Congestive Heart Failure Research Paper

Heart failure, also known as CHF or congestive heart failure affects nearly 5 million people in the U.S. yearly with 1.4 million of those being under the age of 60. Half of these will die within five years of being diagnosed. (Heart Failure Statistics) CHF usually occurs over a period of time as the heart’s pumping ability grows weaker and can either consist of right-side heart failure, left-side heart failure, or both. “Right-side heart failure occurs if the heart can't pump enough blood to the lungs to pick up oxygen” and causes symptoms such as edema. “Left-side heart failure occurs if the heart can't pump enough oxygen-rich blood to the rest of the body” and will show symptoms of dyspnea and fatigue. (What is heart failure?)

There are

classifications set by the New York Heart Association (NYHA) which classifies patients based on their physical limitations from the disease. Class I is when patients have no physical limitation. Class II is slight limitation during exercise that causes fatigue and dyspnea, but still comfortable while resting. Class III is marked limitation during less than normal activity, but still comfortable at rest. Lastly, class IV is when symptoms are present even at rest and discomfort increases with the smallest amount of activity. (Classes of Heart Failure)
Causes of CHF are disorders that increase the workload of the heart or disorders that interfere with the pumping ability of the heart. Risk factors include congenital heart defects, MI, CMP, COPD, anemia, disease of the heart valves and fluid volume overload, and hypertension which is able to be controlled with medications. (Linton, A.D.) A risk factor that is often unheard of are viruses. Any virus that may have damaged your heart puts you at higher risk for developing heart failure later on in life. (Heart failure)
Signs of heart failure can vary depending on current health problems and lifestyle. Some of the common, most known signs to watch out for include being anxious, pale, or weak. Being tachycardic and having a downward trend in blood pressure. If patient is experiencing dyspnea , edema, and lack of appetite with nausea, they need to go see their physician as soon as possible.(Warning Signs of Heart Failure) A physical exam focusing on the heart and lungs can show certain things that are not able to be determined based on inspection. Auscultating the lungs, crackles and wheezes can be a red flag along with hearing the S3 and S4 heart sounds which is resulted from a backup of fluid in the heart. Another sign is impaired oxygen exchange that results in restlessness and confusion. (Linton, A.D.)
Once the physician has a good idea a patient has congestive heart failure, there are several tests that can be ordered to confirm the diagnosis.

A chest radiograph is one option which in a CHF patient will show hazy lung fields, distended vasculature, and cardiomegaly. An echocardiogram will also show heart enlargement along with ineffective ventricular contraction. Laboratory tests are one of the easiest ways to confirm it. They will show a decreased sodium and hematocrit levels, an elevated BUN and creatinine level, and an increased BNP level. Another way is a liver function test which show elevated levels that is usually linked to

hepatomegaly.
Symptoms that can occur in a patient with heart failure are increased jugular venous pressure, jugular venous distention, dependent edema, fatigue, weight gain, and abdominal engorgement which can cause anorexia, nausea, and vomiting. Complications that can arise are heart dysrhythmias, pulmonary edema, renal failure, and cardiogenic shock. (Linton, A..D.)
There are a number of different treatments for patients dealing with heart failure. One of the simpler things to try are a fluid and salt restriction in order to decrease the amount of fluid within the body. Medications are another thing to try before attempting surgery. ACE inhibitors decrease the preload and afterload by blocking the RAA system which results in vasodilatation. (Linton, A.D.) It is also possible to take diuretics if prescribed by a physician. Common diuretics taken consist of Lasix, Bumex, and hydrochlorothiazide. (Congestive Heart Failure) Beta-Adrenergic blockers improve the survival rates by decreasing the heart rate. Inotropic agents, such as dopamine, dobutamine, and amrinone, can be used short term in order to improve cardiac contractility. These agents also improve renal function, decreases fluid retention. Cardiac glycosides can be used ling term in order to improve the pumping ability by increasing contractility and decreasing the heart rate. The last type medications available try are nitrates which are venodilators. Nitrates reduce the workload of the heart.
If none of the above treatments are effective, surgery is an option.

A coronary artery bypass grafting (CABG) can be done if patient is experiencing chest pain, a valve repair or replacement can be done if there is a valve dysfunction present, a partial left ventriculectomy, and a cardiac transplantation available, but will only be done as a last resort. Some other options include temporary devices such as an IABP (Intraaortic Balloon Pump) which is used to increase cardiac output and coronary artery perfusion or a VAD (Ventricular Assist Device) which is for partial or complete heart failure. The VAD supports the patient’s failing heart and has the possibility to be placed long term if the option of transplantation is not available. The last type of treatment for CHF is a CRT or Biventricular Pacing which is used when conduction delays occurs in one of the bundle branches and has leads that are used to stimulate cardiac contraction and improve the cardiac output. (Linton, A.D.) There are also many other ways to help manage heart failure. Examples are maintaining a healthy weight, regular exercise, stop all forms of tobacco, limiting alcohol intake, and controlling hypertension. (Congestive Heart

Failure)
As a nurse there are many different interventions in order to make your patient as comfortable and relaxed as possible. If your patient is experiencing a decrease in cardiac output, you can help by giving the prescribed medications as ordered and watch for any adverse reactions to these medications. Also, you can encourage the patient to get lots of rest and practice stress reducing techniques to try and reduce the cardiac workload. If your patient has impaired gas exchange, you can elevate their upper body to promote better lung expansion, bed rest is encouraged to reduce workload, always educate on deep breathing techniques as well as proper coughing methods every two hours. Administer oxygen if prescribed and educate the patient on safety precautions while on oxygen so they are prepared for discharge. If your patient has excess fluid volume, you can administer diuretics as prescribed to rid of some fluid, educate the patient on ways to reduce the amount of sodium in their diet and help with any menu planning needed. It is also necessary to watch for signs of fluid and electrolyte disturbances such as cardiac dysrhythmias, muscle weakness, and twitching. If your patient is experiencing activity intolerance, you should encourage frequent breaks in between activities, and refer different rehab facilities is intolerances is treatable. Finally, if your patient is having anxiety, as most patients do, you can encourage the presence of family members and provide a calm, relaxing environment for your patient to rest in. Always make sure you are open and honest with all of your patients in order to gain their trust and have a healthy nurse-patient relationship.