AboutMargot RN BScN CGN Expertise I nursed my own Mother and Grandmother at home when they were dying so I have personal experience with the emotions involved. I have also spent the last 15+ years as a Registered Nurse caring for The Elderly and Terminally Ill and it has brought me great satisfaction. I am willing to answer any questions I can.
Experience
Past/Present clients Hundreds of Long Term Care Residents as well as hundreds of Cleitns and families in the community (including my Mother and Grandmother).
Question My 91 yr. old mother, whom lives with me, has had CHF for many years. She experiences extreme difficulty breathing (must have her mouth open), cannot lay down flat, gets swollen ankles, etc. She experiences "episodes" of extreme fatigue and weakness, where she can barely get dressed or walk to the kitchen with her wheeled walker for several days. Sometimes I don't think she will live through the day . . . and then she rallies for a few days or weeks before another "weak spell". What should I expect as her condition deteriorates further? What are the signs that one is nearing death? What do medical professionals look for when they decide it's time to "summon the family"? Knowing what to expect would make things so much easier. Thank you.
Answer Hi Jean and thanks for writing,
This is very general and may not be the course your Mother follows, but I can tell you how an average CHF patient may proceed.
Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs. The "failing" heart keeps working but not as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. The most common symptoms are respiratory in nature. Failure of the left ventricle causes congestion of the pulmonary capillaries. The patient will have dyspnea (shortness of breath) on exertion.
Basically the CHF deprives the body of oxygen and the patient becomes short of breath, tires easily and will rest more and more as they grow weaker. Occasionally Blood Transfusions will provide temporary relief if the Haemoglobin falls too low, this can also cause Angina (chest pains).
Eventually the patient will be so weak they don't want to move around too much and may stay in bed or sit in an easy chair most of the day; just washing and dressing will be exhausting. They often lose their appetite due to decreased energy so it's a vicious circle: low oxygen causes low energy & weakness which decreases appetite, and decreased appetite leads to weakness.
Treatment is generally "Comfort Measures" like oxygen to ease shortness of breath, maybe some medications to ease the heart's workload, and some puffers to open the airways, but it's not typically aggressive treatment as CHF is progressive and irreversible. You also want to watch for increased edema (swelling) in the ankles and lower legs or increased shortness of breath or wheezing which are signs of fluid retention and can usually be treated with medication adjustments. Diuretics increase the loss of salt and water through the kidneys. This reduces the congestion and excess fluid in the lungs improving shortness of breath, the most prominent and limiting manifestation of heart failure. Drugs that dilate blood vessels lower resistant to blood flow and decrease the heart's workload.
In the end the patient is often weak and bedridden and simply slips away quietly after a slow peaceful decline. The patient will feel weak and will be short of breath after exerting themselves, but do not "gasp for breath". Low oxygen levels can cause confusion though and occasionally the confused patient can become agitated. The most common symptom of CHF is Anxiety related to feeling of not being able to catch your breath – doctors often prescribe anti-anxiety medications such as Ativan for their CHF patients, but use these only as required as these medications are sedating and can increase weakness and increase the risk for falls in the elderly. You’ll also want to watch for red areas on the skin as CHF patients are more prone to skin breakdown due to the extra fluid and decreased circulation; you’ll want to ensure she is turned regularly, there are no wrinkles on the sheets and his skin is kept dry but hydrated.
I hope this has helped to answer your questions and I wish you both all my best; please write again if I can be of any more assistance.
