Congestive heart failure (CHF) is a severe condition that can be difficult to manage and requires comprehensive care. Without an effective nursing care plan, CHF patients may not receive the care they need to improve their quality of life. This can lead to further complications and even death.
Solution: The nursing Care Plan (NCP) for Congestive Heart Failure (CHF) provides detailed guidance on managing this condition with evidence-based practice guidelines. Our NCP includes step-by-step instructions on assessment, nursing diagnosis for CHF, interventions, patient education, and more – all designed to help you provide the highest quality of care for your CHF patients. With our NCP, you can ensure that your patients get the best possible treatment.
Table of Contents
What is Congestive Heart Failure (CHF)?
Congestive Heart Failure (CHF) is a medical condition in which the heart becomes too weak to pump blood efficiently. This condition can make physical activities challenging and even lead to death if left untreated.
Various factors, such as high blood pressure, coronary artery disease, and heart valve disorders, cause CHF. Some common symptoms of CHF include breathlessness, fatigue, and swelling in the ankles.
This condition affects millions worldwide, and its incidence continues to rise, making it essential to prioritize heart health. Early detection and management of CHF can significantly improve the quality of life for individuals with this condition.
Pathophysiology
The pathophysiology of Congestive Heart Failure (CHF) is complex and involves a combination of factors such as hypertension, coronary artery disease, and other cardiac diseases. In CHF, the heart muscle becomes weakened and cannot pump blood efficiently, resulting in decreased oxygen delivery to the rest of the body. This results in decreased perfusion to vital organs, leading to various symptoms.
Clinical Manifestations
Heart failure impacts either the left, right, or both sides of the heart. In most cases, it is the left ventricle that gets affected initially. As a result, signs and symptoms vary depending on which part of the organ has been impacted – left-sided heart failure typically leads to a different set of indications compared to right-sided failure.
Left-Sided Heart Failure
- Dyspnea on exertion
- Pulmonary congestion, pulmonary crackles
- Cough that is initially dry and nonproductive
- Frothy sputum that is sometimes blood-tinged
- Inadequate tissue perfusion
- Weak, thready pulse
- Tachycardia
- Oliguria, nocturia
- Fatigue
Right-Sided Heart Failure
- Ascites (abdominal fluid accumulation)
- Congestion of the viscera and peripheral tissues
- Edema of the lower extremities
- Enlargement of the liver (hepatomegaly)
- Ascites
- Anorexia
- nausea
- Weakness
Because heart failure causes vascular congestion, it is often called congestive heart failure, or CHF. Depending on the severity of the condition, a nursing care plan (NCP) for congestive heart failure (CHF) should be tailored to meet each patient’s individual needs.
Causes of Heart Failure
Common Causes of Heart Failure
- coronary artery disease
- high blood pressure
- heart valve disorders,
- and cardiomyopathy.
Other causes of Heart Failure
- damage from a past heart attack
- abnormal rhythms (arrhythmias)
- thyroid conditions
- diabetes
- infections such as endocarditis.
Causes of Sudden Heart Failure
- Allergic reactions.
- Any illness that affects the whole body.
- Blood clots in the lungs.
- Severe infections.
- Use of certain medicines.
- Viruses attack the heart muscle.
Risk factors
Diseases and conditions that increase the risk of heart failure include:
- Coronary artery disease. Narrowed arteries may limit the heart’s supply of oxygen-rich blood, weakening heart muscle.
- High blood pressure. Having high blood pressure for a long time may lead to heart failure by weakening the heart muscle.
- Diabetes. Uncontrolled diabetes can damage the nerves and small blood vessels that help regulate the heart’s function, leading to heart failure.
- Obesity. Being overweight or obese increases the strain on your heart, making it harder for your heart to pump blood.
- Kidney Disease: Kidney disease can cause fluid buildup in the body, leading to heart failure.
- Alcohol use/abuse. Heavy drinking can weaken the heart muscle and increase your risk of developing heart failure.
- Age: The risk of congestive heart failure increases with age.
