Congesti

ve Heart
Failure
SHEMAIA ROUDEMA
ZEPHYRIN

Manifestations
Right side of the heart
Moves unoxygenated blood to the
pulmonary circulation
Failure? Backup of blood in the systemic
venous system.

Cont.
Left sided heart failure
Moves oxygenated blood from the
pulmonary to the systemic
circulation.
Failure? Backup into the lung.
Although HF may start as a rightor left-sided failure, eventually
both sides will be involved.

Signs & Symptoms

Early S & S of CHF (in
infants):
Tachycardia at rest
Fatigue during feeding
Sweating around scalp and
forehead

Cyanosis
Rapid resp.
Rapid pulse
Feeding difficulties
Poor weight gain

Dyspnea

Edema

Sudden weight gain

Frequent respiratory tract

infections

Cyanosis
Generalized or localized
Localized? Exact location is recorded (ex.
Hands, feet, lips or around mouth.)
Is it (deep? light? constant? or transient?)
AA infant? Look for cyanosis in (hands and
bottoms of feet)
Pooling blood in the capillaries of the
extremities in children with chronic
hypoxia can cause clubbing of fingers and
toes.

Rapid Respiration (a.k.a

Tachypnea)
Rate more than 60 breaths/min in newborn @ rest =
DISTRESS
Amount of dyspnea + SOB varies
Acute phase: dyspnea accompanied by flaring of
nostrils, mouth breathing, grunting, sternal retractions.
More trouble breathing when
flat in bed.
Air hunger (child
irritable and restless)
Cry
weak and hoarse.

Rapid Pulse (a.k.a Tachycardia)

One of first signs of CHF
The heart is pumping harder to increase its output in the body.
Cardiac output can be increased by: tachycardia or increased
stroke volume (amount of blood ejected during one contraction)
Infants + small children have limited ability to increase stroke
volume = increased HR to meet normal demand

Feeding difficulties + Poor weight

gain
When infants fed, theyre tired
easily and may stop sucking
after few ounces.
When placed in in crib, they
cry and appear hungry.
During feedings, they may
choke and gag. Pleasure of
sucking is spoiled by inability
to breathe.

Failure to gain weight

Sudden weight gain? May
indicate edema and beginning
of heart failure

Edema + Frequent Resp. Tract

infection
Blood flow to kidneys decreased
Glomerular filtration slows (because of retained sodium
and fluid)
Watch for puffiness about the eyes, legs, feet, +
abdomen.
Urine output
may
decrease.
Resistance
very
low
Slight infections = highly dangerous b/c heart and lungs already
compromised
Immunizations reviewed + updated as needed.
Nurse prevents exposure to other children who have upper resp.
tract infections or other illnesses.

Treatment & Nursing Care

Nursing goals:

Complete bath and linen change = NOT PRIORI

Reduce work on heart

Fed early (if crying) Late (if asleep)

Improve respiration

Physician orders position infant is placed:

Maintain proper nutrition

Knee-chest position or Fowlers position =

facilitates breathing

Prevent infection
Reduce anxiety of patient
Support and instruct
parents

Feedings small and frequent

Soft nipple with large hole to prevent tiring infa

Formulas w/ increased caloric density used

Cont.
Nasogastric tube feedings less tiring for child
O2 administered to prevent dyspnea
Breathing easier? Infant begins to relax
Hold & comfort infant during feedings
Digitoxin + Digoxin (common digitalis preps.)
They slow and strengthen the heartbeat
Infant pulse rate or child below 100 beats/min = med withheld +
physician notified
Older children pulse rate should be more than 70 beats/min

 Patient vomits? Report to physician

Tachycardia + irregularities in the rhythm of pulse significant and should
be reported
S/S of toxicity : nausea, vomiting, anorexia, irregularity in rate + rhythm of
pulse and change in pulse.
Infant discharged while taking meds? Parent taught (how to take pulse +
what signs to be alert for when administering drugs)
Observe signs of hypotension
Diuretics useful for edema
Monitor for electrolyte imbalance

 Daily weighing of the infant helps physician to

determine effectiveness of diuresis.

Diet = w/adequate
fluids, iron-rich foods.

Pneumonia can occur rapidly. (Indications: Fever,

irritability, increase in resp. distress)

Dental care should be

regular.

To prevent hypostatic pneumonia = position

change

Special arrangements
for school necessary.
Child needs careful
arrangements before
any type of minor sx.

Nurse should be competent in CPR

Parents needs support and understanding (b/c
heart is a MAJOR vital organ + fear)
Routine naps + early bedtimes = provide adequate
rest for children