Jugular venous distention (JVD) is often seen with right-sided heart failure. This is due to venous congestion in the systemic circulation.
Edema, especially peripheral, is a common sign of right-sided heart failure. If the patient is bedridden, sacral and scrotal edema may develop.
Hepatosplenomegaly, otherwise known as an enlarged liver and spleen, can occur in right-sided heart failure as a result of the organs become congested with venous blood.
Individuals with decreased cardiac output may have impaired renal perfusion and decreased urine output (oliguria) during the day. However, when lying down at night, fluid shifts from the interstitial spaces into the circulatory system. Combined with the decrease in cardiac workload while resting, renal blood flow increases resulting in nocturia (the patient complaining of having to void frequently throughout the night).
Progressive weight gain may occur due to fluid retention. Daily weights, which involves weighing the patient at the same time each morning upon awakening, remains the most reliable indicator of fluid gain or loss. It is also important to keep an accurate record of fluid intake and output, and suggest patients at home keep a log of daily weights and I&Os.
Patients with heart failure retain fluid which can lead to the development of ascites (the buildup of fluid within the peritoneal cavity). Abdominal fullness from ascites frequently causes anorexia and nausea. Be sure to measure abdominal girth to assess for changes as up to 10 liters of fluid can hide here.
Fatigue is one of the earliest symptoms of heart failure. It is caused as a result of decreased cardiac output, impaired perfusion to vital organs, and decreased oxygenation to tissues. Energy management should be implemented when providing care, which includes organizing care to allow for rest periods throughout the day.
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