Congestive Heart Failure (CHF) is a condition where the heart cannot pump enough blood to other organs in the body. Some causes of CHF include hypertension, past myocardial infarction, heart valve disease, coronary artery disease (CAD), congenital heart defects, endocarditis, and myocarditis to name a few. (American Heart Association, 2013). In this essay we are going to discuss the nursing plan of care, treatment, and patient teaching and family understanding.
Nursing Plan of Care: Congestive Heart Failure (CHF)
Before we can start on how to care for a patient it is equally important to know a brief summary of this condition and some pathophysiology to better understand the nursing care plan. Heart failure whether it is the right or left side is the inability to maintain a good circulation of blood flow throughout the body. The left side is mainly characterized by low cardiac output and low delivery of oxygen and nutrients throughout the body. This in turn results in low body temperature such as hyperthermia and a slow metabolism. So, in result of the left side inability to empty causes pulmonary congestion which triggers the poor gas exchange, low oxygen and hypoxia that can be visible by cyanosis. The right sided failure produces congestion and/or retention of metabolic wastes which causes edema and metabolic acidosis.
Some nursing interventions are assessing for any kind of respiratory distress and if so, provide pulmonary hygiene, administer oxygen to relieve the hypoxia, keep head elevated in bed,
and monitor ABG values. Monitor for any changes to cardiac output including: tachycardia, brachycardia, ECG and heart sounds. Maintaining strict fluid intakes and output measurements, daily weights, assessing for edema, electrolyte levels along with hemocrit levels. Administering prescribed medications like diuretics to enhance the elimination of the excess fluids in the body and ACE inhibitors to prevent the salt being reabsorbed and BETA-blockers are used to reduce the myocardial workload. Due to the low body temperatures the nurse should encourage bedrest and no strenuous activities to prevent shortness of breath and should wear warm clothes and warm beddings. Lifestyle modifications should be expressed to the patient such as emotionally, activities and behavior. A caring environment which promotes rest, noise pollution and air pollution to prevent respiratory stress. Also, the patient should be encouraged to not consume alcohol and cessation of smoking. Diet alteration to a low salt, fat free is beneficial because it minimizes fluid retention. Lastly, keeping track of the vital signs more importantly blood pressure is a vital in keeping HF under control.
Patient and family education a very vital step in the process it can prevent frequent episodes of readmissions. The plan of care must extend to the home with medication compliance, daily weight monitoring, fluids and sodium restrictions, daily activities to a minimum or as tolerated understanding of the signs and symptoms of the disease worsening and when to seek medical attention. It’s also very important that verbalization of the understanding of the teachings is established, so that the nurse can be sure the teachings are carried out as much as possible.