University of California
Type of paper: Thesis/Dissertation Chapter
Congestive Heart Failure In Pediatrics
Congestive Heart Failure is not a disease, but a condition in which the heart is unable to pump enough blood needed to meet the cardiac demands of the body and facilitate systemic circulation. Congestive Heart Failure can be right or left-sided, and is mainly a fluid issue, in which there is a decreased amount of blood to the kidneys. In children, CHF can be long term and is most common in infants; it can also result from heart failure where ventricle contractility is impaired after an increased workload on the heart. “For most infants diagnosed with CHF, the cause is Congenital Heart Disease”(Perry, Hockenberry, Lowdermilk, & Wilson, 2010, p. 1454). There are many signs and symptoms of CHF, and if untreated damage to the heart occurs. Labs and diagnostic tests can include: a metabolic panel, brain natriuretic peptide (BNP), CBC’s, x-ray imaging, and a fetal echocardiography for fetuses suspected of CHF. Medical treatment can be extensive, but easily implemented with preparation, attention, and care.
Congestive Heart Failure can be divided into right sided heart failure (HF) and left sided heart failure (HF). Right sided HF is also known as Cor pulmonale, and is “failure of the right side of the heart that occurs after chronic hypertension in the pulmonary arteries and right ventricles of the heart. Right sided HF occurs with left sided HF and often results in fluid backup in the abdomen, legs and feet causing swelling” (“Cor pulmonale,” 2012, p. 1). Venous high blood pressure throughout the body causes an enlarged liver and spleen, and occasionally edema. “Left sided HF is the most common form of HF and may result in fluid backup in the lungs” and “increased pressure in the left atrium and pulmonary veins” (“Heart Failure,” 2011, p. 1). The lungs become congested with blood, causing elevated pulmonary pressures and pulmonary edema”(Perry et al., 2010, p. 1453). It is not usual to see only right sided or only left sided HF in children.
Signs and symptoms of CHF include: anxiety and restlessness, clubbed fingertips, confusion, cool moist skin, cyanosis, dilated pupils, edema, fatigue, fright, pallor, petechia, and weakness; decreased BP, weak pulses, jugular vein distension, tachycardia(irregularly fast heart beats including an S3 gallop), and decreased cardiac input within the cardiovascular system; dyspnea, shortness of breath on exertion, adventitious breath sounds such as crackles and wheezing or grunting, decreased oxygen saturation, tachypnea, orthopnea, and pulmonary congestion within the respiratory system; decreased urinary output as kidneys compensate for an increase in carbon dioxide by retaining sodium and water, renal overload and potential renal failure within the genitourinary system; and decreased motility, decreased bowel sounds, lack of appetite, nausea and vomiting, and ascites within the genitointestinal system. “If the abnormalities precipitating CHF are not corrected, the heart muscle becomes damaged”(Perry et al., 2010, p. 1454). Diagnosing CHF thru testing is performed in various ways.
Blood tests for congestive heart failure checks for levels of a hormone called B-type natriuretic peptide (BNP). Large amounts of BNP could indicate CHF. Coronary catheterization, or angiogram, is used to identify the strength of ones left ventricle and the health of the heart valves using a dye that is visible under x-ray. An echocardiogram can be used to produce a video image of your heart’s size, structure and function. It can help doctors determine the percentage of blood being pumped out of the left ventricle. “Right heart catheterization is a test in which a catheter is inserted through the neck or groin and is guided into the heart to measure pressures within the chambers” (“CHF Testing,” 2011, p. 2). These various tests, or combinations of tests, helps guide health care teams in the proper treatment of CHF. Medical treatment of Congestive Heart Failure includes but is not limited to: improving the heart’s function; removal of fluid in the peritoneal and thoracic cavities; decreasing cardiac demands; increasing tissue perfusion; and treating anaphylaxis.
