1. The client/caregiver can define congestive heart failure.
   1. The heart is unable to pump sufficient blood to meet the body’s metabolic needs.
   2. Heart failure describes the accumulation of blood and fluids in organs and tissues as a result of impaired heart function.
   3. Heart failure is classified as acute or chronic and right-sided or left-sided.
2. The client/caregiver can briefly describe the anatomy and physiology of the heart.
   1. The heart consists of four chambers: the right and left ventricles and the right and left atria.
   2. The upper chambers, the atria, receive the blood from various parts of the body and pump it into the ventricles.
   3. The right ventricle pumps blood into the lungs, and the left ventricle pumps blood into all parts of the body.
   4. The primary reason for heart failure or decreased cardiac output is damage to the muscular wall of the heart.
3. The client/caregiver can list factors that may increase risk.
   1. Myocardial infarction
   2. Coronary artery disease
   3. Hypertension
   4. Congenital heart defects
   5. Obesity
   6. Aging
   7. Diabetes mellitus
4. The client/caregiver can recognize the signs and symptoms.
   1. Left-sided failure produces hypoxemia and respiratory symptoms
      1. Fatigue with activity
      2. Effort at breathing when active (exertional dyspnea)
      3. Inability to breathe unless sitting upright (orthopnea)
      4. Awakening at night by breathlessness (paroxysmal nocturnal dyspnea)
      5. Elevated blood pressure
      6. Productive cough with pink, frothy sputum
      7. Decreased urine output
      8. In acute situations, pulmonary edema develops, demonstrated by sudden hypoxic, restlessness, and confusion
      9. Elevated blood pressure
   2. Right-sided failure
      1. Gradual unexplained weight gain from fluid retention
      2. Dependent pitting edema in feet and ankles
      3. Fluids retention in sacral area or abdomen (ascites)
      4. Loss of appetite and/or nausea
      5. Dyspnea as a result of enlarged abdomen
5. The client/caregiver can report measures to prevent congestive heart failure.
   1. Lifestyle changes include stress reduction and energy conservation.
   2. Schedule rest periods to reduce fatigue and dyspnea.
   3. Follow the diet or any fluid restrictions prescribed by a physician.
   4. Take medication exactly as prescribed.
   5. Avoid tobacco and alcohol.
   6. Weigh daily at the same time of day using the same scale. Notify the physician if a more than 2-pound gain in 24 hours is identified.
   7. Measure pulse rate and blood pressure daily. Report a heart rate that is less than 60 beats per minute or more than 120 beats per minute.
   8. Elevate your legs while sitting.
   9. Avoid extreme heat, cold, or humidity.
   10. Keep follow-up appointments with the physician and have laboratory work obtained as ordered.
6. The client/caregiver can demonstrate an understanding of nutritional issues related to congestive heart disease (refer to Nutrition and Cardiovascular Disease).
7. The client/caregiver can list possible complications of congestive heart disease.
   • Acute pulmonary edema
   • Damage to organs such as the liver, kidney, or brain
   • Pneumonia
   • Electrolyte imbalance related to diuretic therapy
   • Need for oxygen therapy

Resources

American Heart Association
www.americanheart.org

National Heart, Lung, and Blood Institute (NHLBI)
www.nhlbi.nih.gov

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com