Congestive Heart Failure (CHF)

A. Description

    1. Congestive Heart Failure or CHF is a severe circulatory congestion due to decreased myocardial contractility, which results in the heart’s inability to pump sufficient blood to meet the body’s needs.

    2. About 80% of CHF cases occur before 1 year of age

    B. Etiology

      1. The primary cause of CHF in the first 3 years of life is CHD.

      2. Other causes in children include:

      a. Other myocardial disorders, such as cardiomyopathies, arrhythmias, and hypertension

      b. Pulmonary embolism or chronic lung disease

      c. Severe hemorrhage or anemia

      d. Adverse effects of anesthesia or surgery

      e. Adverse effects of transfusions or infusions

      f. Increased body demands resulting from conditions such as fever, infection and arteriovenous fistula

      g. Adverse effects of drugs, such as doxorubicin

      h. Severe physical or emotional stress

      i. Excessive sodium intake

      3. In general, causes can be classified according to the following:

      a. Volume overload may cause the right ventricle to hypertrophy to compensate for added volume.

      b. Pressure overload usually results from an obstructive lesion, such as COA

      c. Decrease contractility can result from problems such as sever anemia, asphyxia, heart block and acidemia.

      d. High cardiac output demands occur when the body’s need for oxygen exceeds the heart’s output s seen in sepsis and hyperthyroidism.

      C. Pathophysiology

      D. Assessment Findings

        1. Clinical manifestations

        a. It is clinically difficult to differentiate right from left ventricular failure. Failure of one chamber causes reciprocal changes in the opposite chamber.

        b. Weakness and fatigue

        c. Poor feeding, resulting in weight loss

        d. Developmental delays

        e. Irritability

        f. Pallor and Cyanosis

        g. Dyspnea, tachypnea, orthopnea, wheezing, cough, weak cry, grunting, mild cyanosis and coastal retractions

        h. Tachycardia and gallop rhythm

        i. Hepatomegaly

        j. Weight gain from edema, ascites and pleural effusion

        k. Distended neck and peripheral veins.

        l. Sweating

        2. Laboratory and diagnostic study findings

        a. Chest radiography reveals cardiomegaly and pulmonary congestion

        b. CBC reveals dilution hyponatremia, hypochloremia, and hyperkalemia

        c. ECG reveals ventricular hypertrophy

        E. Nursing Management

          1. Monitor for signs of respiratory distress

          a. Provide pulmonary hygiene as needed

          b. Administer oxygen as prescribed

          c. Keep the head of the bed elevated

          d. Monitor ABG values.

          2. Monitor for signs of altered cardiac output, including

          a. Pulmonary edema

          b. Arrhythmias, including extreme tachycardia and bradycardia

          c. Characteristic ECG and heart sound changes

          3. Evaluate fluid status

          a. Maintain strict fluid intake and output measurements

          b. Monitor daily weights

          c. Assess for edema and severe diaphoresis

          d. Monitor electrolyte values and hematocrit level

          e. Maintain strict fluid restrictions as prescribed

          4. Administer prescribed medications which may include:

          a. Antiarrhythmias to increase cardiac performance

          b. Diuretics, to reduce venous and systemic congestion

          c. Iron and folic acid supplements to improve nutritional status.

          5. Prevent Infection

          6. Reduce cardiac demands

          a. Keep the child warm

          b. Schedule nursing interventions to allow for rest

          c. Do not allow an infant to feed for more than 45 minutes at a time

          d. Provide gavage feedings if the infant becomes fatigued before ingesting an adequate amount

          7. Promote adequate nutrition. Maintain a high-calorie, low-sodium as prescribed.

          8. Promote optimal growth and development

          9. As appropriate, refer the family to a community health nurse for follow up care after discharge.

          Nursing Care plan – Congestive Heart Failure


          Lippincott’s Review Series – Pediatric Nursing

          Daisy Jane Antipuesto RN MN

          Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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