Nursing Care Plan for Congestive Heart Failure - CHF

What is congestive heart failure?

Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to deliver oxygen rich blood to the body. Congestive heart failure can be caused by:

1. diseases that weaken the heart muscle,
2. diseases that cause stiffening of the heart muscles, or
3. diseases that increase oxygen demand by the body tissue beyond the capability of the heart to deliver adequate oxygen-rich blood.

The heart has two atria (right atrium and left atrium) that make up the upper chambers of the heart, and two ventricles (left ventricle and right ventricle) that make up the lower chambers of the heart. The ventricles are muscular chambers that pump blood when the muscles contract. The contraction of the ventricle muscles is called systole.
Many diseases can impair the pumping action of the ventricles. For example, the muscles of the ventricles can be weakened by heart attacks or infections (myocarditis). The diminished pumping ability of the ventricles due to muscle weakening is called systolic dysfunction. After each ventricular contraction (systole) the ventricle muscles need to relax to allow blood from the atria to fill the ventricles. This relaxation of the ventricles is called diastole.


Congestive heart failure can affect many organs of the body. For example:

• The weakened heart muscles may not be able to supply enough blood to the kidneys, which then begin to lose their normal ability to excrete salt (sodium) and water. This diminished kidney function can cause the body to retain more fluid.
• The lungs may become congested with fluid (pulmonary edema) and the person's ability to exercise is decreased.
• Fluid may likewise accumulate in the liver, thereby impairing its ability to rid the body of toxins and produce essential proteins.
• The intestines may become less efficient in absorbing nutrients and medicines.
• Fluid also may accumulate in the extremities, resulting in edema (swelling) of the ankles and feet.

Eventually, untreated, worsening congestive heart failure will affect virtually every organ in the body.
Heart failure also affects the kidneys' ability to dispose of sodium and water. The retained water increases the edema.

Congestive Heart Failure Symptoms and Signs
The symptoms of congestive heart failure vary among individuals according to the particular organ systems involved and depending on the degree to which the rest of the body has "compensated" for the heart muscle weakness.
The early symptoms are often shortness of breath, cough, or a feeling of not being able to get a deep breath.
In addition, the three major symptoms of congestive heart failure are :

1. exercise intolerance (a person may be unable to tolerate exercise or even mild physical exertion that he or she may have been able to do in the past);
2. shortness of breath (you may have difficulty breathing (dyspnea), especially when active, or even at rest); and
3. fluid retention and swelling (edema in the legs, feet, and ankles).

Nursing Diagnosis

1. Decreased cardiac out put related to structural defect, myocardial dysfunction.
Ineffective breathing pattern related to pulmonary congestion.
2. Anxiety related to threat to or change in health status resulting in inability to manage feelings of uncertainty and apprehension regarding the life-style changes.
3. Disturbance of sleep pattern related to illness resulting in interrupted sleep caused by nocturnal dyspnea.

Nursing Intervention

• Monitor vital signs every two to four hours including apical pulse, peripheral pulses, capillary refill, CVP and PAP if appropriate. Indicates change in cardiac status and potential for arrhythmias, compromised systemic venous flow.
• Monitor for heart sounds and breath sounds. Indications of recuced cardiac output caused by mechanical failure, pulmonary edema.
• Monitor electrolyte level of sodium increases and potassium decreases. Diuretic therapy may induce hypokalemia; decreased glomerular filtration rate (GFR) may cause hypernatremia; arrhythmias may be induced by potassium imbalances.
• Administer diuretic (hydrochlorothiazide, furosemide) while monitoring for electrolyte imbalances. Acts on distal tubule to increase water and potassium excretion or loop of Henle to promote excretion of sodium and chloride.
• Administer bronchodilator (theophylline). Dilates airways to facilitate breathing if dyspneic.
• Administer inotropic agents (digoxin, dopamine) while monitoring hemodynamic status. Increases cardiac output by increasing cardiac contractility.
• Administer oxygen therapy by cannula. Provides oxygen if hypoxic from decreased cardiac output or with ventilation perfusion imbalance from fluid in alveoli.
• Provide quite environment limiting stimuli. Stimuli and stress stimulate catecholamines and cardiac workload.
• Provide small meals six times per day. Reduces pressure on diaphragm and enhances chest expansion.
• Provide bed rest with head of bed elevated 30 to 60 degrees. Promotes lung expansion and decreases venous return.
• Perform deep breathing exercises, incentive spirometry ever two hours. Improves breathing and oxygen intake.

Label: Nursing Care Plan, Nursing Care Plan for Congestive Heart Failure - CHF