Congestive Heart Failure

CHF 1 Running Head: CONGESTIVE HEART FAILURE

Congestive Heart Failure Adrianne Bazo Montana Tech Nursing Department NURS 1566 Core Concepts of Adult Nursing

March 14, 2008

CHF 2 Noel Mathis RN, BSN, MSN Congestive Heart Failure

Congestive heart failure occurs when there is a malfunction in the pumping action of either the left ventricle, right ventricle, or both which causes blood to pool in the pulmonary arteries and/or veins. This pooling causes pulmonary congestion (fluid build up in the lungs), reduced cardiac output, increased strain on the heart, decreased efficiency of the heart muscle contraction, reduced stroke volume, increased heart rate, and hypertrophy; leading to increased risk of cardiac arrest and a decreased blood supply to the rest of the body. Since blood is the oxygen/nutrient supply to the cells, the effects of CHF are systemic. Risk factors for developing CHF are disorders that increase cardiac workload and disorders that disrupt the pumping ability of the heart. Examples of such diseases are, CAD, cardiomyopathy, acute myocardial infarction, disease of the heart valves, fluid volume overload hypertension, COPD, pulmonary hypertension, and anemia. My patient had triple bypass surgery six years ago, so the cause of her CHF is most likely from acute myocardial infarction. The diagnosis of CHF is primarily made from a composite of patient history, physical exam, laboratory studies, and radiographs. Lab

CHF 3 studies that indicate CHF are, low serum sodium and Hct from hemodilution and inadequate oxygen levels in the arteries from poor pulmonary perfusion. The effects of CHF cause reduced renal funciton producing elevated blood urea nitrogen and creatinine levels. The treatment of CHF is directed on decreasing the effects of the underlying causes. Pharmaceuticals are used to decrease excess fluid (diuretics), and improve cardiac output (ACE inhibitors, Betaadrenergic blockers, inotropics, and nitrates). Nonpharmaceutical interventions to decrease cardiac workload and increase myocardial oxygenation include intra-aortic balloon pump, ventricular assist devices, and biventricular pacing. Also a diet low in sodium is recommended. My patient presents with peripheral edema, low SaO2 oxygenation, rales heard in the lower 2/3 of the posterior lungs, shortness of breath, low Hct (30.5), high total carbon dioxide, high Lactate dehydrogenase (778), and high natriuretic peptide (823). Lactate dehydrogenase and natriuretic peptide are indicators of tissue damage and degree of heart failure.

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