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.

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

Congestive heart failure is usually an acute presentation of heart failure.

Common underlying conditions include coronary atherosclerosis (primary cause), valvular disease, cardiomyopathy, inflammatory or degenerative muscle disease, and arterial hypertension.

Left-Sided Heart Failure

Backward Failure Pulmonary congestion, cough, fatigabilty, tachycardia with an S3 heart sound, anxiety,

restlessness Dyspnea on exertion (DOE), orthopnea, paroxysmal nocturnal dyspnea (PND) Cough may be dry and nonproductive but is most often moist.

Bibasilar crackles advancing to crackles in all lung fields Large quantities of frothy sputum, which is sometimes pink (blood-tinged)

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

Right-Sided Heart Failure

Congestion of the viscera and peripheral tissues Edema of lower extremities (dependent edema), usually pitting edema, weight gain, hepatomegaly Distended neck veins (jugular vein distention), ascites, anorexia, and nausea Nocturia and weakness

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

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

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

Promoting Activity Intolerance

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

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

Managing Fluid Volume

 Administer

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

 Position

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

Controlling Anxiety

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

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

Monitoring and Managing Potential Complications

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

Advise patient to avoid excess fluid intake, and avoid noxious agents such as alcohol and smoking, and participate in regular exercise.

Encourage patient to increase self-care and responsibility