CONGESTIVE
HEART FAILURE
OBJECTIVES:
GENERAL
The students will develop the
knowledge, skills, and attitude
given a situation that includes
medical surgical cases. This
case presentation seeks to
establish the student’s
knowledge about the case of a
65-year-old woman who has
congestive heart failure.
SPECIFIC
To understand the definition,
epidemiology, signs and symptoms,
treatment and management regarding
the case.
To understand the anatomy and
physiology of the heart and relate it to
the patient’s case.
To trace the pathophysiology
regarding the case of the patient.
To implement the nursing care plan
and gather the drug therapy that is
related to the patient’s case.
To formulate the discharge planning
needed by the patient.
INTRODUCTION
Heart failure, sometimes called congestive cardiac failure
(CCF), is a condition in which the heart muscle is weakened
and can’t pump as well as it usually does. The main pumping
chambers of the heart (the ventricles) can change size and
thickness, and either can’t contract (squeeze) or can’t relax
(fill) as well as they should. This triggers fluid retention,
particularly in the lungs, legs and abdomen.
The major causes of heart failure include coronary heart
disease and heart attack, high blood pressure, damage to the
heart muscle (cardiomyopathy), heart valve problems and
abnormal heart rhythms. Of these, coronary heart disease
and heart attack are the most common causes.
Epidemiology:
According to World Health Organization, cardiovascular diseases (CVDs) are the number 1 cause of
death globally, taking an estimated 17.9 million lives each year. An estimated 17.9 million people died from
CVDs in 2016, representing 31% of all global deaths. Of these deaths, 85% are due to heart attack and
stroke while one third of these deaths occur prematurely in people under 70 years of age. Meanwhile,
in the Philippines, hospitalization for congestive heart failure (CHF) was reported to be 1648 cases for
every 100 000 patient claims in 2014. Data were obtained from representative government/private
hospitals and a drugstore in all regions of the country.
SIGNS AND SYMPTOMPS
SHORTNESS
OF BREATH
FATIGUE
AND WEAKNESS
EDEMA
PERSISTENT
COUGH
TREATMENT AND MANAGEMENT
Lifestyle changes:
All heart failure treatment will involve lifestyle modifications including:
Dietary changes
Restrictions on salt intake
Fluid intake restrictions
Exercise
Avoiding cigarettes, alcohol, and recreational drugs
MEDICATION
S
U
R
G
E
R
Y
Coronary revascularization
Ventricular Restoration
Ventricular Assist Device
Heart Transplant
Patient’s Profile:
Age: 65 year old
Sex: Female
Nationality: Filipino
Religion: Roman Catholic
Address: Valenzuela
Date of admission: March 29, 2022
Time of Admission: 8:00am
Chief Complaint: The patient was brought
to the emergency room due to difficulty
breathing. Condition started 2 days PTA
when the patient had easy fatigability
going to the comfort room.
Admitting Diagnosis: Pulmonary edema
and heart enlargement
History of Illness: 10 year history of
hypertension and diabetes
NURSING HEALTH HISTORY
ANATOMY
AND
PHYSIOLOGY
PATHOPHYSIOLOGY
LABORATORY AND
DIAGNOSTIC
COMPLETE BLOOD COUNT
ELECTROLYTES
RENAL FUNCTION TEST
DRUG STUDY
NURSING CARE PLAN
ASSESSMENT
SUBJECTIVE:
The patient stated
“nahihirapan akong huminga”.
OBJECTIVE:
·(+) Crackles from lower to mid
portion of lungs
·Respiratory rate: 35 breaths
per minute
·02 Saturation: 90 %
·Pale
·Diaphoretic
DIAGNOSIS
PLANNING
Ineffective breathing pattern
related to decreased lung
expansion as evidenced by
tachypnea and crackles from
lower to mid portion of the
lungs.
After 1 hour of nursing intervention
the patient will be able to
demonstrate deep breathing
exercise.
After 2 – 3 days of nursing
intervention the patient will achieve
the following:
Establish a normal and effective
breathing pattern as evidenced by:
Respiratory rate of 12-20 cpm
Oxygen saturation within normal
range 95%-100%
Absence of crackles upon
auscultation
INTERVENTION
Independent:
- Placed patient in a high fowlers
position.
