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Discussion

Questions about CHF

A pt has a history of HTN and was on HTCs (but d/c). Legs were already edemas but show no increase in size. No SOB, no abdominal distention, No fatigue, no wheezing/crackles, and all vital signs are stable. PT does not verbalize any pain or discomfort according to my assessment, however family is concerned it might be CHF (but pt hx indicates no CHF incidence)

This was a scenario discussed at my work place and there were many opinions/experience that pointed that is CHF and many that say it wasn't. It became a heated discussion haha

i would look for edema in the lower extremities and if pt has SOB to conclude that is it CHF, but without the SOB would you guys consider it to be CHF or if the pt has to be put back on HTC?

What do you guys think? I would like your guys' input =)

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    • Featured Replies

    What does HTC stand for? Did you mean HCTZ?

    Diagnostic tests like a CXR, BNP and ejection fraction would help clarify if this was CHF.

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    What was the Echo result? BNP? SOB may be a later sign of uncontrolled CHF. Leg edema may or may not be CHF.

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    • Author

    Oops I meant Htcz :)

    this particular resident that was discussed was independent, I have not personally attended to her as I'm only caring for the frail residents. I guess the question was whether what to do in this situations. Do well call 911?call the MD and make a note to see the resident later on and order for Cxr, bnp or echo? ( my coworker who brought up the discussion never told us the end of the story) it just sparked tension bt coworkers of what to do next(what had to be done next).

    What do you think? I believe this situation was very tricky to conclude Chf as the signs/symptoms of chf weren't all present.

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    • Experts

    and it's HCTZ Hydrochlorothiazide...not htcz

    What is the family concerned about? Is the patient SOB? Is she alert enough to tell her family she is OK? Is she on daily weights? Edema isn't the end all be all determination if the patient is in CHF If she is in distress...call 911. I fshe is not then tell the family to call the MD OR call the PCP and ask their thoughts.

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    from what you describe, I would definitely not call 911. And, as a midnight-shifter, I personally would not wake the doctor up if the resident wasn't in distress. I would chart my assessment and place in the sick-call book that the resident has peripheral edema. If I read your post correctly, the edema was your only noteworthy finding. And even that is not a new development.

    I would further explore the family's concern re:CHF. Even if there is no hx of CHF in the chart, that doesn't mean there isn't a true hx of it. These things get missed. Always take what family tells you seriously.

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    Peripheral edema can also be caused by a condition that impedes the return of blood to the right atrium.

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    The development of peripheral edema , in a person who has stopped receiving diuretics, would not be uncommon.

    The diagnosis of CHF would not be considered with that singular symptom.Heart failure is a term for the cardiac ouput is not meeting the needs of the body.

    The resident is asymptomatic, the family is suggesting the diagnosis.

    Follow your facility's protocols.

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    These findings really need to be communicated to the doctor so that he can order appropriate tests - or explain to the family why he's not.

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    If I am reading your question right, you are talking about a stable patient with no acute s/s of anything, that happens to have LE edema that was previously noted and hasn't changed. If that is the correct reading then I wouldn't do anything.. Why? there isn't anything going on. An MD could order some tests and make a ddx, but in the absence of ANYTHING to spur action why bother?

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    Chest x-ray would show CHF. They can also check pro-BNP. If the patient isn't having symptoms, there would be no reason to put them under radiation.

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