Nursing Diagnosis

Nursing Diagnosis  

For Congestive Heart Failure

Possible Nursing Diagnosis

1. Decreased Cardiac Output

2. Excess Fluid Volume

3. Risk for Alteration in Electrolyte Balance

4. Activity Intolerance

5. Knowledge Deficient

Nursing Diagnosis and intervention

Potential problem	Related to	Goal	Outcome	Intervention
Decrease cardiac output	Decreased Contractility	1.Clear lung sounds 2.No shortness of breath 3.Absence of or reduced edema	Patient will maintains optimally compensated cardiac output	1. Administer or evaluated patient’s home compliance with prescribed medication. 2. Assess for complains of fatigue and reduced activity tolerance. Determine at what level of activity fatigue or exertional dyspnea occurs. 3. Weight patient daily at the same time and same scale.

Gullanick. M., & Myers. J. (2013). Nursing Care Plans: Nursing Diagnosis and Intervention. St. Louis, MI. Elsevier

Nursing Care

The role of nurses in the treatment of Congestive Heart Failure

The nurse have critical role to care for both inpatient and outpatient who is suffering from heart failure.  Nursing intervention for patient with heart failure should include

• administration of medication and assessment 
• assessment of fluid balance, strict input and output of fluid volume
• weight patient daily at the same time and on the same scale
• auscultation of lung sounds to detect an increase or decrease in pulmonary crackles
• determining the degree of jugular vein distension
• identification of evaluation of edema
• monitor patient's pulse rate, blood pressure and hypotension due to dehydration
• examination of skin turgor and mucous membranes for signs of dehydration
• assessment for symptoms of fluid overload

The nurse should also educate the patient about lifestyle modifications. smoking cessation, salt, restriction, appropriate levels of exercise, regular follow up appointment, and self-monitoring for sign and symptoms are all important parts of patient's treatment plan.



Angelidou, D. (2010). Caring for the heart failure patient: contemporary nursing interventions. Hospital Chronicles. supplement 1-8.

Quagliett, A., Atwood, E., Ackerman, L., & Froelicher, V. (2000). Management of the patient with congestive heart failure using outpatient, home and palliative care. Progress in Cardiovascular Diseases. 43(3). 259-274.

Treatment

Treatment for Congestive Heart Failure:

If you have Congestive Heart Failure, you doctor might tell you

• To loss weight if you are over weight
• To modified diet to low sodium diet
• Start on some exercise program
•  Will start on medication such as:
  
  • ACE Inhibitor: this medication is to help reduce sodium in your body. Where sodium is water will follow. To reduce the sodium will reduce fluid in the body, therefore will reduce possible edema and blood pressure.
  • Beta-Blocker: this medication is to help reduce your heart rate, but help your heart to have stronger contraction (squeeze), therefore will increase cardiac output
  
  End stage congestive heart failure patients may require aggressive treatments including:
•  left ventricular assist devices (LVAD): is a mechanical pump that is implanted inside a person's chest to help a weakened heart ventricle pump blood throughout the body. Unlike a total artificial heart, the LVAD doesn't replace the heart. It just helps it do its job. 

• implanted pump that helps increase the heart's ability to squeeze, or even heart transplantation.

Sign and Symptoms

Sign and Symptoms:

Early signs and symptoms of Congestive Heart Failure might not always notice or may have no symptoms at all. Sometimes people might dismiss the sublet symptoms, but generally early signs and symptoms of Congestive Heart Failure are:

• Feel tired easily
• Difficulty breathing when exerting
• Feel weak and dizzy
• Feel like the heart is pounding 
• Persistent coughing

Late signs and symptoms of Congestive Heart Failure are:

• Difficulty breathing when in rest
• Waking during the night feel like choking
• Swelling at the legs, ankles and feet from buildup fluid
• Cough with white or pink blood tinge
• Gain a lot of weight over night
• Feel bloated or sick in the stomach
• Lack of appetite

 

Congestive Heart Failure Symptoms, Causes, and Treatment. (n.d.). Retrieved February 7, 2015, from http://www.webmd.com/heart-disease/guide-heart-failure

Diagnosis:

Heart Failure generally start on the left side of the heart, if untreated the disease can be progressively worse by fluid back up to the lungs, causes shortness of breath or pulmonary edema. Over time, the failure of the left side of the heart will effect the right side of the heart, which will cause fluid back up to the system, such as swelling of the feet and ankles, in the liver, palpitation or irregular heart beat and weakness. When doctors suspect you have a heart failure, the doctors will most likely do a Echo Cardiogram, Chest x-ray, Stress test, Blood test, Cardiac computerized tomography (CT) scan, Magnetic Resonance Imaging (MRI), Coronary Angiogram, or Electrocardiogram (EKG).

 

Electrocardiogram: is a sound wave ultrasound to produce a video image of your heart. This test allow the doctor to see the blood movement of the heart, the size and shape of the heart and how well the heart is pumping. It can help doctors look for valve problems or evidence of previous heart attacks, and other heart abnormalities.

 

 X Ray: can help your doctor to see the condition of the lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.

 

Stress Test:  The doctor will asked you to walk on a treadmill or pedal a stationary bike while attached to an ECG machine. This is to measure how is your heart and blood vessels respond to exertion, and other heart problem.

 

 

Blood Test: Your doctor may take a sample of your blood to check your kidney, liver and thyroid function and to look for indicators of other diseases that affect the heart.

A blood test to check for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) may help in diagnosing heart failure if the diagnosis isn't certain when used in addition to other tests.

 

Coronary Angiogram: when a doctor suspect you have a heart failure, it might want you to do a Coronary Angiogram. In this test, a thin, flexible catheter will inserted into a blood vessel at either the groin site or at the arm. A dye will injected through the catheter makes the arteries supplying your heart visible on an x ray. This will help doctor identify narrowed arteries of the heart.

 

EKG: show the electrical activity of your heart through electrodes attached to the skin. The impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps the doctor diagnose heart rhythm problems.

 

MRI: is a magnetic field aligns atomic particles in some of the cells, when radio wave are broadcast toward these aligned particles, they produces images of the heart. This is to evaluate the structure and function of the heart.

References:

Heart Disease and MRI Testing. (n.d.). Retrieved January 30, 2015, from http://www.webmd.com/heart-disease/guide/heart-mri

Heart failure. (2015, January 17). Retrieved January 30, 2015, from http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/tests-diagnosis/con-20029801

Pathophysiology/Etiology

Congestive Heart Failure often develops after other condition such as high blood pressure, coronary heart disease, diabetes, advanced age, tobacco use, obesity and high cholesterol can contribute to the damage or weaken of your heart. This can cause your heart to become stiff to the point that the heart cannot pump blood efficiently throughout the body to meet the oxygen and nutrient needs of the body.

Heart Failure can involve the left side, right side or both side of the heart. Generally the left side of the heart damage first then it will later effect the right side of the heart, which in turn damage both side of the heart.  If  heart failure is on the left side of the heart, the fluid may back up in your lungs, causing shortness of breath. If it is on the right side of the heart, fluid may back up into your abdomen, legs and feet, causing swelling.

About Heart Failure. (2012, August 20). Retrieved January 24, 2015, from http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp


Congestive Heart Failure CHF). (2013, August 18). Retrieved January 24, 2015, from https://www.youtube.com/watch?v=dJBFCergsuM

Heart failure. (2015, January 15). Retrieved January 24, 2015, from http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/causes/con-20029801