Congestive Heart Failure
Congestive heart failure is an older name for heart failure. Congestive heart failure takes place when the heart is unable to maintain an adequate circulation of blood in the bodily tissues or to pump out the venous blood returned to it by the veins (Merriam-Webster). The heart is split into two distinct pumping structures, the right side of the heart and the left side of the heart. Appropriate cardiac performance involves each ventricle to extract even quantities of blood over intervals.
If the volume of blood reimbursed to the heart develops more than both ventricles can manage, the heart can no longer be an efficient pump. Circumstances that trigger heart failure might involve one or both of the heart’s pumping methods. So, heart failure can be categorized as right-sided heart failure, left-sided heart failure, or biventricular heart failure. The left side of the heart is vital for standard heart function and is typically where heart failure arises.
The left atrium obtains oxygen-rich blood from the lungs and pushes it into the left ventricle, the heart’s biggest and greatest pump, which is accountable for delivering blood to the body. Once it has dispersed throughout the body, blood comes back to the right atrium and then journeys to the right ventricle, which pumps it into the lungs to be restocked with oxygen. After the right side loses pumping power, blood can back up in the veins struggling to return blood to the heart.
Right heart failure might happen alone but it is typically a consequence of left-sided failure. When the left side fails, fluid backs up into the lungs and pulmonary pressure is increased. The right ventricle must continually pump blood against this increased fluid and pressure in the pulmonary artery and lungs. Over time this additional strain eventually causes it to fail (William and Hopper). Heart failure can be the result of systolic (contractile) dysfunction, diastolic (relaxation) dysfunction, or a mixed systolic and diastolic dysfunction.
Systolic dysfunction is a contractile problem in which the ventricle is unable to generate enough force to pump blood from the ventricle. Diastolic dysfunction is a problem with the ventricle’s ability to relax and fill. Mixed systolic and diastolic dysfunction is a combination of the two defects (Williams and Hopper). To understand the signs and symptoms of left-sided versus right-sided heart failure, remember that left-sided signs and symptoms are found in the lungs. Left begins with L, as does lung.
Any signs and symptoms not related to the lungs are caused by right-sided failure (Williams and Hopper). Some signs and symptoms of heart failure are shortness of breath (dyspnea), fatigue, chronic cough or wheezing, rapid or irregular heartbeat, lack of appetite or nausea, mental confusion or impaired thinking, fluid buildup and swelling, and rapid weight gain, and the need to urinate more at night. In order to determine heart failure the physician will do a diagnostic test which includes a chest x-ray, echocardiogram, ejection fraction (EF), and electrocardiogram (EKG or ECG).
Therapeutic measures for a patient with congestive heart failure would be daily weights, dietary sodium restrictions, positioning in high or semi-Fowler’s position, frequent vital signs, oxygen by cannula or mask, medical devices: pacemakers, internal cardiac defibrillator, biventricular cardiac pacemaker, ventricular assist device, medications: digoxin, diuretics, inotropes, nesiritide, beta blockers, surgery: heart valve repair or replacement, coronary bypass surgery, heart transplant, and myectomy.
Nursing interventions would be monitor vital signs, breath sounds, and check weight daily. Check for presence of jugular vein distention and presence of hepatomegaly. Monitor EKG changes; evaluate electrolyte levels, intake and output, pain level, anxiety level, discomfort upon mobility. Monitor oxygen therapy and continuous cardiac/pulse oximetry. Assist client into high fowler’s position, assist with mobility and range of motion to prevent vascular congestion and also patient teaching.