Nursing Practices on Congestive Heart Failure

This article discusses nursing practices for congestive heart failure including aetiology, initial care, patient education, disease progression and treatment. It emphasizes the importance of monitoring vital signs, modifying diet plans, administering medicines, providing oxygen therapy, and coordinating with a multidisciplinary team. The article also recommends educating patients and their families about the disease and lifestyle changes that can help prevent it. Treatment options such as beta blockers, cardiac resynchronization, and implantable defibrillators are also discussed.

Running head: NURSING PRACTICES ON CONGESTIVE HEART FAILURE
Nursing practices on congestive heart failure
Name of the student:
Name of the university:
Author note:

1
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
Introduction:
Congestive heart failure is a common chronic condition where the heart is not able to
pump an adequate amount of blood. Heart failure is a common disease that is experienced by the
majority of the individuals around the globe. The symptoms are including shortness of breathing,
tiredness, an increase in urination, higher heart rate, dizziness and coughing (Ponikowski et al.,
2016). Heart failure does not generally because by single cause instead it is a combination of
other cause. Therefore, it requires proper medical assistance for curing and preventing the risk of
the disease. Approximately 50% to 75% of individuals in the population of Australia die from
congestive heart failure (Sahle, Owen, Mutowo, Krum & Reid, 2016). Therefore, the mortality
rate is quite high in Australia. Recent researches suggested that approximately, 10% of the
patient in this congestive heart failure is above the age of 75 years. In the above scenario, a 76-
year-old female admitted to the hospital in the medical ward. She was admitted to the hospital
and diagnosed with congestive heart failure. Her medical report shows all the symptoms of
developing congestive heart failure. Therefore, this essay will focus on the aetiology of the
disease, primary care after admitting to the hospital, the lifestyle of the patient, progression
towards illness and treatment of the disease in next paragraphs. The supporting papers are taken
from CINAHL out of which 4 journals particularly focused on congestive heart failure and the
rest are focused on nursing care. The key words used for this research are including aetiology of
congestive heart failure, pathophysiology of congestive heart failure, initial care provided by
nurse in congestive heart failure, clinical education provided by the nurses and treatment,
exercise provided by nurse.
Aetiology of congestive heart failure:
Congestive heart failure is a chronic disease that affects the blood pumping ability of the
of the heart muscle. This phenomenon often referred to as heart failure. Generally observed when
fluid around the heart abnormally increased and subsequently heart pump blood abnormally.
Left-sided Congestive heart failure is the most predominant one in individuals. It occurs when
the left ventricle of the heart unable to pump blood adequately out of the body (What is Heart
Failure, 2018). As the situation progresses, fluid started accumulated in the centre, and

2
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
eventually, the breathing becomes difficult. It is crucial to get checked by medical expertise at
least in once in a year. There are few leading causes of Congestive heart failure. The first cause
of Congestive heart failure is hypertension where blood pressure of the body becomes higher
than normal blood pressure. This hypertension narrows down the arteries of the heart and makes
it harder to maintain healthy blood flow in the body. Cholesterol or other fatty acids also acts as
predominate cause of block in coronary arteries. The valve of the heart regulates the standard
blood flow in the heart of every individual. In a few scenarios, the valve of the heart is not able
to work correctly. Subsequently, an improper opening and closing phenomenon of valve give
rise to Congestive heart failure ( Ter Maaten et al., 2015). Symptoms that immediately observed
are irregular heartbeat, fatigue and excessively rapid breathing; skin appears blue, loss of
appetite and sudden weight gain. Individuals might have increased urination and shortness of
breath (Tham, Bernardo, Ooi, Weeks &McMullen, 2015). In the above scenario, Mrs Paulinea
Carlos is a 76-year female who was admitted to the medical ward via direct admission. After an
investigation, it was reported that her respiratory rate was 30, which is abnormal. In standard
individual respiratory rate is 12 to 24 per minute, more than 24 consider as strange due to
heaviness in heart and lungs. She did not attend the blood test, but her full oxygen level
indicated 97%, which is abnormal for healthy individuals. Her medical report suggested that
increased urination at night, which is the first indication of Congestive heart failure. Moreover,
her medical report also suggested bilateral oedema of valves. This oedema generally observed
when it is difficult for vain to push blood into the heart and this subsequently leads to varicose
veins and fluid accumulation in legs. This is a typical scenario for congestive heart disease,
lungs, liver and thyroid disease. In the above situation, the Medical report of Mrs Carlos
indicates all the causes of Congestive heart failure and need immediate medical assistance.
Initial nursing care for patient:
Congestive heart failure is one of the leading causes of a higher rate of morbidity
worldwide. The heart is one of the vital organs which is responsible for balanced blood
circulation in the body. Any malfunction of processes leads to drastic anatomical changes. If
inappropriate blood circulation observed for more extended period then it gives rise to severe

