BPM; BP 145/55 mm Hg; RR 24 bpm. Pain 0 on a scale of 0 to 10. SpO2 = 89% on RA
Nurses Notes
1000 am: Pt alert, oriented but restless due to SOB. Client able to speak in short sentences, able to answer questions. Lungs w/rales bilaterally, respiratory rate 24, regular but labored. S1, S2, and S3 heart sounds present. All peripheral pulses palpable 2+, skin warm/dry, 3+ pitting edema to bilaterally extremities. Client has facial and periorbital edema. Active bowel sounds x 4 quadrants. Peripheral IV to right hand with NS to keep vein open.
Labs
- Sodium 132 mEq/L (135-145 mEq/L)
- Potassium 3.4 mEq/L (3.5-5 mEq/L
- Chloride 95 mEq/L (96-106 mEq/L)
- Blood Urea Nitrogen 18 mg/dl (7-20 mg/dl)
- Creatinine 1.1 mg/dl (0.7-1.3 mg/dl)
- Blood Sugar 120 mg/dl (100-125 mg/dl)
- BNP 950 (< 100 ng/dl)
Meds
- Captopril 20mg po daily
- Lasix 40mg po daily
- Digoxin 0.125 mcg po daily
- Pioglitazone 45 mg po in AM
