Congestive Heart Failure

Congestive heart failure (CHF) can affect adults and children. It occurs when the heart is no longer able to maintain the pumping needs of the body. For patient over the age of 65, 10% of those individuals suffer from CHF. After being diagnosed with CHF, management can be difficult for patients, causing frequent readmissions into the hospital setting. Heart failure can occur on either side of the heart, right or left. Management and clinical manifestations depend on the location of the weakened heart (Huether & McCance, 2017, p. 632).

Pathophysiology

Congestive heart failure occurs after the heart muscle is weakened, which can happen with high blood pressure, coronary artery disease, myocarditis, and cardiomyopathy to name a few. Each of these disease processes affects the heart a little differently. High blood pressure weakens the heart by stretching out the heart muscle too much. This can result in a poor pumping action of the heart along with stiffened heart muscles. When the heart gets high amounts of fluids running through the heart vessels it is unable to pump like a healthy heart because it is being asked to work too hard. Removal of the fluid becomes necessary (Huether & McCance, 2017, p. 632).

Coronary artery disease (CAD) weakens the heart when extra plaque builds up in the heart’s vessels. The vessels become less pliable, blood flow is decreased, and heart failure results. Myocarditis is commonly caused by a virus that leads to an inflamed heart. This inflammation results in left sided heart failure. Cardiomyopathy is when their is damage to the heart muscle, which could be from a disease process, infection, or even substance abuse. As you can see, several medical conditions can cause congestive heart failure. Some causes are more preventable than others. It is important to know the root cause when selecting treatment methods (Huether & McCance, 2017, p. 632).

Pharmacological Treatment

Symptom management is essential for patients with CHF. Management is usually dependent on several medication classes.  Furthermore, medication compliance is essential for patients with CHF. Diuretic therapy is often utilized when the heart is no longer able to adequately pump and fluid congestion has set in. Common examples include, Furosemide, Bumetanide, and Chlorothiazide. The goal is to allow the heart to pump as effectively as possible and this is accomplished through fluid removal of the vascular system (The American Heart Association, 2018; Yayla et al., 2015).

Overtime, a patient’s heart vessels become stretched when high fluid volumes are present. When this happens, medications are needed for the heart to have an effective pump. Medications utilized are angiotensin-converting enzyme inhibitors, such as Lisinopril and Enalapril, and beta blockers, such Carvedilol and Metroprolol succinate (The American Heart Associaton, 2018).

Pediatrics

The pathophysiological process of heart for children is similar to adults. It often occurs as a result of cardiomyopathies, dysrhythmias, or electrolyte imbalances. Left sided heart failure is more often seen, which leads to pulmonary hypertension and venous congestion. Children usually experience shortness of breathe, retractable breathing, a high respiratory rate, sweating, and nasal flaring. Weight gain, ascites, and peripheral edema are often seen when children are experiencing venous congestion. Diagnostic measures include a chest x-ray, laboratory testing, and monitoring of symptoms. Treatment is focused on reducing the work of the heart. Fluid removal is accomplished with the help of diuretics. In severe cases, surgery is needed or even a heart transplant (Huether & McCance, 2017, p. 666).

Patient Education

As mentioned above, patients with CHF often face frequent hospital readmissions. Patient education is essential as the patient prepares to go home. The discharge process truly starts at the beginning of the patient’s admission. For example, by educating the patient on day one about their medications, he or she is more likely to remember the medications when they go home because they will have been educated on their purpose and function each time they are receiving the medication. Visual aids can also help the patient remember what they taking and why they are taking it.  Furthermore, nurses are encouraged to use teach-back educational methods when working with patients. It allows the patient to actively participate in their education and helps the nurse gage what they truly know. By using teach back methods, research has shown the hospital readmissions have decreased when consistently utilized (Aimkuist, 2017).

References

Almkuist, K. D. (2017). Using Teach-Back Method to Prevent 30-Day Readmissions in patients

with heart failure: A systematic review. MEDSURG Nursing26(5), 309-351.

Huether, S. E., & McCance, K. L. (2017). Understanding  pathophysiology (6th ed.). St. Louis,

MO: Mosby.

The American Heart Association. (2018). Medications used to treat heart failure. Retrieved

fromhttp://www.heart.org/HEARTORG/Conditions/HeartFailure/

TreatmentOptionsForHeartFailure/Medications-Used-to-Treat-Heart-

Failure_UCM_306342_Article.jsp#.WrmoVCOZP-Y

Yayla, Ç., Akyel, A., Canpolat, U., Gayretli Yayla, K., Eyiol, A., Akboğa, M. K., & … Çengel, A.

(2015). Comparison of three diuretic treatment strategies for patients with acute

decompensated heart failure. Herz40(8), 1115-1120. doi:10.1007/s00059-015-4327-y

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