Left-Side CHF 1Running head: LEFT-SIDE CONGESTIVE HEART FAILURELeft-Side Congestive Heart FailureElisabeth FandrichMontana Tech Nursing Department NURS 1566 Core Concepts of Adult NursingApril 10, 2008 Noel Mathis RN, BSN, MSNLeft-Side Congestive Heart Failure
Left-Side CHF 2When the heart does not pump as strongly as it should, it cannot perfuse the body effectively.Some of the blood that would normally be pumped out of the heart to the body systems backs upinto the lungs and other parts of the body, most commonly the legs and feet. When fluid collectsin the lungs, it will interfere with breathing causing shortness of breath, and difficulty breathing,especially when lying supine.Congestive heart failure can be caused by chronic hypertension, congenital heat defects, heartvalve disease, cardiomyopathy, history of heart attack or myocardial infarction (scar tissueinterferes with the pumping action), chronic kidney failure, coronary artery disease or infection of the heart muscle or valves. Congestive heart failure is more common in individuals over the ageof 70 than in other demographic groups. Other causative factors are over- or under-active thyroidhormone production and chronic excessive consumption of alcohol. Precipitating factors that cantrigger congestive heart failure in patients with already enfeebled hearts are obesity, stress, highsodium or fluid intake, fever, infection of the lungs, tachycardia and pulmonary embolism.Symptoms of congestive heart failure are dependant on the side of the heart that is impaired.Left-side congestive heart failure causes pulmonary edema. This results in shortness of breath andfatigue during mild exertion, shortness of breath during sleep, wheezing, and a “hacking” cough.The symptoms of left-side congestive heart failure and those of pneumonia are very similar, because they both result from the accumulation of fluid in the lungs. 346,K,B was had beentreated for pneumonia at a local clinic, and when the symptoms did not resolve, she becameconcerned and came to the emergency room. The patient’s admitting diagnosis was pneumonia.Initial blood labs were drawn and showed low RBC (3.73), low Hgb (11.4), low Hct (33.9),slightly high % Neuts (74.6%), low % Lymphs (16.1), high sedimentation rate (28), high glucose(124), high TSH (5.50) and no growth in the blood cultures. These values indicate fluid volumeexcess due to pulmonary edema, absence of infection and underactive thyroid hormone secretion.
Left-Side CHF 3Along with assessment data gathered (in particular, tachycardia), further heart studies wereindicated. EKG showed sinus tachycardia with fusion complexes and left bundle branch block. Achest CT showed coronary arterial calcifications and bilateral pleural fluid collections. Anechocardiogram was ordered. The results of that test were not available to me. Synthroid wasordered to correct the low thyroid hormone level. The determination was made by the patient’s primary care physician and cardiac specialist that the patient did not have pneumonia as previouslythought, but in fact has left-side congestive heart failure.Treatment of congestive heart failure first focuses on correcting any underlying causes. 346, K,Bhad inadequate secretion of thyroid hormone, and Synthroid was ordered to correct theimbalance. Lifestyle changes are often indicated, including smoking cessation, weight reduction,diet adjustments, daily exercise, and reduction of alcohol consumption. Medications designed toimprove perfusion and improve cardiac efficiency are often indicated. An example of this type of medication is Digoxin. This medication causes the heart rate to slow, and the heart to beat moreforcefully. This medication was also ordered for 346,K,B. Vasodilators are often ordered, to easethe flow of blood through the body, thus reducing the workload of the heart. Diuretics areordered to reduce fluid retention. Lasix was ordered for 346, K, B to abate the pulmonaryedema. In many cases, morphine is ordered to relieve the anxiety that is often felt by patients with pulmonary edema. In severe cases of congestive heart failure, heart transplant may be necessary.There are several types of devices that can be implanted which may help increase the longevity of the diseased heart. 346,K,B was also prescribed ASA and Plavix to reduce the risk of development of a clot which would have the potential of becoming a pulmonary embolus.Follow up lab work of 346,K,B showed only slight changes in the abnormal values. More bloodwork was ordered, but the results of that were not available to me. The patient was being treatedfor pneumonia. I did not get a chance to see if the new treatment regimen would improve the
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