have a question re: CHF

[Rena RN 2003, RN]

we are given a study guide to help with our final exam. i have every single answer except for a question that deals with CHF.

which is an early sign of CHF that the nurse should recognize?

a. tachypnea

b. bradycardia

c. inability to sweat

d. increased urine output

now from what i have from the textbook, i know that pulmonary congestion, anxiousness, restlessness, dyspnea @ rest, orthopnea, and a dry hacking cough (progresses to frothy) are signs of CHF (left sided failure). i also know that dependent edema, hepatomegaly, nausea, anorexia, generalized weakness, and nocturia are signs of CHF (right sided failure).

and i know that as a nurse, i should promote rest with a quiet environment, increase the force and efficiency of heart contractions (with drugs), and eliminate excess fluid accumulation (lasix).

so please don't think i haven't looked for the information to my original question. i've looked. several times in fact. and i see absolutely nothing about tachypnea or bradycardia. and i honestly don't think C or D is the correct answer.

can someone help me please

[maureeno]

if a heart cannot keep up with demand, respirations will increase.

one of my children breathed 100X/minute before his [thank God] successful heart surgery.

[RN always, BSN, RN]

I looked it up in one of my patho books. It says that tachypnea is a later sign. The early signs it lists are extertional, paroxysmal, and nocturnal dyspnea

fatigue

neck vein engorgement

hepatomegaly

maybe some of the ICU/CCU nurses might have a better understanding of this.

[KaroSnowQueen, RN]

Increased NORCTURNAL urine output is a sign, didn't know this until hubby was diagnosed and treated, and his 15 times a night trips to the potty stopped.

[Rena RN 2003, RN]

*ding ding ding*

maureen wins the prize. emailed the instructor. she says tachypnea is an early sign. don't know where she got the information from but since she's making up the exam, i'll go with her answer :chuckle

thanks for looking it up for me RN always :) i appreicate it. :) and thanks to everyone else for the replies. :)

[maureeno]

difficulty breathing and rapid breathing are often co-existant.

I learned this the hard way with my son 19 years ago. last night, after answering your question, I was taken back to that horrible night when my 4 month old child was in crisis with RSV. With his heart defects, consequent FTT [failure to thrive] the respiratory bug nearly killed him. Watching that infant struggle to breath, his respirations were pants, his neck and chest muscles heaving, changed me forever.

[RNsweetie]

Maureen Thanks for sharing your experiance. That must have been an awful time in your life. Those memories will stay with you forever. Life changing...... Glad to hear everything went well, must have been a long road.

Good luck to you Rene. Sounds like your on your way.

[Rena RN 2003, RN]

oh maureen! i'm so sorry my question brought back those painful memories for you!