Heart failure, sometimes referred to as congestive heart failure, is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.

Heart failure is a clinical syndrome characterized by signs and symptoms of fluid overload of inadequate tissue perfusion.

.The underlying mechanism of heart failure involves impaired contractile properties of the heart (systolic dysfunction) or filling of the heart (diastolic) that leads to a lower-than-normal cardiac output.

. Heart failure is a life-long diagnosis managed with lifestyle changes and medications to prevent acute congestive episodes.The low cardiac output can lead to compensatory mechanisms that cause increased workload of the heart and eventual resistance to filling of the heart.

. cardiomyopathy. Common underlying conditions include coronary atherosclerosis (primary cause). valvular disease. inflammatory or degenerative muscle disease.Congestive heart failure is usually an acute presentation of heart failure. and arterial hypertension.

Left-Sided Heart Failure Backward Failure ✐ Pulmonary congestion. ✐ Bibasilar crackles advancing to crackles in all lung fields ✐ Large quantities of frothy sputum. paroxysmal nocturnal dyspnea (PND) Cough may be dry and nonproductive but is most often moist. orthopnea. fatigabilty. which is sometimes pink (blood-tinged) . ✐ ✐ restlessness Dyspnea on exertion (DOE). anxiety. tachycardia with an S3 heart sound. cough.

Forward Failure ✐ Tachycardia ✐ Weak thready pulse ✐ Anxiety ✐ Oliguria and nocturia ✐ Altered ingestion ✐ Pale ✐ Cool and clammy skin .

usually pitting edema. and nausea ✎ Nocturia and weakness .Right-Sided Heart Failure ✎ Congestion of the viscera and peripheral tissues ✎ Edema of lower extremities (dependent edema). weight gain. anorexia. hepatomegaly ✎ Distended neck veins (jugular vein distention). ascites.


or beats. . pear-shaped organ about the size of a fist. The heart is made of muscle that rhythmically contracts. pumping blood throughout the body. the inferior vena cava and the superior vena cava. Oxygen-poor blood from the body enters the heart from two large blood vessels. When the atrium fills.The human heart is a hollow. it contracts. and blood passes through the tricuspid valve into the right ventricle. and collects in the right atrium.

When the ventricle becomes full. Blood returning from the lungs to the heart collects in the left atrium. and the tricuspid valve closes to prevent blood from moving back into the atrium. As the right ventricle contracts. which carries blood to the lungs to pick up fresh oxygen. . it forces blood into the pulmonary artery. When blood exits the right ventricle. it starts to contract. preventing blood from passing back into the ventricle. the ventricle relaxes and the pulmonary valve shuts.

blood flows through the mitral valve into the left ventricle. and the mitral valve between the two chambers closes. .When this chamber contracts. the left ventricle contracts and forces blood into the aorta. and the aortic valve at the opening of the aorta closes. the ventricle begins to relax. The left ventricle fills and begins to contract. In the final phase of blood flow through the heart. After the blood in the left ventricle has been forced out.


Promoting Activity Intolerance Risk for or Related to imbalance between oxygen supply and demand secondary to decreased cardiac output. .

heart rate should return to baseline within 3 minutes. before. and immediately after an activity to identify whether they are within the range.  Take vital signs. patient should rest if symptoms are severe but otherwise should resume regular activities.  . especially pulse.  Encourage patient to perform an activity more slowly than usual. Instruct the patient to avoid prolonged bed rest.Monitor patient’s response to activities. during.

Managing Fluid Volume .

 Teach patient to adhere to a low-sodium diet by reading food labels and avoiding commercially prepared convenience foods. Administer diuretics early in the morning so that diuresis does not disturb nighttime rest. monitor intake and output.  Monitor fluid status closely: auscultate lungs.  Monitor IV fluids closely . compare daily body weights.

frequent changes of position. or the patient may prefer to sit in a comfortable armchair to sleep. place bed legs on 20 to 30 cm blocks. positioning to avoid pressure. .  Assess for skin breakdown. elastic pressure stockings. and institute preventive measures like. Position patient. increase the number of pillows. and leg exercises. to shift fluid away from the heart. elevate head of bed.

Controlling Anxiety .

 Promote physical comfort and psychological support.Decrease anxiety so that the patient’s cardiac work is also decreased  Administer oxygen during acute stage to diminish the work of breathing and to increase comfort.  . a family member’s presence provides reassurance.

brief directions for an activity if necessary. state specific.  Provide accurate information.  . calm and confident manner.  Assist in identifying factors that contribute to anxiety and avoid anxiety-provoking situations (relaxation techniques).Speak in a slow.

Monitoring and Managing Potential Complications .

and generalized weakness. raisins. squash and watermelon are good sources of potassium. Bananas. hypomagnesemia. peaches.  Assess electrolyte levels periodically to alert health team to hypokalemia. spinach. grapefruit. potatoes. orange or tomato juice.  Advise patient to increase dietary intake of potassium. hypotension.  .Monitor for hypokalemia caused by diauresis (potassium depletion) Signs are weak pulse. diminished deep tendon reflexes. faint heart sounds. muscle flabiness. and hyponatremia.

and avoid noxious agents such as alcohol and smoking. Advise patient to avoid excess fluid intake.  Encourage patient to increase self-care and responsibility . and participate in regular exercise.

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