Congestive Heart Failure (CHF)

Definition

Congestive Heart Failure (CHF), now often called Heart Failure (HF), is the inability of the heart to pump sufficient blood to meet the body's metabolic demands. It results in fluid congestion, decreased perfusion, and activation of neurohormonal compensation.

Types

• Left-sided HF: Pulmonary congestion, such as dyspnea, orthopnea, crackles, frothy pink sputum, fatigue.
• Right-sided HF: Systemic congestion, such as peripheral edema, JVD, hepatomegaly, ascites, weight gain.
• HFrEF: Reduced ejection fraction (≤ 40%).
• HFpEF: Preserved ejection fraction (≥ 50%).

Diagnostics

BNP > 100 pg/mL; echocardiogram for ejection fraction; chest x-ray for pulmonary congestion and cardiomegaly; ECG.

Nursing Interventions

Position high-Fowler's, administer oxygen, daily weights (gain > 2 lb/day or > 5 lb/week reportable), restrict sodium (2 g/day) and fluids, monitor I&O, administer diuretics, ACE inhibitors/ARBs, beta-blockers, SGLT2 inhibitors per guidelines. Teach patients to recognize and report weight gain, dyspnea, swelling, or decreased urine output.

NCLEX Relevance

Differentiating left- vs right-sided symptoms is high-yield. Daily weight is the most accurate fluid measure.