Question about CHF

[Ginger80]

Hi, I'm an LPN working in LTC, and a resident of mine has CHF. Her legs have been swelling, and so the nurse on the shift before me raises the foot of the bed to elevate her legs. When I came onto shift, my supervisor told me to lower her legs, because since she has CHF, the fluids could accumulate in her lungs, and so it was better to have the edematous legs.

When I asked another nurse about this, she did not know what the right thing to do was, she just said "I would keep the legs elevated".

Help!

[Southern Fried RN]

Maybe someone should call the physician or nurse practitioner for additional Lasix (or whatever diuretic). Seriously, if the patient's legs are swelling more lately that probably needs to be addressed. Fluid might already be in the lungs, how is the patient breathing?

[roser13, ASN, RN]

I think that we cannot give advice on how to care for your patients. Please call the patient's MD with any concerns.

[VivaLasViejas, ASN, RN]

Elevate the HOB and the feet if the resident is wheezing/coughing/dyspneic. Check an SaO2 and put on some O's if necessary, and then call the PCP for additional orders.......I've seen people go into CHF and decompensate very quickly, so if she's deteriorating she needs to be seen ASAP, whether it's her doctor or the ER. DON'T WAIT.

[tiroka03, LPN]

I believe breathing is more critical here. I would call the MD and see about antidiretics. Depending on how edematous the legs were, I would make a decision on that. Usually TED hose or ace wraps can be ordered as well, so the pt doesn't get into this situation again.

[rkitty198, BSN, RN]

Diuretics and not antidiuretics definitely.

I had a patient go into an acute exacerbation of CHF and it was very scary. Usually when there is swelling in the extremities they are on some form of lasix or aldactone, unless contraindicated.

I would do as the others say and call the MD. I don't think elevating someone's legs is a big deal.

[whatwasithinkinglol]

I would notify the MD. Checking her weight and vitals is helpful too.

Although I'm a student LPN, my mother just had a major CHF episode a month ago and almost had to be intubated due to congestion (that started with 3+ edema). It happens fast, don't wait.

[Jenni811, RN]

if your patient legs are edematous he/she has right sided heart failure. The only way the fluid would back up into the lungs and cause pulmonary edema is if the patient also had left sided heart failure. (Think about pathology of the heart and the blood flow through the heart and what happens when the right side vs. the left side isnt pumping effectivley.).

So...if the patient does NOT have left sided heart failure, i'd raise the legs up. If patient does, and legs are more edematous than normal, then i'd call physician.

[neuroms]

Jenni hit it on the head; your scenario depends on the sidedness and degree of CHF to an extent. A venous insufficiency should be addressed with a diuretic and elevating the feet or, better yet, SCD's to restore appropriate peripheral venous return. Any emergent atelectasis should be addressed with more aggressive diuretic therapy per the PCP.

[nursej22, MSN, RN]

We teach all CHF patients to weigh themselves daily and to call their MD if they gain more than 3 pounds in 1 day or 5 pounds in a week. The doc will usually have them take additional lasix or come into the office.

Also they should be on a low salt diet (2-3) grams and limit fluids to 2 liters a day.

As pp stated, there are several reasons for lower extremity edema and treatment should be directed at that.

Edema increases risk of skin breakdown, so be sure to change postions!

[telenurse212]

to answer your question, YES, elevate the edematous legs because the fluids will just continue to accumulate in the pt's lower extremities. It's a temporary measure, you want to treat the cause which is the fluid building up. The patient already has fluids building up and i don't think fluids from his/her lower extremity will make a difference, if anything it will help with the edema. Don't ignore the swelling, weight gain of 2lb over night or 5 lbs in a week is very significant and should be reported to the doctor because the symptoms will progress if the patient doesn't get treated with diuretic therapy, diet management, etc.

[Ginger80]

Thank you all for your replies. I will have to check if this resident has left-sided CHF too. (I don't know the answer because I care for 140+ residents on my shift, which is 2300-0700). This resident is in her 90s, and at this point is a "Comfort measures only", but not palliative. I will dig into this more.