3
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
heart disease. Therefore, providing sufficient clinical nursing care to the patient with heart
disease require sound knowledge about the disease and application of that knowledge for
providing appropriate care. Thus, nursing intervention of nursing care in healthcare sectors for
patient with heart failure should include priorities such as monitoring of vital signals,
modification of diet plan of the patient, accurate administration of medicines prescribed by
cardio experts, providing Oxygen therapy, monitoring the improvement because of revised diet,
coordination between diagnosis and administration of specific medications (Atherton et al.,
2018).As a clinical nurse of cardiovascular disease, primary care should be the identification of
signs of congestion and refer the patient for X-ray. Identification of clinical stability of the
patient is another critical factor nurses should take in to account. The blood test of the patient
should be done and noted in paper or on any computer. The pulse rate of the patients should be
monitored whether it is high or not. Peripheral perfusion, heart rate and rhythm of the patient
should be monitored. Her blood pressure should be monitored, generally in case Congestive
heart failure patient usually have high blood pressure (Vedel &Khanassov, 2015). Her body
temperature should be measured since due to abnormal distribution of oxygen metabolism rate of
the patient ceases rapidly. Therefore, nurses should encourage bed rest. Creatinine level, glucose
level, urea level, full blood count, troponin and natriuretic peptide level should be measured.
Nurses should monitor the urination frequency at night, her level of consciousness (Carthon,
Lasater, Sloane & Kutney-Lee, 2015). The weight gain observed along with the sudden loss of
appetite, in this case, suggestions for nurses is to monitor food habit of the patient along with the
habit of smoking and addiction of alcohol consumptions. After observing all the important vital
signs, nurses should address the anxiety of the patient and patient family by promptly answering
their query related to the disease. Nurses should be transparent about the signs and symptoms of
the patient and the implementation plan of the patient. Nurses should communicate with a
multidisciplinary team of the hospital for providing the excellent treatment.
Clint education:
Educating patient is an important part of health care system for managing patient with
congestive heart failure. Therefore, the involvement of nurses for educating the patient and their

4
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
family members is a crucial factor for providing the accurate treatment. Patients require
education for adapting with the symptoms of the disease and coming up with treatment
procedure so that they can be more corporative with hospital authority and that education should
be effective verbal communication followed by writing information. In the above scenario, Mrs.
Carlos is a patient of congestive failure. After her admission in a hospital ward, as a nurse, it
should be recommended to communicate effectively with patient family and provide history,
symptoms and treatment of congestive heart failure. Nurses should introduce a new concept to
the Family members of the patient to make it easier for them to understand the disease (Lewis et
al., 2016). As a nurse, I would recommend to a few foods that should be included in the food
diet. Fruits and vegetables should be included in the diet of the patient to reduce the risk of heart
failure. Family members should ensure that the patient only consumes foods that contain low
sodium. Too much consumption of sodium can cause the sudden increase in blood pressure and
subsequently, the risk of developing heart disease increases (Mancia et al., 2017). The family
should ensure that patient strictly avoid foods containing mayonnaise, pickles, marinades and
food containing excess fat. It should be recommended to monitor the weight of the patient on a
daily basis. A slight increase of the weight requires adjustment diet to prevent further risk of the
disease. Moderate exercise such as aerobic per week reduces the risk of heart failure and
enhances the quality of life. Walking, bicycling and swimming also help to eliminate the risk of
heart failure( Mancia et al. , 2017). However, heavy exercises are strictly prohibited. It is also
suggested to quit smoking in order to reduce the risk of the congestive heart failure. It is also
suggested to avoid the travelling in areas with high altitude and avoid lifting heavy materials,
running fast for reducing the risk of heart failure (Sacks et al., 2017). Moreover, it is also
recommended to the family members that family members should take into account the
psychological state of the patient. Patients might be anxious, might has anger issues because of
difficulty in coming up with the disease. Therefore, patience and empathy is the only key to
handle patient with heart failure.
Progress of disease and treatment:
Congestive heart failure is chronic long-term diseases that get worse with time. it is a
condition where the heart is not able to pump blood efficiently, and oxygen deficiency in body

