Introduction
Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle doesn’t pump blood as well as it should. When this happens, blood often backs up, and fluid can build up in the lungs, causing shortness of breath.
Heart failure doesn’t mean the heart has stopped working. Rather, it means that the heart works less efficiently than normal. Due to various possible causes, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart can’t pump enough oxygen and nutrients to meet the body’s needs.
The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. The kidneys may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. Congestive heart failure is the term used to describe the condition.
This blog post discusses what congestive heart failure (CHF) is, its symptoms, nursing care plans and interventions with some examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Causes of Congestive Heart Failure
Heart failure is caused by many conditions that damage the heart muscle, including:
Coronary artery disease. Coronary artery disease (CAD), an artery disease that supplies blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
Heart attack. A heart attack happens when a coronary artery becomes suddenly blocked, stopping blood flow to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that doesn’t work the way it should.
Cardiomyopathy. Damage to the heart muscle from causes other than artery or blood flow problems, such as infections or alcohol or drug abuse.
Conditions that overwork the heart. Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can happen when several diseases or conditions are present at once.
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Symptoms of Congestive Heart Failure
You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:
Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen (called edema), and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.
Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.
Types of Congestive Heart Failure
Systolic dysfunction (or systolic heart failure) happens when the heart muscle doesn’t contract with enough force, so less oxygen-rich blood is pumped throughout the body.
Diastolic dysfunction (or diastolic heart failure) happens when the heart contracts normally, but the ventricles don’t relax properly or are stiff, and less blood enters the heart during normal filling.
A calculation done during an echocardiogram called the ejection fraction (EF) is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. Your doctor can discuss which condition you have.
Diagnosis of Congestive Heart Failure
A doctor will ask many questions about the symptoms and medical history. A doctor may also order tests to determine the cause and severity of the heart failure. These include:
Blood tests. Blood tests are used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia. Anemia is a blood condition that happens when there is not enough hemoglobin (the substance in red blood cells that enables the blood to transport oxygen through the body) in your blood.
B-type natriuretic peptide (BNP) blood test. BNP is a substance secreted from the heart in response to blood pressure changes that happen when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen and decrease when the heart failure condition is stable. The BNP level in a person with heart failure — even someone whose condition is stable — may be higher than in a person with normal heart function. BNP levels do not necessarily correlate with the severity of heart failure.
Chest X-ray. A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.
Echocardiogram. This ultrasound test shows the heart’s movement, structure, and function.
Ejection fraction (EF) is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present. Your doctor can discuss which condition you have.
Electrocardiogram (EKG or ECG). An EKG records the electrical impulses traveling through the heart.
Cardiac catheterization. This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.
Stress Test. Noninvasive stress tests provide information about the likelihood of coronary artery disease.
Other tests may be ordered, depending on the condition.
Treatment for Congestive Heart Failure
There are more treatment options available for heart failure than ever before. Tight control over your medications and lifestyle, coupled with careful monitoring, are the first steps. As the condition progresses, doctors specializing in the treatment of heart failure can offer more advanced treatment options.
The goals of treating heart failure are to keep it from getting worse (lowering the risk of death and the need for hospitalization), ease symptoms, and improve quality of life.
Some common types of medicines used to treat it are:
- ACE inhibitors (angiotensin-converting enzyme inhibitors)
- Aldosterone antagonists
- ARBs (angiotensin II receptor blockers)
- ARNIs (angiotensin receptor-neprilysin inhibitors)
- Beta-blockers
- Blood vessel dilators
- Digoxin
- Calcium channel blockers
- Diuretics
- Heart pump medications
- Potassium or magnesium
- Selective sinus node inhibitors
- Soluble guanylate cyclase (sGC) stimulator
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Stages of Congestive Heart Failure (CHF)
Stage A
People with stage A CHF do not yet have dysfunction of the pumping activity of the heart but have a high risk of developing CHF due to related conditions, such as chronic high blood pressure, diabetes, and coronary artery disease.
