Congestive heart failure is a serious problem for many individuals in this country. Primarily, it affects older Americans but it is possible for younger individuals to be affected by this condition as well. When individuals have congestive heart failure the heart continues to work and does not actually fail but instead it has difficulty pumping enough blood to keep the body supplied with what it needs. Individuals that suffer from congestive heart failure are able to perform many normal activities but they cannot do anything that is strenuous or taxing on the body because they will become overly tired and short of breath quite easily. There are several conditions that can result in congestive heart failure and these include cardiomyopathy, congenital heart defects, an infection of the heart muscle or any of the heart valves, high blood pressure, a past heart attack, diseases of the heart valves, and coronary artery disease, or a narrowing of the arteries.

Disease Condition

In congestive heart failure the blood flow that normally comes from the heart is slowed down and therefore the blood that is coming through the veins and returning to the heart often backs up. This can cause swelling of various tissues. In general the swelling is usually seen in the legs and feet but any part of the body can swell due to the congestion in the tissues that this fluid buildup causes (Congestive, 2005). One of the main places that fluid can backup and cause a serious problem is in the lungs (Congestive, 2005). When this happens the individual with this condition usually experiences difficulty in breathing and this is especially seen when the individual is lying down (Congestive, 2005). In addition to this backing up of blood and swelling of tissues, having congestive heart failure also affects the kidneys. They are not able to dispose as easily of the water and sodium that they would normally get rid of and the retaining of the water in the body increases the swelling (Congestive, 2005).

In addition to the causes that were listed above in the introduction, there are also other risk factors for congestive heart failure. These include both lifestyle factors and medical conditions, as well as other things. If an individual has a risk factor for congestive heart failure, the likelihood of getting that disease or condition is increased. However, it is possible to develop congestive heart failure even without the risk factors, and possible that congestive heart failure will not occur in some people that do have the risk factors. However, the likelihood of developing congestive heart failure goes up with the number of risk factors an individual has, so they are important and significant.

From the standpoint of medical conditions the following are risk factors for developing congestive heart failure: coronary artery disease, previous history of heart disease, obesity, high blood pressure, diabetes, severe emphysema, and hyperthyroidism (Badash, 2003). The lifestyle factors that increase an individual's risk of developing congestive heart failure include smoking, the excessive consumption of alcohol, and using anabolic steroids on a long-term basis (Badash, 2003). Men have a slightly higher risk of developing congestive heart failure than women do and congestive heart failure is seen to be most common in individuals that are age 65 or older (Badash, 2003). This does not mean that younger women cannot get congestive heart failure, only that it is not as common.


Diagnosing congestive heart failure is something that a doctor must do. Having swollen ankles and legs and/or difficulty breathing is a possible sign or symptom of congestive heart failure but these problems can be caused by other things as well (Congestive, 2005). Another symptom that should be looked for is a gain in weight when the fluid in the body builds up (Congestive, 2005).

There are many different instruments and other medical tactics used to diagnose congestive heart failure. Obtaining a complete and thorough clinical history for the patient is the first step towards this diagnosis (Shamsham & Mitchell, 2000). Once this has been completed, the patient is usually placed in a classification based on how severe their suspected congestive heart failure is and what they can and cannot do on a normal basis (Shamsham & Mitchell, 2000). A complete physical is also performed (Shamsham & Mitchell, 2000). Being able to diagnose congestive heart failure in someone who is elderly is sometimes difficult because anorexia, anxiety, and other seemingly odd problems that are considered to be atypical of congestive heart failure are the things that are seen most often in this age group (Shamsham & Mitchell, 2000).

Diagnostic testing for congestive heart failure includes an electrocardiogram, chest radiography, an angiogram, and echocardiogram, and other techniques such as magnetic resonance imaging (Shamsham & Mitchell, 2000). Looking at the differences that are seen between the systolic and diastolic function of the patient's heart can also be indicative of congestive heart failure (Shamsham & Mitchell, 2000). All of these tests will help the physician get a good look at the functioning of the patient's heart and these tests can be taken together with the signs and symptoms that may be seen in order to make a definitive diagnosis.


Treating congestive heart failure requires a specific program and there are several things that must be done. Usually the treatment program includes rest, modified daily activities, proper diet, and drugs such as digitalis, diuretics, beta-blockers, ACE inhibitors, or vasodilators (Congestive, 2005). There are various different drugs that are utilized in the treatment of congestive heart failure and all perform different functions. Vasodilators and ACE inhibitors work to expand the blood vessels and therefore decrease the resistance seen that causes the blood to back up (Congestive, 2005). When this happens the blood is more easily able to flow through the veins and arteries of the body and therefore the work that the heart has to do is easier and also more efficient. Beta-blockers are designed to help improve the left ventricle of the heart and its pumping ability (Congestive, 2005). Diuretics work to eliminate excess water and salt from the body and help the kidneys deal with this problem, while digitalis helps the heart to pump more strongly (Congestive, 2005).

If a specific causes is seen for congestive heart failure in an individual it should definitely be treated. If possible it should also be corrected. There are some individuals that have congestive heart failure due to very high blood pressure and often when the high blood pressure comes down the congestive heart failure will fail to be an issue any longer (Congestive, 2005). Sometimes abnormal heart valves can also cause congestive heart failure and these valves can often be surgically repaired or replaced (Congestive, 2005). Occasionally, an individual with congestive heart failure will have a heart that is so badly damaged that there is no possible and realistic way to repair it or treat it properly with medications (Congestive, 2005).

This is when a heart transplant could be an option for these individuals and a more drastic approach should be considered. However, most congestive heart failure is moderate or mild and these individuals can be treated easily as long as they follow their doctor's guidelines (Congestive, 2005). Being supervised properly from a medical standpoint can help them from becoming invalids in the future (Congestive, 2005).

Nursing Care

When nurses and others become involved with the care of individuals that have congestive heart failure, the outcome for the patient is often much better (Plowfield, 2004). This is because many things that these individuals do not understand about their condition can be solved by nurses and of others that take care of them. There are many areas of concern that individuals with congestive heart failure deal with, however, and some of these nursing concerns are more significant than others. The three most important ones discussed here will be activity, lack of knowledge, and pain management.

Where lack of knowledge is concerned it can be very significant for those that have congestive heart failure because many of them do not understand everything they need to know about some of their medications and other issues that they must deal with. Plowfield (2004) reports a case where one congestive heart failure patient was having hallucinations and nightmares and was very concerned about this. Upon further investigation the nursing student that was paired with the nurse taking care of this particular individual discovered that two of the medications that were prescribed were not being taken by the patient.

The patient had decided that he did not need these medications and had therefore simply stopped taking them. If the individual would have been informed that suddenly stopping these types of medications could cause nightmares and other withdrawal symptoms he might have avoided the sudden stoppage of his medication. Nurses must ensure that patients understand everything that they need to know about their medications. Some patients might be annoyed with this because they may feel as though they are being given redundant information or are being talked…