The prevalence of congestive heart failure is on the increase both in the United States and all over the world, and it is the leading cause of hospitalization in the elderly population. Congestive heart failure is a progressive disease generally seen in the elderly, which if not properly managed, can lead to repeated hospital admissions or death. Heart failure means that the heart muscle is weakened. A weakened heart muscle may not be strong enough to pump an adequate amount of blood out of its chambers. To compensate for its diminished pumping capacity, the heart may enlarge. Commonly, the heart’s pumping inefficiency causes a buildup of blood in the lungs, a condition called pulmonary congestion.
Congestive heart failure continues to grow in prevalence due to the ageing population and the survival rates of myocardial infarctions (Fundukian, 2011). Congestive heart failure means that the heart is still pumping blood, but at a slower rate than normal, so the pressure in the heart starts to increase as a result. This slower heart rate causes the heart to be unable to pump enough blood to provide the rest of the body with the amount of nutrients and oxygen that it needs. As the pressure increases in the heart, the chambers stretch to hold more blood, or they become stiff and thickened. This compensation mechanism works, but eventually the myocardium will weaken and the heart will decrease in its efficiency to pump blood. This results in a reduction of blood supply to the kidneys, which then begin to lose their ability to excrete salt and water. This lessened function of the kidney causes the body to retain more fluid. The fluid build-up then leads to edema or congestion of tissues (Fundukian, 2011).
Congestive heart failure is a serious condition with significant morbidity and mortality. In the United States, African Americans significantly have a higher risk for developing CHF than other ethnic groups, whether or not the heart failure is preceded by a myocardial infarction. Hypertension and diabetes are more prevalent in African Americans, and that explains a large part of the racial and ethnic differences in the risks for developing CHF (Gore, 2008). Assessment. Patient’s demographics, clinical history, alongside with complete history and physical is obtained by the nurse. Head to toe assessment is done to check for any physical signs of complications from the disease, commonly dependent edema, and the functional status of the patient.
The functional status, which includes the activities of daily living (ADL), is assessed to determine the severity of the disease (Ramos, Prata, Goncalves, & Coelho, 2013).In addition to the physical assessment, brain natruretic peptid (BNP), a hormone that checks for the functionality of the heart is also checked, and is a measuring tool to diagnose CHF (Ramos, Prata, Goncalves, & Coelho, 2013). Pathophysiology. Heart failure may be classified according to the side of the heart affected, (left- or right-sided failure), or by the cardiac cycle involved, (systolic or diastolic dysfunction)(Haydock & Cowie, 2010).
Late blood supply edema may develop (Haydock & Cowie, 2010). Where edema occurs depends on what side of the heart is failing. Left-sided heart failure results from the inability of the left ventricle to function properly. Blood fails to get out to other parts of the body as quickly as it returns from the lungs. When blood doesn’t get back to the heart, it backs up in the lungs blood vessels. Blood is then forced into the intracellular space in the lungs causing pulmonary edema (Haydock & Cowie, 2010).
Right-sided heart failure results from the inability of the right ventricle to function properly. Blood isn’t pumped to the lungs as quickly as it returns from the other parts of the body. Fluid then begins to back up in the veins and pushes out into the tissues, causing edema, most often in the feet, lower legs, and ankles. (Haydock & Cowie, 2010). Sluggish blood flow also deprives organs of oxygen and other nutrients causing fatigue and difficultly with physical exertion. The heart tries to compensate for its lack of pumping ability by becoming hypertrophic. This causes the muscle in the heart’s wall to thicken thus improving the pumping ability of the heart (Haydock & Cowie, 2010). The heart may also increase heart rate to improve output and circulation. The kidneys eventually join in by retaining salt and water to increase volume, but this extra fluid can cause edema and further complicate the situation. (Haydock & Cowie,2010).
Despite varying etiologies, there are molecular and biochemical features that contribute to heart failure (Keys & Kotch, 2004). Activation of the sympathetic nervous system causes enhancement of the adrenergic system, which in effect, contributes to loss of cardiac function. Enhancement of adrenergic functions can lead to hypertension in susceptible individuals, and in effect, contributes to heart failure (Keys & Kotch, 2004). Causes. Causes of congestive heart failure could be coronary artery disease (CAD), which is when the arteries that supply the heart with oxygen and blood become blocked or narrowed. Other causes include previous heart attack due to the tissue scarring, or cardiomyopathy which is damage to the heart muscle. Cardiomyopathy is caused by problems other than decreased blood flow. The causes include infections, alcohol, or drug use. Other factors that can contribute to congestive heart failure are hypertension, heart valve disease, thyroid disease, kidney disease, diabetes, or congenital heart defects (Fundukian, 2011)
Symptoms. Symptoms of congestive heart failure consist of fatigue, dependent edema, fluid build-up in the lungs, increase in urination because of the extra fluid, nausea, vomiting, abdominal pain, and decreased appetite (Fundukian, 2011). Diagnosis of CHF is done first by physical examination, such as heart rate, and heart sounds or murmurs. If a physician believes more tests are needed, common ones include an electrocardiogram or chest x-ray to detect previous heart attacks, arrhythmia, or heart enlargement, and echocardiogram using ultrasound to image the heart muscle, valves, and blood flow patterns. The physician may also want to do a heart catheterization, to allow the arteries of the heart to be visualized using angiography. Upon getting a diagnosis of CHF, the physician will usually start with asking the patient to change things in their diet, such going to a low sodium diet.