Stage A Symptoms
A person usually has no symptoms of CHF at this stage but may experience symptoms of their chronic conditions, including:
- Shortness of breath
- Difficulty breathing
- Swelling in the hands, feet, and ankles
Stage B
Structural heart disease develops at this stage, such as reduced heart pumping function, which can lead to an enlarged left ventricle. It can also result from a previous heart attack.
Stage B Symptoms
Most people at stage B still do not show symptoms of CHF.
Stage C
People at this stage will show symptoms of CHF linked to underlying structural heart disease, including fatigue or breathlessness. These symptoms usually occur due to problems with the squeezing function of the left ventricle or the pumping chamber of the heart.
Stage C CHF also includes people who no longer show symptoms but are currently undergoing treatment for previous symptoms, such as those who spent time in the hospital with heart failure exacerbation.
Stage C Symptoms
Common symptoms include:
- Fatigue
- Breathlessness
- Difficulty breathing
Stage D
People will have advanced structural heart disease at stage D and display significant symptoms, even when they are at rest.
Stage D Symptoms
Symptoms may include:
- Shortness of breath
- Difficulty breathing
- Swelling of legs, arms, hands, and ankles
- Fatigue
- Nausea
- Rapid heartbeat
- Weight gain
- Lightheadedness
- Persistent cough
Prevention of Congestive Heart Failure (CHF)
Symptoms of CHF range from mild to severe but may get worse over time if not managed medically.
Lifestyle strategies can reduce the risk of developing CHF and can also slow its progress.
To prevent or slow the progression of CHF, people should take the following steps:
Maintain a healthy body weight: Excess body weight can place strain on the heart and increase the risk of more damage to the heart.
Exercise regularly: The AHA recommends getting 150 minutes of moderate-intensity exercise every week. Individuals with heart failure should talk to their doctors about getting an individualized exercise “prescription.”
Manage stress: Meditation, therapy, and relaxation techniques can help a person manage stress, which can have adverse effects on the heart.
Eat a heart-healthy diet: Daily food intake should be low in trans fats, rich in whole grains, and low in sodium and cholesterol. Experts often recommend that people with heart failure limit their sodium intake to 2,000 milligrams (mg) daily. However, individuals should check with their doctor to determine their sodium and fluid intake.
Monitor blood pressure regularly: A doctor can do this at regular check-ups. However, doctors also recommend people use home blood pressure monitors or sphygmomanometers.
Vaccinations: Be sure to stay on top of vaccinations for influenza and pneumococcal pneumonia.
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Nursing Care Plans Based on Nursing Diagnosis
Nursing Care Plan 1: Diagnosis: Decreased Cardiac Output related to increased preload and afterload and impaired contractility
Evidenced by an irregular heartbeat, heart rate of 128, dyspnea upon exertion, and fatigue.
Desired outcome
The patient will be able to maintain adequate cardiac output.
| Interventions | Rationales |
| Assess the patient’s vital signs and characteristics of the heartbeat at least every 4 hours. Assess breath sounds via auscultation. Observe for decreasing peripheral tissue perfusion signs such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin. | To assist in creating an accurate diagnosis and monitoring medical treatment effectiveness. Breath sounds of crackles/rales are important signs of heart failure. The presence of signs of decreasing peripheral tissue perfusion indicates deterioration of the patient’s status which requires immediate referral to the physician. |
| Administer the cardiac medications and diuretics as prescribed. | To alleviate the symptoms of heart failure and to treat the underlying condition. |
| Administer supplemental oxygen as prescribed. Discontinue if SpO2 level is above the target range or as ordered by the physician. | To increase the oxygen level and achieve a SpO2 value of at least 94%. |
| Educate patients on stress management, deep breathing exercises, and relaxation techniques. | Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. |
Nursing Care Plan 2: Diagnosis – Activity intolerance related to an imbalance between oxygen supply and demand
Evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion
Desired Outcome
The patient will demonstrate active participation is necessary and desired activities and demonstrate an increase in activity levels.