The primary focus is treating any underlying causes of signs and symptoms associated with CHF. Improving cardiac function may be done with oxygen administration, repositioning patients for comfort and increased vascular circulation, and medication administration including: Digoxin (Lanoxin) which increases cardiac output by increasing the strength and contractility of the heart; and ACE inhibitors, such as Captopril (Capoten) and Enalapril (Vasotec), which inhibit vasoconstriction, thus vasodilating blood vessels. Removal of fluid in the peritoneal thoracic cavities may include fluid restriction, and be completed via paracentesis or thoracentesis, or by administering diuretics such as Furosemide (Lasix) and Spironolactone (Adalactone), which decrease water concentration in the blood and in turn lower arterial blood pressure. “Diuretics are the mainstay of therapy to eliminate excess water and salt to prevent re-accumulation”(Perry et al., 2010, p. 1459).
Children are not more likely to have sodium-restricted diets because they need a higher caloric intake than adults and they may not eat as much as adults with CHF. Decreasing cardiac demands includes keeping metabolic needs low and may be done by maintaining body temperature, limiting activity, reducing the work of breathing, and treating any infections so the body can reach homeostasis. Cool cloths, clustered care, oxygen administration, sedative medications to promote relaxation, and prophylactic antibiotics may all be effective treatment methods for decreasing cardiac demands. Increasing tissue perfusion can be done with oxygen administered via nasal cannula, face mask, face tent or oxygen hood and will increase oxygenation to the heart and blood vessels and “improve myocardial function or lessen tissue oxygen demands” (Perry et al., 2010, p. 1459-60). Oxygen dilates blood vessels and increases pulmonary blood flow. Treating anaphylaxis includes: identification of allergens, detection of early and late signs of anaphylaxis, and management of anaphylaxis.
Identification of allergens is recognizing what people may be allergic to or what may trigger anaphylactic reactions. Early signs of anaphylaxis are irritability, headache, dizziness, itching, sneezing, watery eyes, and rash. Late signs of anaphylaxis are shortness of breath and wheezing, pulmonary edema, decreased cardiac output, and if untreated, death. Management of anaphylaxis includes establishing airways for patients that may need intubation; oxygen administration; antihistamine and vasopressor administration; and education of how to prevent future anaphylactic events. As a nurse caring for a patient with Congestive Heart Failure, one needs to complete thorough assessments to identify signs and symptoms of CHF, report any abnormal lab values or findings to physicians immediately, and be prepared to assist with any interventions needed to manage the condition and provide comfort and support to patients and their families.
Nurses responsibilities include but are not limited to assessing patients and the severity of their condition, forming nursing diagnoses for potential risks to patients and staff caring for patients with CHF, observing for worsening conditions, planning and implementing adequate and professional care for CHF patients and their families, correct medication calculation and administration, and evaluating the effectiveness of care for patients to ensure that conditions will improve. CHF is a condition that has affected the lives of many people. Some well-known persons include: Bill Clinton, David Letterman, Larry King, Mike Ditka, Tommy Lasorta, Dick Cheney, Phyllis Diller, Elizabeth Taylor and Victoria Gotti.
Famous people such as these often have access to better health care because of financial stability. This often times proves beneficial when treating congestive heart failure in earlier stages, and helps them extend their lifespan with less signs and symptoms. Unfortunately they also live a life that is altered by their disease and ultimately no form of financial stability will cure the condition. Congestive Heart Failure is not a disease, but a condition in which the heart is unable to pump enough blood needed to meet the cardiac demands of the body and facilitate systemic circulation. There are many signs and symptoms of CHF, and if untreated damage to the heart occurs. Medical treatment can be extensive, but easily implemented with preparation, attention and care.
Cor pulmonale. (2012). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/ PMH0001186/
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Heart Failure. (2011). Retrieved from http://www.mayoclinic.com/health/heart-failure/ds00061/dsection=causes Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2010). Maternal Child Nursing Care (4th ed.). Missouri: Mosby Elsevier.