Nursing Guide to Congestive Heart Failure and Pulmonary Edema: Nursing Diagnosis, Interventions, & Care Plans

Congestive Heart Failure & Pulmonary Edema Etiology and Epidemiology

In the U.S., heart failure is the most common health problem and the most common reason for hospitalization amongst patients aging 65 years or older. Approximately 915,000 cases are reported each year within the older adult population, at a cost of $30 billion annually to treat (King & Goldstein, 2021).

Heart failure can be classified in stages or degrees, including episodes of pulmonary edema and acute exacerbation (King & Goldstein, 2021). Heart failure often results from the aging process and with reduced ejection fraction, with the most common cause deriving from coronary artery disease.

In most cases, heart failure is caused by left ventricular dysfunction, with the ejection fraction compromised or preserved (King & Goldstein, 2021). Pulmonary edema is associated with acute decompensated heart failure, which is secondary to dysregulation of pulmonary fluid homeostasis along with the forces that stabilizes the fluid within the alveolar spaces (King & Goldstein, 2021).

Edema & CHF Nursing Diagnosis 

To diagnose heart failure and pulmonary edema, providers should ask about the individual’s medical history and perform a physical exam.

Diagnostic testing may also be used and includes:

• Blood tests
  • Brain natriuretic peptide (BNP)
  • Complete blood count (CBC)
  • Lipid panel
  • Liver function tests (LFTs)
  • Troponin
  • Thyroid-stimulating hormone (TSH)
  • Serum electrolytes
• Electrocardiogram (EKG)
• Echocardiograph (Echo)

Management

To manage congestive heart failure (CHF) and pulmonary edema:

• Assess airway, breathing, and circulation (ABCs)
• Administer the following:
  • IV diuretics
  • Vasodilators
  • Nitroglycerin
• Utilize the following:
  • Continuous positive airway pressure (CPAP) / bilevel positive airway pressure (BiPAP)
  • Coronary revascularization
• Admit to hospital for further evaluation

Congestive Heart Failure & Pulmonary Edema Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with Heart Failure and Pulmonary Edema are listed below.

Signs and Symptoms:

• Altered mental status
• Irritability
• Increasing dyspnea
• Decrease in activities of daily living
• Increase in swelling of the legs, ascites, and edema
• Increase in weight
• Chest pain
• Fatigue
• Transient ischemic attacks (TIAs)
• Palpitations

CHF & Pulmonary Edema Nursing Diagnosis/Risk For

• Fluid overload
• Ineffective breathing pattern
• Ineffective gas exchange
• Altered mental status
• Pain
• Stroke
• Pulmonary embolism

Pulmonary Edema Nursing Interventions

• Collect baseline cognitive level
• Assess the following:
  • Weight
  • Vital signs
  • Jugulovenous distension
  • Cardiac (heart sounds)
  • Pulmonary (respiratory rate and lung sounds)
  • Abdomen (ascites)
  • Lower extremities (edema)
  • Intake and output
• Develop a daily routine
• Allow rest time and time with activities

Expected Outcomes

• Remain asymptomatic
• Have normal lung and heart sounds
• Maintain weight
• Remain free from swelling and edema

Individual/Caregiver Education

• Getting regular checkups
• Eating a healthy diet and restricting salt intake
• Getting enough rest
• Reporting physical changes
• Keeping a daily schedule
• Avoiding activities that cause physical changes
• Avoiding alcohol
• Assisting with activities of daily living
• Monitoring fluid intake
• Consulting provider, as needed

Content Release Date 

4/1/2022

Content Expiration

12/31/2025

Content Contributor

The content was created by Relias staff writer Tiffany Fields, RN, BSN, MSN, DNP, CRNP.

Tiffany has been a clinical nurse for over 20 years. She was educated and trained as a Licensed Practical Nurse in Alabama, where she practiced as a Gerontological Nurse at the local Nursing Homes. She earned her Associate, Bachelor’s and Master’s degrees in Nursing and a Doctorate in Nursing Practice. She also as a Certified Family Nurse Practitioner degree. Her clinical expertise is Adult-Geriatric Nursing and Medical-Surgical medical complexity. She is currently Assistant Director of Nursing at a Rural Hospital as well as a writer for Relias.

Resources

• Latest on Congestive Heart Failure and Pulmonary Edema https://www.uscjournal.com/articles/current-thinking-acute-congestive-heart-failure-and-pulmonary-edema
• Pulmonary Edema https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/pulmonary-edema

References

• Bello, G., De Santis, P., & Antonelli, M. (2018). Non-invasive ventilation in cardiogenic pulmonary edema. Annals of translational medicine, 6(18). https://atm.amegroups.org/article/view/19394/20876
• Dharmarajan, K., & Rich, M. W. (2017). Epidemiology, pathophysiology, and prognosis of heart failure in older adults. Heart failure clinics, 13(3), 417-426. https://www.sciencedirect.com/science/article/abs/pii/S1551713617300144?via%3Dihub
• Habal, M. V., & Garan, A. R. (2017). Long-term management of end-stage heart failure. Best Practice & Research Clinical Anaesthesiology, 31(2), 153-166. https://www.sciencedirect.com/science/article/abs/pii/S1521689617300435?via%3Dihub
• King, K. C. & Goldstein, S. (2021). Congestive heart failure and pulmonary edema. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK554557/
• Kurmani, S., & Squire, I. (2017). Acute heart failure: definition, classification and epidemiology. Current heart failure reports, 14(5), 385-392. https://link.springer.com/article/10.1007/s11897-017-0351-y