Predisposing Factors: Precipitating Factors:

-Age -Gender
-Ischemic Heart Disease -Valvular Disease -Diet
-Chronic Hypertension -Myocardial Infarction -Lifestyle
-CAD

Heart cannot eject blood and cannot accommodate

Left ventricle unable to effectively pump blood out of
blood that returns from venous circulation
the ventricle into the aorta and systemic circulation

Increased venous pressure in the pulmonary vessels

Pulmonary venous blood

Venous engorgement of the cardiac output JVD volume
liver
systemic blood pressure Pressure
HEPATOMEGALY and perfusion to the -WEAKNESS
kidney -FATIGUE Fluid from the pulmonary
Pressure within portal vessels capillaries goes to
-TACHYCARDIA
Activation of RAAS -DIZZINESS
Fluid flows to the abdominal Pulmonary tissues and alveoli
-COOL
cavity Angiotensin I EXTREMITIES
PULMONARY EDEMA
ASCITES Angiotensin II
-COUGH
Pressure in the stomach and Adrenal Cortex release -DYSPNEA/TACHYPNEA
intestines aldosterone -PULMONARY CRACKLES
-O2 Sat.
Gastrointestinal Distress Aldosterone

ANOREXIA/ABDOMINAL PAIN Sodium and water -WEIGHT GAIN

retention

EDEMA
Diagnostic Procedure

1. Echocardiogram
2. ECG
3. X-ay
4. CVP

Labs:

1. B-type natriuretic peptide BNP –Key diagnostic indicator of HF. High levels of BNP are signs of
high cardiac filling pressure and can aid diagnosis of HF.
2. Serum Electrolytes
3. BUN
4. Creatinine
5. CBC
6. Urinalysis

Nursing diagnosis:

EDEMA FATIGUE

NSG Dx: NSG Dx:

Fluid volume excess related to Fatigue related to imbalance between

ineffective contracting of the
ventricles and back up of blood during
ventricular filling, as evidenced by
pitting edema of legs and feet.
oxygen supply and demand, as
evidenced by weakness, tachycardia,
dizziness, cool extremities

Interventions: Provide low sodium Interventions: Provide periods of rest

diet, monitor intake/output, monitor
for signs of edema, monitor daily
weights, Limit Fluid intake to 1L/day
between activities, maintain adequate
nutrition, assist with ADLs as needed,
stop activities if severe shortness of
breath, pain or dizziness develops,
help pt. set realistic goals for daily
activities

Medications: DECREASED CARDIAC OUTPUT

Furosemide, Spironolactone, NSG Dx:
Benthiazide
Decreased Cardiac output r/t altered
preload as evidenced by JVD,
Dx. Procedure/Labs weakness, edema

High level of BNP

High value indicates increased

ventricular stretch
Interventions: Provide periods of rest
between activities, maintain adequate
nutrition, assist with ADLs as needed,
help pt. set realistic goals for daily
Medications: Digoxin, Anticoagulant
activities, Provide low sodium diet,
and Antianginal
monitor intake/output, monitor for
signs of edema, monitor daily
weights, Limit Fluid intake to 1L/day
Dx. Procedure/Labs: CVP < 4 cmH20

Decreased cardiac preload