Nursing Intervention

Place the patient in Fowler's position and give him supplemental oxygen to help him breathe more easily. Organize all activity to provide maximum rest periods. Weigh the patient daily, and check for peripheral edema. Also, monitor I.V. intake and urine output especially for patient with diuretic Assess vital signs and mental status. Auscultation for abnormal heart and breath sounds. Frequently monitor blood urea nitrogen and serum creatinine, potassium, sodium, chloride, and magnesium levels. Provide continuous cardiac monitoring during acute and advanced stages to identify and treat arrhythmias promptly. To prevent deep vein thrombosis from vascular congestion, help the patient with range-of-motion exercises. Apply antiembolism stockings as needed. Check for calf pain and tenderness.

 Monitor the patient for signs and symptoms of fluid overload, impaired gas exchange, and activity intolerance explanation of the disease process helps the patient understand the need for the prescribed medications, activity restrictions, diet, fluid restrictions, and lifestyle changes. Helping the patient work through and verbalize these feelings may improve psychological well-being assess abnormal response to increased activity Increase client activity each shift according to the indications Increase of activity when no complaint Dyspnea, or not perceived Dyspnea increases Increase the time down from the bed to 15 minutes per shift Neurological Monitoring Environmental management Oxygen therapy Fluid Management Respiratory Management Self care assistance

Medical Management

 Angiotensin Converting Enzyme (ACE) Inhibitors -These medications block the formation of angiotensin II, a hormone with many potentially adverse effects on the heart and circulation in patients with heart failure. Examples of ACE inhibitors include: Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Zestril, Prinivil) Benazepril (Lotensin) Ramipril (Altace)

Possible side effects of these drugs include: a nagging, dry cough low blood pressure worsening kidney function and electrolyte imbalances rarely, true allergic reactions

 Angiotensin Receptor Blockers(ARBs)

-These drugs act on the same hormonal pathway as the ACE inhibitors, but instead block the action of angiotensin II at its receptor site directly. Examples of this class of medications include: Losartan (Cozaar) Candesartan (Atacand) Telmisartan (Micardis) Valsartan (Diovan) Irbesartan (Avapro) Olmesartan (Benicar)

 Beta-blockers

Possible side effects include: fluid retention low blood pressure low pulse general fatigue and lightheadedness Beta-blockers should generally not be used in people with certain significant diseases of the airways (for example, asthma, emphysema) or very low resting heart rates.

 Digoxin - It stimulates the heart muscle to contract more forcefully. Potential side effects include: nausea vomiting heart rhythm disturbances kidney dysfunction electrolyte abnormalities These side effects are generally result of toxic levels in the blood and can be monitored by blood tests. The dose of digoxin may also need to be adjusted in patients with significant kidney impairment.

 Diuretics -are often an important component of the treatment of congestive heart failure to prevent or alleviate the symptoms of fluid retention. These drugs help keep fluid from building up in the lungs and other tissues by promoting the flow of fluid through the kidneys.

Examples of various classes of diuretics include: Furosemide (Lasix) Hydrochlorothiazide (Hydrodiuril) bumetanide(Bumex) Torsemide (Demadex) Spironolactone (Aldactone) Metolazone (Zaroxolyn)

Potential side effects of diuretics include: Dehydration electrolyte abnormalities particularly low potassium levels hearing disturbances low blood pressure