-.Monitored vital signs, assessed
and recorded respiratory rate and
depth.
- Auscultated breath sounds
every 4 hours.
- Educated and assisted in
sustained deep breathing
exercises.
- Encouraged frequent rest
periods
RATIONALE
- To permit maximum lung excursion
and chest expansion.
- To obtain baseline data. To detect
early signs of respiratory problems.
- Examine effectiveness of
intervention and to detect decreased
or adventitious breath sounds.
- allow patient to participate in
maintaining health status and
improve
Ventilation
- Extra activity can worsen
shortness of breath
EVALUATION
After 1 hour of nursing intervention
the patient will be able to
demonstrate deep breathing
exercise.
After 2 – 3 days of nursing
intervention the patient will achieve
the following:
Establish a normal and effective
breathing pattern as evidenced by:
Respiratory rate of 12-20 cpm
Oxygen saturation within normal
range 95%-100%
Absence of crackles upon
auscultation
Hence, The Goal was partially met.
- Utilized pulse oximetry to
check oxygen saturation and
pulse rate. Evaluated skin color
and capillary refill.
- To detect alterations in
oxygenation. Lack of oxygen
will cause blue/cyanosis
coloring to the lips, tongue, and
fingers
Dependent:
Administered oxygen as
ordered.
Supplemental oxygen is
required to maintain PaO2 at an
acceptable level.
ASSESSMENT
Subjective:
“Namamanas ang mga paa ko
umabot na dito sa tuhod ko” as
verbalized by the patient
Objective:
BP 180/100
HR 110/min
RR 35/min
O2 sat 93%
- (+) edema up to the knees area
- *Hypothetical
+ 2 pitting edema bilateral lower
extremities
- oliguria
- Elevated Serum Potassium: 6.1
- (+) crackles from lower to mid
portion of the lungs.
- CXR result showing pulmonary
edema
DIAGNOSIS
PLANNING
Excess fluid volume related to
maladaptive compensatory
mechanisms secondary to
congestion of tissue perfusion
as evidence by (+) edema, (+)
crackles lung sound and CXR
result of pulmonary edema.
Short term:
After 1 hour of nursing
intervention the patient will
be able to acquire knowledge
and understanding about the
importance of diet
modification (fluid intake
restriction, low salt – low
potassium diet)
After 3 days of nursing
intervention the patient will be
able to achieve the following
Vital signs within normal range:
BP 90/60mmHg - 120/80mmHg
HR 60 – 100 bpm
RR 12 – 20 cpm
O2 95 – 100% (Johns Hopkins
Univ., 2022)
b. (-) or absence of crackles
sound from mid to lower
portion of the lungs
c. Urine output of within
normal range
d. Maintain normal fluid
volume as evidence by absence
of edema
INTERVENTION
- Monitored vital sign and assessed
lung sound for baseline data
- Measured and documented hourly
I&O
- Monitored weight regularly using
the same scale and at the same time
of day, wearing the same amount of
clothing.
RATIONALE
- Provide an information base against
which to monitor and assess progress
and effectiveness during
implementation of intervention.
-To monitor fluid status; the normal
range for 24-hour urine volume is 800
to 2,000 milliliters per day with a
normal fluid intake of about 2 liters per
day (MedlinePlus, 2022).
- Elevated edematous of lower
extremities, and handle with care
-Sudden weight gain may mean fluid
retention. Different scales and clothing
may show false weight inconsistencies
- Educate patient and family members
the importance and strict compliance
in proper nutrition, hydration, and diet
modification.
- Elevation decreases pressure and
may help reduced edema. Edematous
skin is more susceptible to injury.
EVALUATION
Short term:
After 1 hour of nursing intervention the
patient acquired knowledge and
understanding about the importance of
diet modification.
After 3 days of nursing intervention
the patient achieved the following:
¾Vital signs:
·BP 140/90
·HR 100/min
·RR 25/min
·O2 sat 95%
¾(+) crackles sound below mid portion
of the lungs
¾Urine output of 250ml/day
¾+ 1 pitting edema in bilateral lower
extremities
Goal was partially met.
Dependent:
Administered diuretics as
ordered, documented the
response; Furosemide 40 mg IV
stat
- Increased excretion of excess
fluids and electrolyte
DISCHARGE PLANNING