Congestive heart failure (CHF) refers to the stage where fluid builds up around the heart due to weakening of the heart muscles. It can be caused by conditions like high blood pressure, heart attack, and valve disorders. Symptoms include fatigue, shortness of breath, swelling, and weight changes. Diagnostic tests include EKGs, echocardiograms, stress tests, and blood tests. Treatment involves medications to open blood vessels, slow the heart rate, and reduce fluids, as well as potential surgeries like angioplasty or valve repair. Nursing focuses on monitoring cardiac output, managing activity levels and fluids.

1. Congestive Heart Failure
Shashikanthraddy Patil
M.Sc. Nursing

2. Definition
Congestive heart failure (CHF) is a chronic
progressive condition that affects the
pumping power of your heart muscles.
While often referred to simply as “heart
failure,” CHF specifically refers to the
stage in which fluid builds up around the
heart and causes it to pump inefficiently.

3. Risk Factors
 CAD
 Age
 HTN
 Obesity
 Cigarette smoking
 Diabetes mellitus
 High cholesterol

4. Etiology
May be caused by any interference with normal
mechanisms regulating cardiac output (CO)
Common causes
1.HTN
2.Myocardial infarction
3.Valvular disorders

5. Clinical Manifestations
 Pulmonary edema (what will you hear?)
 Agitation
 Pale or cyanotic
 Cold, clammy skin
 Severe dyspnea
 Tachypnea
 Pink, frothy sputum

6. Chronic Congestive Heart Failure
Clinical Manifestations
 Fatigue
 Dyspnea
 Tachycardia
 Edema – (lung, liver, abdomen, legs)
 Nocturia

7. Chronic Congestive Heart Failure
Clinical Manifestations
 Behavioral changes
 Restlessness, confusion, ↓ attention span
 Chest pain
 Weight changes (r/t fluid retention)
 Skin changes
 Dusky appearance

8. Diagnostic Studies

9. 1. An electrocardiogram (EKG or ECG) records
your heart’s rhythm.
2. An echocardiogram uses sound waves to record
the heart’s structure and motion. The test can
determine if you already have poor blood flow,
muscle damage, or a heart muscle that doesn’t
contract normally.
3. An MRI takes pictures of your heart. With both
still and moving pictures, this allows your doctor
to see if there’s damage to your heart.

10. 4. Stress tests show how well your heart
performs under different levels of stress.
5. Blood tests can check for abnormal
blood cells and infections. Blood tests can
also check the level of BNP, a hormone
that rises with heart failure.
6. Cardiac catheterization can show
blockages of the coronary arteries.

11. Medical and Surgical
Management

12. Medical management
•Angiotensin-converting enzyme inhibitors (ACE
inhibitors) open up narrowed blood vessels to improve blood
flow. Vasodilators are another option if you cannot tolerate
ACE inhibitors.
•Beta-blockers can reduce blood pressure and slow a rapid
heart rhythm.
•Diuretics reduce your body’s fluid content. CHF can cause
your body to retain more fluid than it should.
Surgeries
•If medications aren’t effective on their own, more invasive
procedures may be required. Angioplasty, a procedure to
open up blocked arteries, is one option. Your cardiologist
may also consider heart valve repair surgery to help your
valves open and close properly.

13. Nursing Management
Nursing Diagnoses and Interventions

14. 1. Decreased cardiac output related to
changes in myocardial contractility.
Goal: show vital signs within acceptable limits,
decreased dyspnoea episodes of angina (report).
Nursing Interventions :
a. Auscultation apical pulse, assess the frequency and
rhythm of the heart
b. Record the heart sounds
c. Palpation of peripheral pulses
d. Assess the skin of cyanosis and pallor
e. Provide a comfortable and quiet environment

15. 2. Activity intolerance related to imbalance
between supply oxygenation needs.
Goal : Participate in a desired activity, meets the needs of
self-tolerance achieving increased activity can be measured,
evidenced by a decrease in fatigue and weakness and vital
signs during exercise.
Nursing Interventions :
a. Check vital signs before and after the activity.
b. Note the cardiopulmonary response to activity, note
tachycardia, dyspnoea, sweating, pale.
c. Assess the precipitator / causes weakness example:
treatment, pain, medication.
d. Evaluation of an increase in activity intolerance.
e. Provide assistance in self-care activities in accordance with
the indication.

16. 3. Excess fluid volume related to decreased
glomerular filtration rate (GFR)
Goal : The balance of inputs and outputs, clean breath
sounds, vital signs within acceptable range, stable weight, no
edema.
Nursing Interventions :
a. Monitor urine output
b. Monitor / calculate the balance of income and output 24
hours.
c. Maintain a sitting / semi-Fowler position during the acute
phase.
d. Auscultation of breath sounds, or sound record and an
additional reduction.
e. Monitor blood pressure.