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Running Head: CONGESTIVE HEART FAILURE

Congestive Heart Failure

Adrianne Bazo

Montana Tech Nursing Department

NURS 1566 Core Concepts of Adult Nursing

March 14, 2008

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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

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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, Beta-

adrenergic 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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