Chapter 38: Heart Failure Nursing Care

The pathophysiology involves compensatory mechanisms including renin-angiotensin-aldosterone system activation, sympathetic nervous system stimulation, and ventricular remodeling that initially maintain cardiac output but ultimately worsen the condition through fluid retention and structural changes. Classification systems including New York Heart Association functional classes and American College of Cardiology Foundation staging help stratify patients based on symptom severity and disease progression. Acute decompensated heart failure presents with pulmonary congestion, dyspnea, and hemodynamic instability requiring immediate interventions such as diuretics, vasodilators, positive inotropes, and respiratory support. Chronic heart failure management emphasizes evidence-based pharmacotherapy including angiotensin-converting enzyme inhibitors, angiotensin receptor neprilysin inhibitors, beta-blockers, aldosterone antagonists, and sodium-glucose cotransporter-2 inhibitors, along with device therapies like implantable cardioverter-defibrillators and cardiac resynchronization therapy. Advanced treatment options encompass mechanical circulatory support devices, ventricular assist devices, and heart transplantation for end-stage disease. Comprehensive nursing care focuses on hemodynamic assessment, medication management, patient education regarding sodium restriction and daily weight monitoring, prevention of hospital readmissions, and coordination of palliative care services to optimize quality of life throughout the disease trajectory.