| Interventions | Rationales |
| Assess the patient’s activities of daily living and actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. | To create a baseline of activity levels and mental status related to fatigue and activity intolerance. |
| Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media for long periods. Alternate periods of physical activity with rest and sleep. | To gradually increase the patient’s tolerance to physical activity. |
| Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room. | To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room. |
| Refer the patient to the physiotherapy / occupational therapy team as required. | To provide more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity. |
Nursing Care Plan 3: Diagnosis: Excess Fluid Volume related to decreased cardiac output and increased glomerular filtration rate (GFR)
Evidenced by S3 heart sound, the blood pressure level of 190/85, orthopnea, pitting edema of the ankles, and weight gain
Desired Outcome
The patient will demonstrate a balanced input and output and stabilized fluid volume.
| Interventions | Rationales |
| Assess vital signs and auscultate lungs to find any crackles or wheezes. | Heart failure, especially left-sided, may lead to pulmonary congestion, as evidenced by crackles or wheezes upon auscultation of the lungs. |
| Commence a fluid balance chart, monitoring the input and output of the patient. | To monitor patient’s fluid volume accurately and effectiveness of actions to monitor the progress of excess fluid volume. |
| Restrict fluid intake as instructed by the physician. | To reduce fluid volume and manage edema. |
| Weigh the patient on a daily basis. | Diuretics are needed to manage heart failure but may put the patient at risk for sudden fluid loss, which is reflected through his/her weight. Monitor patient’s serum electrolytes and renal function to the physician as needed. |
Nursing Care Plan 4: Diagnosis – Acute Pain related to decreased myocardial blood flow
Evidenced by a pain score of 10 out of 10, verbalization of pressure-like/ squeezing chest pain (angina), guarding sign on the chest, the blood pressure level of 180/90, respiratory rate of 29 cpm, and restlessness.
Desired Outcome
The patient will demonstrate pain relief as evidenced by a 0 out of 10, stable vital signs, and an absence of restlessness.
| Interventions | Rationale |
| Administer prescribed medications that alleviate the symptoms of acute chest pain (angina). | Aspirin may be given to reduce the ability of the blood to clot so that the blood flows easier through the narrowed arteries. Nitrates may be given to relax the blood vessels. Other medications that help treat angina include anti-cholesterol drugs (e.g., statins), beta-blockers, calcium channel blockers, and Ranolazine. |
| Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication. | To monitor the effectiveness of medical treatment for the relief of angina. The time of monitoring of vital signs may depend on the peak time of the drug administered. |
| Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen as prescribed. Discontinue if SpO2 level is above the target range or as ordered by the physician. | To increase the oxygen level and achieve a SpO2 value of at least 94%. |
| Place the patient on complete bed rest during angina attacks. Educate patients on stress management, deep breathing exercises, and relaxation techniques. | Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. The effects of stress are likely to increase myocardial workload. |
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Nursing Care Plan 5: Diagnosis – Deficient Knowledge related to a new diagnosis of Congestive Heart Failure
Evidenced by the patient’s verbalization of “I want to know more about my new diagnosis and care.”
Desired Outcome
At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of congestive heart failure and its management.
| Interventions | Rationales |
| Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g., denial of diagnosis or poor lifestyle habits) | To address the patient’s cognition and mental status towards the new CHF diagnosis and help the patient overcome blocks to learning. |
| Explain what CHF is its types (specifically whether the CHF of the patient is left-sided, right-sided, or biventricular). Avoid using medical jargon and explain in layman’s terms. | To provide information on CHF and its pathophysiology in the simplest way possible. |
| Educate the patient about lifestyle changes that can help manage CHF. Create a plan for Activities of Daily Living (ADLs) with the patient that involve smoking cessation, increase in physical activity, dietary changes, blood pressure control, stress management, and diabetes management (if the patient has diabetes). | Smoking, a sedentary lifestyle, poor dietary choices, poor blood pressure control, chronic stress, and unmanaged diabetes are linked to CHF. |
| Inform the patient of the details about the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) to treat heart failure. Ask the patient to repeat or demonstrate the self-administration details to you. | To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details. |
| Refer the patient to a dietitian and physiotherapist. | To enable the patient to receive more information in managing diet and physical activity from specific healthcare team members. |