Heart Failure (CHF) Nursing Care Plan
Congestive heart failure (CHF), otherwise known simply as heart failure (HF) is the medical term that describes the heart’s inability to pump sufficiently to maintain blood flow and meet the body’s metabolic needs. This ineffective pumping leads to congestion of the venous circuit on both the pulmonary and systemic sides, leading to poor tissue perfusion and fluid overload.
Congestive heart failure results from changes in either the left or right side of the heart. This could be for example; the right side of the heart is unable to adequately clear blood from the systemic circuit, resulting in a backup of blood throughout the body. Alternatively, failure of the left side of the heart may result in fluid collecting in the lungs.
As noted above, congestive heart failure is divided into two distinct categories; left-sided heart failure, and right-sided heart failure1.
Left-Sided Heart Failure
Left-sided heart failure is an abnormal condition of the heart characterised by impaired function of the left ventricle2. If the impairment of the left ventricle is significant, the cardiac output will be greatly reduced. The increased volume and pressure on the left ventricle due its ineffective action will reflect backwards into the pulmonary circulation. the increased pressure will force fluid out of the pulmonary circulation and into the interstitium and alveoli, resulting in a crackling sound on auscultation2.
Right-sided Heart Failure
Right-sided heart failure results from ineffective pumping of the right ventricle, resulting in venous congestion in the systemic circuit2. Right-sided heart failure will result in elevated pulmonary vascular resistance (PVR). as the PVR continues to rise, the workload of the right ventricle increases, demanding more oxygen, which may result in a thickening of the ventricle walls. As the failure continues, blood will begin to back up in the systemic circulation resulting in peripheral oedema2.
Left-sided Heart Failure
Nursing assessment will likely reveal the patient speaks in phrases, tachypnoeic and uses accessory muscles of respiration. There will likely be audible crackling of the lungs on auscultation, and low oxygen saturations. Tachycardia, hypotension and low capillary refill are also common.
Right-sided Heart Failure
Clinically, the patient will have weight gain due to fluid retention, distended neck veins and increased jugular venous pressure (JVP), hepatomegaly and splenomegaly with dependent peripheral oedema.
Signs and Symptoms of Heart Failure
- Oedema, particularly in the legs, ankles and feet.
- Irregular tachycardia
- Decreased exercise tolerance
- Persistent cough or wheeze
- Increased nocturnal urinary urgency
- Lack of appetite and nausea
- Difficulty concentrating
- Chest pain (although not common in heart failure patients)
- Coughing up pink foamy mucus3