Congestive Heart Failure
Congestive Heart Failure is a condition in which the heart cannot pump enough blood to meet the needs of the rest of the body (Department of Health & Human Services, 2012). The failure can occur in on either side of the heart.
In left-side heart failure, fluid backs up into the lungs, causing shortness of breath, due to the fact that the blood entering the left side of the heart comes from the pulmonary artery, and when the left ventricle cannot pump fluid out of the heart or when the left atrium cannot empty completely into the ventricle it backs up into the lungs.
In right-side heart failure, fluid can back up into the abdomen, legs, and feet, causing swelling. The blood being pumped into the right ventricle comes from systemic veins, and when the right atrium or ventricle can’t sufficiently empty, the fluid tends to back up into the body. There are many ways to treat this condition.
ACE inhibitors may be prescribed. These drugs are vasodilators, and help to widen blood vessels to reduce the workload on the heart, decrease blood pressure and increase blood flow (Mayo Clinic Staff, 2013). Many people with this disease are also prescribed diuretics, to increase fluid loss from the body and reduce fluid buildup and swelling. However, patients often need mineral supplements in addition to taking these drugs. When drugs are not sufficient enough, surgery may also be required.
A coronary bypass is a sort of transplant, where veins from an arm or leg are used to bypass a blocked coronary artery, allowing blood to flow freely through the heart. Beta blockers are drugs that block Beta 1 and 2 receptors on the heart, which constrict blood vessels. By doing this and keeping blood vessels dilated, these drugs reduce blood pressure and heart rate. However, Carvedilol is the only agent labeled by the FDA for use in patients with heart failure (Chavey, 2000).
The many symptoms of this condition can occur suddenly (during activity) or develop slowly over time. Common symptoms include: cough, fatigue, loss of appetite, increased need to urinate, swollen feet and/or ankles, swelling of the abdomen due to excess fluid, weight gain, shortness of breath, heart palpitations and/or irregular pulse (American Heart Association, 2011).
This condition is best diagnosed after an examination for symptoms. A doctor could do several tests such as an electrocardiogram or an echocardiogram, as well as tests such as an MRI or blood tests to aid.
Some patients will be recommended for surgery such as an angioplasty, a pacemaker or even a complete heart transplant. While this condition is a chronic illness, the prognosis can be good if the symptoms are treated successfully. There are four main stages to this disease:
Stage 1: high risk for developing disease
Stage 2: patients have an enlarged/dysfunctional left ventricle but have no symptoms Stage 3: patients develop symptoms, get diagnosed
Stage 4: patient experiences symptoms even after treatment
(Heart Failure Society of America, 2002)
Depending on the specific cause of CHF, a patient could initially begin treatment at home with medications such as a diuretic and lifestyle changes (like no more drinking/smoking). Sometimes surgery to fix blockage of the coronary arteries or a congenital heart defect will be recommended. This would be done in a hospital and recovery at a rehabilitation clinic or at home. A benefit of an assisted living facility would be having preplanned meals and activities.
The CHF patient may not seek additional care until Stage 3 or 4 (Heart Failure Society of America, 2002). Also, if a patient’s symptoms are uncontrollable, hospitalization could be necessary. A downside of an assisted living facility is the spread of infection. CHF patients routinely struggle with breathing issues so a respiratory infection could be life threatening. Another example of risk in an assisted living facility is endocarditis, an infection of the inner lining of the heart chambers.
It can be caused by bacterial infections in the bloodstream, and patients with heart failure are at a much higher risk for succumbing to this infection (US Department of Health & Human Services, 2010). Contracting an infection like this can quickly kill someone already living with heart failure. It is important that a patient with CHF be monitored for signs of distress.
Vital signs like high blood pressure, rapid pulse, irregular respirations and fluid intake/output should be monitored. All of these vitals will already have expected irregularities, which lead to initial diagnosis. After care is started, the vitals should be monitored for additional changes. In the event of an emergency such as inability to breathe, a nursing assistant should call an ambulance right away and begin life-supporting measures such as CPR (Carter, 2012).
Legal and ethical issues associated with caring for someone with congestive heart failure vary widely. For example, a doctor has many ethical guidelines he or she must follow with those patients in need of a heart transplant.
