Perpetual Help College of Manila

1240 V. Concepcion St., Sampaloc, Manila

A Case Study
On

Congestive Heart Failure

Presented to:

Ms. Rosemalyn Ronquilllo, R.N

Clinical instructor

In Partial Fulfillment of the Requirements

In
Related Learning Experience
(RLE)

By:

De Leon, Jenny
De Leon, Kenneth
David, Jessica
Del Pilar, Czarina Aika F.
Esteleydes, Eunice Kristia A.
Ferrer, Julius U.
Gagan, Bernard S.
Gan, Kenneth
Gapasin, Jenny Lee
Geli, Paula
Learning Objectives:

 Define, understand and improve our knowledge and understanding with regards

to the causes, signs and symptoms and nursing implications for Congestive

Heart Failure

 Review the anatomy and physiology of the affected organ and system and

explain the pathophysiology of the disease.

 Study the patient’s history of past and present illness.

 Classify the ordered drugs and associate its action and effects to the patient.

 Conduct physical assessment and formulate Nursing care plan for the patient

and evaluate the client’s condition from the time of the admission up to

discharge.
Description of Case

Congestive Heart failure is the inability of the heart to pump sufficient blood to
meet the needs of tissues of oxygen and nutrients. It is a clinical syndrome
characterized by signs and symptoms of fluid overload or inadequate tissue perfusion. It
is a progressive chronic condition and can be one sided or both sided failure

Clinical Manifestation

 Symptoms of inadequate tissue perfusion

 Diminished cardiac output with accompanying dizziness, confusion, fatigue,
exercise or heat intolerance, cool extremities and oliguria
 Congestion of tissues
 Increased pulmonary venous pressure (pulmonary edema) manifested by cough
or shortness of breath
 Dysrhythmia may indicate heart failure or may be noted as a result of the
treatment for heart failure
 Increased systemic venous pressure, as evidenced by generalized peripheral
edema and weight gain

Etiology

Modifiable Factors

 Ischemic heart disease 

 Cigarette smoking
 Hypertension (high blood pressure)
 Obesity 
 Diabetes 
 Valvular heart disease 
Non Modifiable Factor

 Gender
 Age

LEFT SIDED HEART FAILURE

The left side of the heart receives blood rich in oxygen from the lungs and pumps
it to the remainder of the body. As the ability to pump blood forward from the left side of
the heart is decreased, the remainder of the body does not receive enough oxygen
especially when exercising. This results in fatigue.

In addition, the pressure in the veins of the lung increases, which may cause fluid
accumulation in the lung. This results in shortness of breath and pulmonary edema.

Clinical Manifestation

 Dyspnea (breathing difficulty)

 Orthopnea – difficulty in breathing at rest or when lying flat in bed (supine
position causes the fluid to back up in the lung)
 Cough or whezzing
 Crackles can be heart in the lungs
 Paroxysmal Nocturnal Dyspnea – waking up at night short of breath.
 Cerebral hypoxia – result of decreased cardiac output causes:
 Anxiety
 Wheezing
 Dizziness
 Syncope
 Fatigue
  Weakness
 Anorexia
 Hypokalemia
 Increase level of aldosterone
 Clubbing of the fingers
 Polycythemia
 S3, S4 heart sound, Pulsus Alterans
 Confusion
 Insomnia (difficult to sleep)
 Nocturia – pass urine at night
 Oliguria (less urine output ↓ 500 mls) – late manifestation

Common causes of left-sided failure include the following:

 Drinking too much alcohol

 Heart attack
 Heart muscle infections
 High blood pressure
 Hypothyroidism
 Leaking or narrow heart valves
 Any other disease that damages the heart muscle
 Poor left-side heart function due to prior heart attacks

RIGHT SIDED HEART FAILURE

Right-sided heart failure, the right ventricle loses its pumping function, and blood
may back up into other areas of the body, producing congestion. Congestion affects the
liver, the gastrointestinal tract, and the limbs. In addition, the right ventricle may be
unable to pump blood efficiently to the lungs and to the left ventricle.

Clinical manifestation

 Congestion of the viscera and peripheral tissue

 Edema of lower extremities (dependent edema), usually pitting edema, weight
gain, hepatomegaly
 Distended neck veins (jugular vein distention), ascites, anorexia, and nausea
 Nocturia and weakness

Causes

 Left-sided heart failure and lung diseases such as chronic bronchitis and

emphysema.
 Other causes include congenital heart disease, clots in pulmonary
arteries, pulmonary hypertension, and heart valve disease.

-(Medical Surgical Nursing, Brunner And Suddarths 11th Edition)