Complications
Complications of CHF can include:
- Arrhythmia (abnormal heart rhythm)
- Blood clots
- Depression and anxiety
- Pulmonary edema (fluid buildup in the lungs)
- Loss of kidney function
Congestive Heart Failure (CHF) Nursing Care Plan
The nursing care plan for Congestive Heart Failure (CHF) should focus on assessment, diagnosis, interventions, patient education, and more – all designed to help you provide the highest quality of care for your CHF patients.
Assessment
Subjective Data
- Patient’s description of symptoms
- activity level
- diet/nutrition status.
Objective Data
- Vital signs
- physical examination findings.
CHF Nursing Diagnosis
- Decreased cardiac output
- Activity intolerance
- Excess fluid volume
- Risk for impaired skin integrity
- Ineffective tissue perfusion
- Ineffective breathing pattern
- Impaired gas exchange
- Fatigue
- Anxiety
Nursing Interventions for Heart Failure
1) Monitor for signs of respiratory distress
-
- Provide pulmonary hygiene as needed
- Administer oxygen as prescribed
- Keep the head of the bed elevated
- Monitor ABG values.
2) Monitor heart rate and rhythm
Assess for signs of volume overload
Weigh daily to assess fluid retention
Monitor intake and output.
3) Restrict sodium intake
- Encourage the patient to follow a strict low-sodium diet
- Provide education about salt substitutes
- Teach the patient to read food labels.
4) Strict intake and output (I&O’s)
- Monitor for signs of fluid overload
- Encourage the patient to drink enough fluids
- Discourage excessive salt, sugar, and alcohol intake.
5) Monitor swelling/edema
Check extremities daily for swelling/edema
Encourage the patient to elevate lower extremities periodically
Apply external compression garments.
6) Monitor laboratory values
- electrolytes
- BUN
- creatinine levels.
7) Monitor for signs of altered cardiac output
- dyspnea
- orthopnea
- tachycardia
- edema.
8) Evaluate fluid status:
- Check for signs of dehydration or fluid overload
- Monitor daily weights.
10) Administer prescribed medications which may include:
- Diuretics
- Antiarrhythmics
- Beta-blockers
- Iron and folic acid supplements
11) Educate patient and family members about lifestyle changes:
- Smoking cessation
- Reduction of salt intake
- Low-fat diet
- Regular exercise.
Other Interventions include:
- Encourage gradual increases in activity level as tolerated
- Provide emotional and psychological support.
- Refer for cardiac rehabilitation if indicated.
- Monitor ankle circumference, which can indicate fluid retention.
- Encourage proper foot care to prevent skin breakdown due to edema.
Documentation Guidelines
- Document the patient’s response to interventions and treatments
- Record any changes in vital signs
- Document all medications given, including dosages, route, time, and date.
- Note any environmental factors that may be contributing to symptoms (e.g., stress, pollution)
- Assess the patient’s understanding of the disease process and help with self-care management.
- Record subjective and objective information related to the patient’s condition.
- Document patient/family teaching sessions.
Discharge and Home Healthcare Guidelines
- PREVENTION: To avoid exacerbation, educating the patient and their family about monitoring for any heightened shortness of breath or edema is essential. They should be instructed to restrict fluid intake to 2-2.5 liters daily and reduce sodium consumption according to the doctor’s orders. It is also necessary for them to check their daily weights and report any weight gain of more than four pounds within two days.
- MEDICATIONS: Make sure the patient and their family know all medicines, their purpose, dosage, route, potential side effects, and any regular laboratory tests required for drugs like digoxin.
- COMPLICATIONS OF HF: Inform the patient to seek emergency help in case of sudden breathlessness or chest pain that does not subside with rest.
Final Words
Heart failure nursing diagnosis and interventions should be tailored to patients’ needs to provide the best care. By closely monitoring signs and symptoms, providing education about lifestyle changes, administering medications as prescribed, and providing emotional and psychological support, nurses can help their patients manage heart failure. Nurses must stay up-to-date on current treatments and protocols to ensure they provide the highest quality of care for their patients.
References:
- https://www.ncbi.nlm.nih.gov/books/NBK574497/
- https://en.wikipedia.org/wiki/Heart_failure
- https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.