Heart failure affects approximately five million Americans and causes over one million hospitalizations annually, according to Debra Moser, DNSc and lead author of a 2008 article addressing decompensated heart failure published by the Postgraduate Institute for Medicine. End-of-life congestive heart failure symptoms require supportive treatment to provide the dying patient with some measure of relief and a decent quality of life during the patient's final days.
Trouble Breathing
End-of-life congestive heart failure causes a back-up of fluid in the cardiovascular system and lungs. Patients experience extreme shortness of breath, called dyspnea, and a productive cough. Patients frequently cough up frothy white or pink-tinged sputum. The symptoms of shortness of breath are constant even at rest and with oxygen therapy.
Anxiety
Donna D. Ignatavicius, MS RN, and M. Linda Workman, Ph.D., authors of the 2006 edition of "Medical-Surgical Nursing: Critical Thinking for Collaborative Care" explain how the symptom of constant air hunger causes anxiety in end-of-life congestive heart failure patients. Some patients cannot tolerate the application of a high-flow oxygen mask, which makes controlling the dyspnea difficult. Patients often need medication for anxiety in order for medical therapy to be effective.
Depression
The debilitating effects of dyspnea create depression in congestive heart failure patients. Physicians prescribe antidepressants to help alleviate depression and to give patients a better quality of life.
Skin Ulcers
Swelling from fluid retention combined with poor peripheral circulation leads to skin breakdown. The skin on the lower extremities becomes tight from swelling; it is shiny and breaks open easily. Fluid weeps through the skin, and ulcers form, which take a long time to heal, if at all. Skin breakdown is a source of infection for end-stage congestive heart failure patients.
Abdominal Distention
Fluid overload throughout the cardiovascular system causes fluid to build up in the abdomen. End-stage congestive heart failure patients experience abdominal pain, loss of appetite and constipation. Abdominal distention aggravates breathing problems because the pressure in the belly interferes with the normal movement of the diaphragm during breathing.
Trouble Sleeping
Patients with end-of-life congestive heart failure cannot sleep due to shortness of breath, cough, abdominal distention, pain and anxiety. Patients remain in a sitting or semi-reclining position. An armchair in front of a table with pillows onto which the patient can lean forward, or a recliner, may become a patient's bed. Although these two methods are necessary for ease of breathing, comfort and rest are diminished.
Confusion
Low oxygen perfusion affects the brain. Patients with end-stage congestive heart failure may experience confusion and behavior changes due to low blood oxygen levels. Even with oxygen therapy, the ability of the lungs to exchange oxygen is impaired, so a patient's symptoms do not necessarily improve.
References
- "Nurses Meeting the Clinical Challenge of Fluid Overload in Acute Decompensated Heart Failure"; Debra K. Moser, et al; 2008
- "Medical-Surgical Nursing-Critical Thinking for Collaborative Care"; Donna D. Ignatavicius & M. Linda Workman; 2006
- The MayoClinic.org: Heart Failure