5
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
observed. Subsequently, it leads to the high blood pressure and other cardiac problems.
Shortness of breathing and the exponential increase of heartbeat, oedema, and lack of oedema
leads to the development of congestive heart failure as observed in this case study. In this
scenario, the medical report suggested that she had no appetite and gained weight a lot. The
report also suggested the shortness of breathing and increased urination. Other symptoms such as
coughing and wheezing also observed in the patient in during the time she was admitted to the
hospital. Moreover, she had bilateral oedema of calves. All of these symptoms will give rise to
the third stage congestive heart failure and require the assistance of medical expertise to handle
the situation. With time she might exhibit the symptoms of memory loss and confusion if not
prevent immediately. Treatment for stage three congestive heart failure is quite similar to the
treatment that provided in stage one and two. Primarily, Angiotensin-converting enzyme
inhibitor should be given if the patient has high blood pressure (Yu et al., 2014). Beta blockers
are also given to the patient if the patient has high blood pressure because, in the majority of the
cases, patients had a dysfunctional left ventricle of the heart. The beta blocker is specifically
effective for the elderly patient. Beta blockers such as acebutolol, atenolol, bisoprolol generally
prescribed in the hospital (Cadrin-Tourigny et al., 2017). However, the sides effects are also
predominate because of usage of beta blocker. Cardiac resynchronisation and implantable
defibrillators have shown the evitable result to obtain superior medical therapy. However, it is
also suggested for the treatment of a patient with dysfunctional heart failure. Hydralazine and
nitrate combinations are used if other treatments don't stop your symptoms (Sliwa et al., 2016).
Diuretics also suggested in a few cases if symptoms continue even after treatments ( Pose et al.,
2017). The advantage of using these medications is that these medications help to reduce the
heartbeat of the patient if the heartbeat is faster than 70 beats per minute. Here the patient’s
ECG report shows that the heart rate is 99 which are abnormal for a normal patient. Therefore,
these kinds of treatment help to reduce the risk of developing congestive heart failure and
prevent the other possibilities of heart disease.

6
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
Conclusion:
Thus it can be concluded that congestive heart failure is a critical condition in individual
worsen with the time. The prime reason behind the occurrence of congestive heart failure is an
exponential decrease of the blood flow in the heart muscles. However, the first monitoring and
family-centric care provided by healthcare practitioner can prevent this critical disease. As a part
of the healthcare practitioner, heart failure specialist nurses has enormous role to support the
patient and provide quality care to the patient for curing the disease. Sometimes, nurses from the
non-cardio specialist area also provide out reached service throughout the recovery from
congestive heart failure for well being of the patient. However, Maintenance of lipid-free diet
with regular exercise has an enormous role in enhancing the quality of life. Diverse medicinal
drugs are used to cure the patient with congestive heart failure especially the beta blocker.
However, these beta blockers have side effects in elder patient with weak heart muscles.
Therefore, congestive heart failure can be prevented efficiently by enhancing lifestyle, the
cooperation of medical practitioner and certain drugs.

