Dyspnea in patients with congestive heart failure is influenced by patient activity, so that the New York Heart Association (NYHA) divides CHF into 4 categories based on the signs and symptoms of the activities carried out. (Johnson, 2010; Wendy; 2010).
Patients with :
- NYHA class IV : Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.
- NYHA class III : Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
- NYHA class II : Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
- NYHA class I : No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). (www.heart.org).
CHF causes pulmonary function failure, resulting in accumulation of fluid in the alveoli. This causes the heart to not function optimally in pumping blood. Another impact that arises is the changes that occur in the respiratory muscles. These things cause the oxygen supply to the entire body to be disrupted resulting in dyspnea (Johnson, 2008; Wendy, 2010).
Research with a systematic review and meta-analysis revealed rehabilitation of heart failure in low and moderate risk heart failure (NYHA II and III) (Sagar, 2015).
Nurses as providers of nursing care through independent and collaborative actions, facilitate patients to solve problems. Nursing diagnoses that appear in patients with dyspnea namely ineffective breathing pattern can be given interventions such as giving a semifowler position and collaboration with doctors in administering oxygen (NANDA, 2014; NIC, 2015).
Non-pharmacological management that can be done is education, exercise and increased functional capacity. One solution to dyspnea problems can be done by giving oxygenation to reduce respiratory rate. Giving position and breathing exercise can be done to reduce effort and improve respiratory muscle function.
Tolerable physical exercise also becomes management in improving tissue perfusion and improving circulation (Smeltzer, 2008; Sani, 2007).
Range of motion (ROM) is a motion exercise by moving a joint as wide as a joint motion. The exercise aims to increase blood flow to the muscles thereby increasing peripheral tissue perfusion (Babu, 2010).
The research conducted by Nirmalasari used a quasy experiment design with a pretest-posttest control group design. Using the stratified random sampling method with classification; CHF NYHA class II and III. The total respondents were 32 people who were divided into control groups and intervention groups. The control group only received hospital standard intervention while the intervention group received hospital standard intervention and deep breathing exercise and active range of motion.
The results of the research conducted by Nirmalasari showed that deep breathing exercise and active range of motion interventions, effective and reduced dyspnea in CHF patients.
Bibliograph
- Johnson, Miriam J and Stephen G. Oxberry. 2010. The Management of Dyspnoea in Chronic Heart Failure. Current Opinion in Supportive and Palliative Care. 4: 63-68.
- Wendy C. 2010. Dyspnoea and Oedema in Chronic Heart Failure. Pract Nurse. 39(9)
- Classes of Heart Failure. (https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure)
- Sagar VA, Davies EJ, Briscoe S, Coats AJS, Dalal HM, Lough F, et al. 2015. Exercise-based rehabilitation for heart failure?: systematic review and meta-analysis.
- NANDA International, Inc. 2014. NURSING DIAGNOSES: DEFINITIONS & CLASSIFICATION 2015-2017. Tenth Edition. Edited by. T. Heather Herdman, PhD, RN, FNI. Wiley Blackwell.
- Nursing Interventions Classifications (NIC). 6th Edition. Missouri: Mosby Elsevier
- Smeltzer, Susanna and B. Bare. 2008. Textbook of Medical Surgical Nursing: Brunner and Suddarth's. 11th ed. Philadelpia: Lippincott William Wilkins.
- Sani A. 2007. Heart Failure: Current Paradigm. Jakarta: Medya Crea.
- Price, Sylvia A dan Lorainne M. Wilson. 2006.
- Babu, Abraham Samuel. 2010. Protocol-Guided Phase-1 Cardiac Rehabilitation in Patients with ST-Elevation Myocardial Infarction in A Rural Hospital. Heart views. 11(2):52-6.