Depending on factors such as the patient’s age, severity of the condition and their personal wishes and beliefs, the patient may want to have a power of attorney, a will and possibly a DNR on file (Carter, 2012). Patients with congestive heart failure must be careful of the amount of physical activity they participate in.
Short spurts of low-level exercise are often safe to perform, but it is important not to make the heart work too hard for its reduced capacity. Heart failure in its early stages may not greatly reduce mobility, but as it progresses, it can eventually make a patient completely immobile.
It is important as caregivers to know the limits of a patient’s mobility, and not to push them. In order to reduce risks, the extent of a patient’s mobility should be made clear, and guidelines should be followed. It is important to communicate with the facility, care team, family and patient to make sure everyone is aware of safety procedures to reduce the chance of heart attack or complete heart failure of these patients (American Heart Association, 2011).
The diet plan for a patient diagnosed with CHF would need to be “low sodium”. Foods that are naturally low in sodium like fresh fruit and veggies, and lean meats are the best choice for this diet. A doctor may also restrict a patient’s fluid intake.
A diet high in sodium and drinking and consuming too many fluids (water, soups, etc.) can cause additional water retention, thus making the heart work harder (Mayo Clinic Staff, 2013). Patients who have been put on diuretics may be instructed to eat more foods high in potassium, like bananas, dried fruits, avocados, nuts, and whole grains, because often potassium levels drop. (Department of Health & Human Services, 2012). They may also be instructed to eat extra fiber, which helps food move along the digestive tract, and may help control blood glucose levels, as well as possibly decreasing cholesterol levels.
As CHF progresses, personal care will become more difficult. Regular tasks will require a lot of energy. Medications the patient may be taking such as diuretics could cause more frequent urination, also resulting in more energy exertion. Other simple tasks for hygiene such as brushing teeth and hair will also require energy where there is not a lot to spare. If the patient is retaining a lot of fluid, it could be difficult to move around, and even breath fully.
Emotionally it will be tough for a patient to come to terms with not being physically able to do personal care and hygiene anymore, and needing someone to do it for them (US Department of Health & Human Services, 2010). Hopefully a CNA could soothe the patient and make personal care less stressful. Let the patient do as much as he/she can tolerate physically, and try to treat the patient with empathy and respect, not pity.
The condition is progressive and unfortunately terminal. At some point, the patient may need hospice care. A CNA could try to listen to what the person has to say if they feel like saying anything at all. As a nursing assistant, it is important to stay positive, and to continue encouraging the patient to be as independent as possible (Carter, 2012).
The scariest part about a progressive disease is the anticipation of death. All people will deal with this differently, but it is important to stay open-minded and do what we can to help patients and families cope and remain positive about the situation. Listening is one of the most important parts of communication, and one of the most valuable skills to have as a nursing assistant.
American Heart Association. (2011, Jan 24). Congestive Heart Failure. Retrieved October 10, 2013, from http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/Congestive-Heart-Failure_UCM_307111_Article.jsp.
Carter, P. (2012). Lippincott’s Textbook for Nursing Assistants: A Humanistic Approach to Caregiving. Philadelphia: Lippincott Williams & Wilkins.
Chavey, W. (2000, Dec 1). The Importance of Beta Blockers in the Treatment of Heart Failure. American Family Physician, 11. Retrieved October 3, 2013, from http://www.aafp.org/afp/2000/1201/p2453.html
Department of Health & Human Services. (2012, Jan 9). What is Heart Failure? Retrieved October 10, 2013, from http://www.nhlbi.nih.gov/health/health-topics/topics/hf/.
Heart Failure Society of America. (2002). NYHA Classification – The Stages of Heart Failure. Retrieved September 29, 2013, from http://www.abouthf.org/questions_stages.htm
Mayo Clinic Staff. (2013, Aug 16). Heart Failure. Retrieved October 10, 2013, from http://www.mayoclinic.com/health/heart-failure/DS00061.
Ogbru, O. (2012). Beta Blockers. Retrieved October 10, 2012, from http://www.medicinenet.com/beta_blockers/article.htm
U.S. Department of Health & Human Services. (2010, Oct 1). What is Endocarditis? Retrieved October 3, 2013, from http://www.nhlbi.nih.gov/health/health-topics/topics/endo/