7
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
References:
Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I., ... &
Thomas, L. (2018). National Heart Foundation of Australia and Cardiac Society of
Australia and New Zealand: Australian clinical guidelines for the management of heart
failure 2018. The Medical Journal of Australia, 209(10), 1.Retrived from: https://doi.org/
10.1016/j.hlc.2018.06.1042.
Bartunek, J., Davison, B., Sherman, W., Povsic, T., Henry, T. D., Gersh, B., ... & Homsy, C.
(2016). Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART‐1) trial
design. European journal of heart failure, 18(2), 160-168. doi:10.1002/ejhf.434
Cadrin-Tourigny, J., Shohoudi, A., Roy, D., Talajic, M., Tadros, R., Mondésert, B., ... & Guerra,
P. G. (2017). Decreased mortality with beta-blockers in patients with heart failure and
coexisting atrial fibrillation: an AF-CHF substudy. JACC: Heart Failure, 5(2), 99-106.
Retrive from: https://doi.org/10.1016/j.jchf.2016.10.015
Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of
hospital work environments and missed nursing care is linked to heart failure
readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf, 24(4), 255-263.
Retrived from : http://dx.doi.org/10.1136/bmjqs-2014-003346
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D.
(2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical
Problems, Single Volume. Elsevier Health Sciences. Retrived from :
https://books.google.co.in/books?hl=en&lr=&id=f-
MCDQAAQBAJ&oi=fnd&pg=PP1&dq=education+provided+by+nurses+in+congestive
+heart+failure&ots=KKSBwWFkGN&sig=LmpMpAfAykixPnycswYVPKw3oy8#v=one
page&q=education%20provided%20by%20nurses%20in%20congestive%20heart
%20failure&f=false
Mancia, G., Oparil, S., Whelton, P. K., McKee, M., Dominiczak, A., Luft, F. C., ... & La Torre,
G. (2017). The technical report on sodium intake and cardiovascular disease in low-and
middle-income countries by the joint working group of the World Heart Federation, the
European Society of Hypertension and the European Public Health
Association. European heart journal, 38(10), 712-719.doi:10.1093/eurheartj/ehw549

8
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., ... & Jessup,
M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic
heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart
failure of the European Society of Cardiology (ESC). Developed with the special
contribution of the Heart Failure Association (HFA) of the ESC. European journal of
heart failure, 18(8), 891-975. Retrieve from: (http://creativecommons.org/licenses/by-nc-
nd/4.0/ ) .
Pose, A., Almenar, L., Gavira, J. J., López‐Granados, A., Blasco, T., Delgado, J., ... & Manito,
N. (2017). Benefit of tolvaptan in the management of hyponatraemia in patients with
diuretic‐refractory congestive heart failure: the SEMI‐SEC project. ESC heart
failure, 4(2), 130-137. DOI: 10.1002/ehf2.12124
Sacks, F. M., Lichtenstein, A. H., Wu, J. H., Appel, L. J., Creager, M. A., Kris-Etherton, P.
M., ... & Stone, N. J. (2017). Dietary fats and cardiovascular disease: a presidential
advisory from the American Heart Association. Circulation, 136(3), e1-e23. DOI:
10.1161/CIR.0000000000000510
Sahle, B. W., Owen, A. J., Mutowo, M. P., Krum, H., & Reid, C. M. (2016). Prevalence of heart
failure in Australia: a systematic review. BMC cardiovascular disorders, 16(1), 32. Doi:
10.1186/s12872-016-0208-4
Sliwa, K., Damasceno, A., Davison, B. A., Mayosi, B. M., Sani, M. U., Ogah, O., ... & Yonga,
G. (2016). Bi treatment with hydralazine/nitrates vs. placebo in Africans admitted with
acute HEart Failure (BA‐HEF). European journal of heart failure, 18(10), 1248-1258.
doi:10.1002/ejhf.581
Ter Maaten, J. M., Valente, M. A., Damman, K., Hillege, H. L., Navis, G., & Voors, A. A.
(2015). Diuretic response in acute heart failure—pathophysiology, evaluation, and
therapy. Nature Reviews Cardiology, 12(3), 184. Retrived from :
https://www.rug.nl/research/portal/files/32723592/Chapter_2.pdf
Tham, Y. K., Bernardo, B. C., Ooi, J. Y., Weeks, K. L., & McMullen, J. R. (2015).
Pathophysiology of cardiac hypertrophy and heart failure: signaling pathways and novel
therapeutic targets. Archives of toxicology, 89(9), 1401-1438. DOI: 10.1007/s00204-015-
1477

9
NURSING PRACTICES ON CONGESTIVE HEART FAILURE
Vedel, I., & Khanassov, V. (2015). Transitional care for patients with congestive heart failure: a
systematic review and meta-analysis. The Annals of Family Medicine, 13(6), 562-571.
Rertrived from: http://www.annfammed.org/content/13/6/562.full.pdf
What is Heart Failure. (2018). Retrieved from
http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-
Heart-Failure_UCM_002044_Article.jsp#.W3D6Es4zbIV
Yu, O. H. Y., Filion, K. B., Azoulay, L., Patenaude, V., Majdan, A., & Suissa, S. (2014).
Incretin-based drugs and the risk of congestive heart failure. Diabetes Care, DC_141459.