They may also want to prescribe medications. Types of medications could include angiotensin converting enzyme (ACE) inhibitors, which block formation of angiotensin II hormone, angiotensin receptor blockers (ARB) to block the action of angiotensin II at the receptor site, and diuretics, just to name a few (Fundukian, 2011). If these primary treatments are ineffective for the patient, the physician may want to revert to other methods such as surgery. Depending on the specific problem in the heart, the physician could recommend bypass surgery, to route blood around the blocked artery, heart valve surgery for replacement or repair of a dysfunctional valve, or infarct exclusion surgery to remove scar tissue that accumulated due to a previous heart attack.
The final measures would be placement of a left ventricular assisted device (LVAD), which helps to pump blood throughout the body. This is usually only used in patients who are waiting for a heart transplant. The outcome or prognosis of congestive heart failure is extremely variable. It is usually related to its functional class. These functional classes are Class 1, patient has a weakened heart but is without symptoms or limitation, Class 2, only limitation of heavier workloads, Class 3, limitation of everyday activity, and Class 4, severe symptoms at rest or with any degree of effort (Fundukian, 2011).
Management of congestive heart failure. Healthcare workers play an important role in educating patients with congestive heart failure about the disease and how to manage it. According to Garcias and Wright (2010), congestive heart patients who are taught by knowledgeable nurses may have a better understanding of their disease and how to improve their quality of life and decrease mortality and hospital admission rates. Self-care is a complex and multi-faceted phenomenon that needs a comprehensive consideration of patients including their emotional situation, psychological characters, physical abilities, family support, living facilities, comorbidities (especially cognitive function) and their ability for learning. Insufficient knowledge about CHF, symptom recognition and ways of self-care along with hopelessness and psychological problems limited their abilities for an effective self-care.
A supportive environment, motivation and adequate care programs using effective educational methods that build self-care skills, should be recommended to health care providers and families (Siabani, Leeder, & Davidson, 2013) There are several ways to prevent congestive heart failure. Diet management is a key factor in securing a future without congestive heart failure. Maintaining a proper diet is crucial. Being overweight will act as a burden to the heart causing it to work harder to pump blood throughout the body. It is necessary to reduce sodium intake to avoid retaining fluids. The next step would be to increase potassium intake. Individuals who have congestive heart failure are usually prescribed diuretics to help excrete fluids causing a loss of potassium. Potassium can be found in green leafy vegetables and most fruits, particularly bananas, oranges, and dried fruit. Other factors for congestive heart failure prevention would involve exercise, not smoking and limited alcohol consumption. (Haydock & Cowie, 2010). Various drugs are incorporated into treatment for congestive heart failure.
The use of drugs is intended for reducing fluids within the body or to reduce blood pressure in the arteries of the body. Typical drugs used for treatment are Ace inhibitors, beta-blockers, digitalis, diuretics and vasodilators. Beta-blockers are intended to improve function for the left lower ventricular pumps. Diuretics are intended to assist in eliminating products that primarily contribute to congestion such as salt and water. Digitalis serves a very important role in strengthening the heart so it can serve as a more efficient, reliable, and effective pump. Treatment may involve surgery if the failure is a result of a poor functioning heart valve. Surgery could involve repair or replacement of a heart valve or in drastic cases, replacement of the heart itself (Gore, 2008).
Lifestyle adjustment is necessary to effectively curtail the increasing prevalence of CHF. It is important should therefore optimize control of hypertension and diabetes (Gore, 2008). General treatment will also consist of exercise, weight loss, rest and specific attention to maintaining a suitable diet plan. The Practice Framework of a person that has congestive heart failure is greatly affected. Individuals must reduce the amount of exertion on their bodies to prevent over stimulating the heart.
The limitations caused by the failure make performing even routine tasks more difficult. Some of the activities of daily living (ADL’s) that this individual might have issues with might be, getting dressed and undressed, toileting, personal hygiene, bathing and eating (Haydock & Cowie, 2010). To reduce hospitalization of the CHF patient, nurses must teach patients about illness, symptoms, diet, medication, and energy conservation. The more knowledge a nurse can give to a patient concerning CHF, the more the patient can do to reduce hospitalizations. Gerontological nurses must provide high quality, research-based clinical care for these patients (Bushnell & Lopez, 1992).
Conclusion: Congestive heart disease is a disease that grows fast in prevalence, causing a high rate of hospitalization every year. It is more prevalent in the elderly population. The symptoms of congestive heart failure mimic that of other diseases, but shortness of breath, fatigue, and dependent edema are common in patients. When taking care of patients with congestive heart failure, it is important to incorporate cultural and spiritual considerations.
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