In congestive heart failure, the heart's weakened conditioned impairs its ability to pump blood efficiently. Over time, blood backs up in the blood vessels, creating fluid overload--congestion--in the vessels and organs. Heart failure is a chronic disease and requires lifelong management through medications and diet to control its symptoms. Many people with CHF experience occasional exacerbation severe enough to require hospitalization. Patients hospitalized with CHF can expect to be treated with diuretics and other medications, supplemental oxygen, and close monitoring of their electrolyte levels, fluid balance, heart rhythms and blood pressure.
Diuretic Medications
Most people with CHF who require hospitalization have accumulated so much excess fluid in their lungs that they have difficulty breathing. Fluid overload typically causes extreme swelling in the legs and feet as well. Physicians will prescribe diuretics, medications that trigger the kidneys to make large amounts of urine, to pull the excess fluid out of the body and relieve congestion in the lungs and elsewhere. Loop diuretics, the strongest medications in this class, are given in intravenous doses of 40 to 80 mg at intervals of four to 24 hours, depending on the severity of the patient's condition. Increasing urine output to as much as 2 liters a day may be necessary for patients with severe CHF. Monitoring the patient's weight loss indicates the effectiveness of the treatment. Some patients lose as much as 30 pounds of excess water while hospitalized. Most patients experience rapid improvement in their breathing as excess fluid is drawn out of the lungs and excreted in the urine.
Oxygen
When fluid in the lungs fills the sacs where oxygen and carbon dioxide are exchanged, not enough oxygen is absorbed and circulated in the blood, creating breathlessness. Giving patients supplemental oxygen through a face mask or nasal prongs increases the amount of oxygen available and makes breathing easier. Nurses monitor patients' oxygen levels frequently and adjust the supplemental flow rate as needed.
Other Medications
Many patients hospitalized with CHF require dose adjustments of medications they take daily, or they may need changes in their medications. Typically doctors prescribe angiotensin-converting enzyme--ACE--inhibitors or angiotensin II receptor blockers, medications that decrease the heart's workload by dilating the blood vessels and reducing blood pressure. They may also prescribe digoxin, a medication that increases the heart's ability to contract, making it a stronger pump, and beta blockers, drugs that slow the heartbeat and reduce blood pressure.
Potassium Replacement
Loop diuretics strip potassium, an important electrolyte, from the body along with water. Potassium plays an important role in controlling heart rhythms, and depleted potassium levels can cause dangerous arrhythmias. Low potassium levels are especially dangerous for patients on digoxin because digoxin can accumulate to toxic levels when blood levels of potassium are low.
Monitoring
Safe and appropriate treatment of patients with CHF requires frequent monitoring. Often patients' heart rhythms are monitored by telemetry to observe for dangerous arrhythmias. Patients are weighed daily to measure fluid loss, and daily blood tests monitor electrolytes. Frequent checks of heart rate, blood pressure and oxygen saturation monitor the effectiveness of treatment.
References
- "Medical-Surgical Nursing: Critical Thinking for Collaborative Care"; Donna D. Ignatavicius, M. Linda Workman; 2006
- MayoClinic.com: Heart Failure
- MedicineNet.com: Congestive Heart Failure
- American Heart Association: Heart Failure
