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!

[Jenni811, RN]

Correct me if i'm wrong anybody. but left sided heart failure can occur from right sided OR right sided can occur from left sided... I can't remember which way it goes...but either way, its not uncommon to have both.

So basically what im saying is, yes you need to be carefull with that kind of stuff but Diuretics would be the first route to go if patient is retaining fluid.

Look at patient's weight (if they have CHF they should be on daily weights). Any significant weight gain should be reported.

The weight gain varies from one place to another but basically i think its 5lbs in 1 week or 2 lbs in 24 hours.

[Southern Fried RN]

Correct me if i'm wrong anybody. but left sided heart failure can occur from right sided OR right sided can occur from left sided... I can't remember which way it goes...but either way, its not uncommon to have both.

So basically what im saying is, yes you need to be carefull with that kind of stuff but Diuretics would be the first route to go if patient is retaining fluid.

Look at patient's weight (if they have CHF they should be on daily weights). Any significant weight gain should be reported.

The weight gain varies from one place to another but basically i think its 5lbs in 1 week or 2 lbs in 24 hours.

Severe left side heart failure eventually results in right side failure. The patient who starts with tachypnea, crackles, cough will have that before developing JVD and peripheral edema.

Purely right side failure (cor pulmonae) is not nearly as common and results from disease in the pulmonary vasculature/lungs.

Left side is much more common however many patients have features of both.

The other thing to consider is whether this patient is edematous from hypoalbuminemia from something like liver disease.

[Jenni811, RN]

Thanks :-) i knew one was caused by the other. Forgot which way it went!

but yea...crackles, dyspnea, SOB

[akulahawkRN, ADN, RN, EMT-P]

Something that should really be remembered is that right side heart failure can lead to left side heart failure and left-sided heart failure can lead to right-sided heart failure. The speed at which the "other side" of the heart will fail depends on which side was affected first. If the left side of the heart failed first than the right side will fail early quickly afterward. If the right side of the heart failed first than the left side will also fail eventually, but the failure will happen much more slowly simply because the left side is typically much stronger to begin with.

So the legs begin to swell, you can put the legs up but you're going to have to ask the patient about how well they are breathing and you're going to want to listen to the lungs. If you begin hearing sounds in the lungs that are anything but clear, or the patient starts reporting any sort of shortness of breath, that is a sign that something else is going wrong. And if you think about the particular circuits that each side of the heart supplies, when one side of that the heart fails, you can pretty much begin to understand where you're going to see your first signs and symptoms.

[CapeCodMermaid, RN]

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.

140 residents???? By yourself??? This can't be a skilled facility.