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HEART FAILURE: CHRONIC Failure of the left and/or right chambers of the heart results in insufficient output to meet tissue needs and causes pulmonary and systemic vascular congestion. This disease condition is termed heart failure (HF). Despite diagnostic and therapeutic advances, HF continues to be associated with high morbidity and mortality. (Agency for Health Care Policy and Research [AHCPR] guidelines [6/94] promote the term heart failure [HF] in place of congestive heart failure [CHF] because many patients with heart failure do not manifest pulmonary or systemic congestion.) The New York Heart Association functional classification system for HF includes classes I to IV. Common causes of HF include ventricular dysfunction, cardiomyopathies, hypertension, coronary artery disease, valvular disease, and dysrhythmias. CARE SETTING Although generally managed at the community level, inpatient stay may be required for periodic exacerbation of failure/development of complications. RELATED CONCERNS Myocardial infarction Hypertension Cardiac surgery Dysrhythmias Psychosocial aspects of care Patient Assessment Database ACTIVITY/REST May report: Fatigue/exhaustion progressing throughout the day; exercise intolerance Insomnia Chest pain/pressure with activity Dyspnea at rest or with exertion May exhibit: Restlessness, mental status changes, e.g., anxiety and lethargy Vital sign changes with activity CIRCULATION May report: History of hypertension, recent/acute multiple MIs, previous episodes of HF, valvular heart disease, cardiac surgery, endocarditis, systemic lupus erythematosus (SLE), anemia, septic shock Swelling of feet, legs, abdomen, “belt too tight” (right-sided heart failure) May exhibit: BP may be low (pump failure), normal (mild or chronic HF), or high (fluid overload/ increased SVR) Pulse pressure may be narrow, reflecting reduced stroke volume Tachycardia (may be left- or right-sided heart failure) Dysrhythmias, e.g., atrial fibrillation, premature ventricular contractions/tachycardia, heart blocks Apical pulse: PMI may be diffuse and displaced inferiorly to the left Heart sounds: S 3 (gallop) is diagnostic of congestive failure; S 4 may occur; S 1 and S 2 may be softened Systolic and diastolic murmurs may indicate the presence of valvular stenosis or insufficiency, both atrial and ventricular. Pulses: Peripheral pulses diminished; central pulses may be bounding, e.g., visible jugular, carotid, abdominal pulsations; alteration in strength of beat may be noted Color ashen, pale, dusky, or even cyanotic Nailbeds pale or cyanotic, with slow capillary refill Liver may be enlarged/palpable, positive hepatojugular reflex Breath sounds: Crackles, rhonchi Edema may be dependent, generalized, or pitting, especially in extremities; JVD may be present EGO INTEGRITY
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May report: Anxiety, apprehension, fear Stress related to illness/financial concerns (job/cost of medical care) May exhibit: Various behavioral manifestations, e.g., anxiety, anger, fear, irritability
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