NURSING MANAGEMENT: CHRONIC HEART FAILURE
The overall goals for the patient with HF include (1) a decrease in symptoms (e.g.,
shortness of breath, fatigue), (2) a decrease in peripheral edema, (3) an increase in
exercise tolerance, (4) compliance with the medical regimen, and (5) no complications
related to HF.
Treatment or control of underlying heart disease is key to preventing HF and episodes of
o For example, valve replacement should be planned before lung congestion
develops, and early and continued treatment of CAD and hypertension is critical.
o The use of antidysrhythmic agents or pacemakers is indicated for people with
serious dysrhythmias or conduction disturbances.
Patients with HF should be counseled to obtain vaccinations against the flu and
Preventive care should focus on slowing the progression of the disease.
o Patient teaching must include information on medications, diet, and exercise
regimens. Exercise training (e.g., cardiac rehabilitation) does improve symptoms
of chronic HF but is often underprescribed.
o Home nursing care for follow-up care and to monitor the patient’s response to
treatment may be required.
Successful HF management is dependent on the following principles: (1) HF is a
progressive disease, and treatment plans are established with quality-of-life goals; (2)
symptom management is controlled by the patient with self-management tools (e.g., daily
weights, drug regimens, diet and exercise plans); (3) salt and water must be restricted; (4)
energy must be conserved; and (5) support systems are essential to the success of the
entire treatment plan.
Important nursing responsibilities in the care of a patient with HF include (1) teaching the
patient about the physiologic changes that have occurred, (2) assisting the patient to adapt
to both the physiologic and psychologic changes, and (3) integrating the patient and the
patient’s family or support system in the overall care plan.
o Many patients with HF are at high risk for anxiety and depression, and major
depression is more prevalent in female patients and patients less than 60 years of
o Patients with HF can live productive lives with chronic HF.
o Effective home health care can prevent or limit future hospitalization. Managing
HF patients out of the hospital is a priority of care.
o Patients with HF will take medication for the rest of their lives. This can become
difficult because a patient may be asymptomatic when HF is under control.
o Patients should be taught to evaluate the action of the prescribed drugs and to
recognize the manifestations of drug toxicity.
Patients should be taught how to take their pulse rate and to know under
what circumstances drugs, especially digitalis and -adrenergic blockers, should be withheld and a health care provider consulted.
It may be appropriate to instruct patients in home BP monitoring,
especially for those HF patients with hypertension.
Patients should be taught the symptoms of hypo- and hyperkalemia if
diuretics that deplete or spare potassium are being taken. Frequently the
patient who is taking thiazide or loop diuretics is given supplemental
o The nurse, physical therapist, or occupational therapist should instruct the patient
in energy-conserving and energy-efficient behaviors after an evaluation of daily
activities has been done.
Patients may need a prescription for rest after an activity. Many hard-
driving persons need the “permission” to not feel “lazy.”
Sometimes an activity that the patient enjoys may need to be eliminated.
In such situations the patient should be helped to explore alternative
activities that cause less physical and cardiac stress.
The physical environment may require modification in situations in which
there is an increased cardiac workload demand (e.g., frequent climbing of
stairs). The nurse can help the patient identify areas where outside
assistance can be obtained.
o Home health nursing is an essential component in the care of the HF patient and
Home health nurses conduct frequent physical assessments, including vital
signs and weight.
Protocols enable the nurse and patient to identify problems, such as
evidence of worsening HF, and institute interventions to prevent
hospitalization. This may include altering medications and initiating fluid