Congestive Heart Failure (CHF)

• Definition: Failure of the cardiac muscle to maintain sufficient cardiac output and tissue perfusion.
• Pathophysiology: The left ventricle (LV) loses its ability to eject blood into the systemic circulation, resulting in a large volume of blood remaining in the LV after systole. Backup of blood may progress to the left atrium, then to the pulmonary system (left-sided heart failure), then to the right ventricle and atrium, and finally to the systemic circulation (right-sided heart failure).
• Etiology: Congenital defects, hypertension, cardiac valvular or peripheral vascular disease, damage to cardiac tissue, rheumatic fever, fluid overload, severe anemia, obstructive lung disease, endocrine disorders, sepsis, or electrolyte imbalances.
• Manifestations: Dependent upon the degree of left versus right heart failure and compensatory capability. Left-sided heart failure may include: tachycardia, dysrhythmias, tachypnea, orthopnea, anxiety, cyanosis, decreased BP and peripheral pulses, crackles, wheezes, S₃/S₄ gallop, apical murmurs, elevated pulmonary capillary wedge pressure, and decreased cardiac output/index. Right-sided heart failure may include: dependent edema, JVD, bounding pulses, oliguria, dysrhythmias, liver/spleen enlargement, increased CVP, and altered liver function tests.
• Med Tx: Bed rest if severe, fluid and sodium restriction, O₂, diuretics, inotropics, antihypertensives, vasodilators, antiarrhythmics, fluid restriction, bed rest, intra-aortic balloon pump, possible surgical intervention, and correction of underlying cause.
• Nsg Dx: Decreased cardiac output, impaired gas exchange, fluid volume excess or potential deficit R/T diuretic use, activity intolerance, knowledge deficit, anxiety, potential for infection, potential impaired skin integrity related to edema and poor tissue perfusion.
• Nsg Care: Monitor VS, peripheral pulses, heart/lung sounds, and I&O. Elevate HOB, assist with ADL, and promote calm environment. Calculate safety of digitalis dose. Monitor response to medications and therapy. Count pulse for a full minute prior to administration of digitalis—decisions to withhold digitalis are based on knowledge of age-appropriate pulse rates. Turn every 1–2 hours. Educate and provide emotional support.
• Prognosis: Varies greatly with etiology, severity, compliance, and complicating factors. Many people live productive lives for decades following diagnosis. CHF in children usually resolves after correction of the underlying cause.