Congestive Cardiac Failure: Nursing Perspective
Congestive heart failure is a congenital condition that affects millions of American’s every year. Heart failure often manifests in a chronic condition for victims of the disease.
There are several nursing interventions important for control and maintenance of the condition. Congestive heart failure can result in serious complications including edema, respiratory disorders and can lead to premature death. Treating congestive heart failure appropriately is critical to a patient’s outcome. Perhaps even more critical to a patient’s outcome is patient education targeted at prevention and healthy living. Nursing management of the condition depends upon appropriate medical evaluation, medication administration, monitoring and patient education. These ideas are explored in greater detail below.
Congestive heart failure is often congenital in nature. Congestive heart failure usually manifests when the cardiac muscle is old and tired and stops circulating properly. This may result from damage to the heart; alternatively myocarditis and cardio myopathy may be present which might lead to congestive heart failure. Heart attacks that end up killing part of the heart tissue and this can also lead to congestive heart failure.
Congestive heart failure is basically a slow deterioration of the hearts ability to fully and effectively circulate oxygenated blood. Right sided heart failure differs from left sided; in right sided heart failure a patient experiences systemic back up, manifesting as pedal edema or swelling of the feet. Left sided heart failure tends to present with pulmonary edema, (fluid in lungs) and is more serious (Arocha & Patel, 1995). Left sided heart failure is also more common.
Respiratory dysfunction occurs as a result of left sided heart failure – as fluid builds up in the lungs it is pulled to the back, and if someone is lying flat, more lung surface is covered and the patient will have trouble lying. An appropriate nursing intervention will include sitting the patient upright in the full upright flowers position, so that the fluid tends to occlude less of the lung field helping oxygenation.
There are other interventions including supplemental oxygen and medications that address both increasing cardiac output, such as digoxin and also diuretic drugs like furosemide which work to increase renal output which can sometimes help to void some of the fluid from the lungs. Digoxin is commonly prescribed to help the heart pump more strongly, and works well for individuals with systolic problems; however it would not work for a diastolic problem (Silver & Stevenson, 2000:10). Lasix also operates as a diuretic and may help patients with edema (Robinson, 1988:158).
If someone has CHF, and they have left sided heart failure which is causing pulmonary edema, Lasix will treat the symptom, but digoxin will treat the actual condition. Physicians often weight the condition of the patient and have to determine if administering digoxin might actually harm the patient b/c the heart is already fragile and it might cause extra effort because it causes the heart to contract harder.
There are medications that are going to treat the cause vs. The symptom, as a nurse it is important to recognize which drugs to which so they might anticipate how a course of medications might play out. They will know to look for complications secondary to overwork from digoxin, or might know to look for dehydration as a complication from administering Lasix. As a nurse, in individual should be watching input/output of an individual on Lasix, whereas a patient on dixogin might need to have more thorough monitoring of an ECG/EKG and vital sign changes.
Congestive heart failure often results in a domino effect, where edema initially presents as a result of cardiac failure, respiratory dysfunction results, and eventually total heart failure occurs.
Nursing interventions might also include supplemental oxygen, because when the fluid backs up into the lung fields it eliminates a percentage of lung tissue available for oxygen disbursement. A nurse might also monitor pulse oximetry for non-invasive assessment of saturation of oxygen molecules in blood hemoglobin to assess how well a patient is doing. Hypoxia might manifest itself as a low pulse ox rate, and appropriate intervention may be taken accordingly.
Part of the management of congestive heart failure lies in the prospect of patient education. Patient education is a critical component to successful outcomes for cardiac patients. No matter the outcome of surgery, a better alternative to the treatment of any disease is prevention (Adomeit et. al, 2001). Congestive heart failure is an example of a disease that can be managed and perhaps even prevented through patient education programs. This is exemplified by the manner in which congestive heart disease works. Edema for example is traditionally responsible for sending cardiac patients to the hospital on average three times per year (Adomeit, et. al, 2001).
A patient education program would allow the patient to learn more about their disease, the importance of taking medication, adhering to a special diet and keeping track of any weight gain (Adomeit, et. al, 2001). Patients who are educated regarding their care may prevent frequent episodes or complications in the future.
Patient education must account for the potential of patients to return to an active, productive and normal lifestyle, and take into consideration that patients will be eating out, working during lunch and participating in any number of other events which might open the door for relapse (Silver & Stevenson, 2000). Psychosocial interventions might also be important to managing congestive heart failure (Antoni, et. al, 2001). Congestive heart failure is a pervasive issue. Currently more than 5 million Americans are living with the condition, with more than 2 million hospitalized each year (Silver & Stevenson, 2000). Patient education should also aspire to reach the 10 or 15 million Americans who are “asymptomatic now but are at high risk for developing heart failure in the near future” (Silver & Stevenson, 2000:7).
There are many risk factors for congenital heart disease including previous myocardial infarctions, high blood pressure, valve disease, infection or heart defects (AMA, 2004). Congestive heart failure results in a heart that still works, but not optimally. Congestive heart failure can lead to many complications including edema and respiratory disorders. Treating congestive heart failure adequately requires lifestyle changes, medical intervention and continual maintenance of a patient’s conditions and prospect for well being.
Nursing interventions must adequately address the side effects of this chronic illness, which may include edema, pulmonary disorders and general malaise. Patient education is a crucial element to enabling congestive heart conditions to enable them to function in a realistic manner. The physical manifestations of the illness must be addressed first and foremost, followed by follow up care and education that can help patients lead a normal and active lifestyle.
References
AMA. (2004). “Congestive Heart Failure.” American Heart Association, Inc. {Online} Available: http://www.americanheart.org/presenter.jhtml?identifier=4585
Adomeit, A; Baur, A; Salfeld, R. (2001). “A New Model for Disease Management.” The McKinsey Quarterly.
Antoni, M; Ironson, G; Saab, P; Schneiderman, N. (2001). “HEALTH PSYCHOLOGY: Psychosocial and Biobehavioral Aspects of Chronic Disease Management.” Annual Review of Psychology
Arocha, J; Patel, V. (1995). “Novice Diagnostic Reasoning in Medicine: Accounting for Evidence.” Journal of the Learning Sciences, Vol. 4
Meaney, M. (2000). “A Deliberative Model of Corporate Medical Management.” Journal of Law, Medicine & Ethics, Vol. 28
N.A. “NHLBI, Heart Failure.” Department of Health and Human Services. {Online} Available: http://www.nhlbi.nih.gov/health/public/heart/other/hrtfail.htm
Robinson, Z.W. (1988). “Nurses’ Work: The Sacred and the Profane.” University of Pennsylvania Press.
Silver, M; Stevenson, L.W. (2000). “Success with Heart Failure: Help and Hope for Those with Congestive Heart Failure.” Perseus Publishing, Reading
Congestive Heart Failure
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