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Heart Failure Nursing Care Plans

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Diabetes and advanced heart failure

Failure of the left and/or right chambers of the heart results in insufficient output to meet tissue needs and causes pulmonary and systemic vascular congestion. This disease condition is termed heart failure (HF). Despite diagnostic and therapeutic advances, HF continues to be associated with high morbidity and mortality.  This is a nursing care plan for Heart Failure.

Heart Failure Nursing Priorities

  1. Improve myocardial contractility/systemic perfusion.
  2. Reduce fluid volume overload.
  3. Prevent complications.
  4. Provide information about disease/prognosis, therapy needs, and prevention of recurrences.

Heart Failure Discharge Goals

  1. Cardiac output adequate for individual needs.
  2. Complications prevented/resolved.
  3. Optimum level of activity/functioning attained.
  4. Disease process/prognosis and therapeutic regimen understood.
  5. Plan in place to meet needs after discharge.

Heart Failure Nursing Care Plans

  1. Decreased Cardiac Output — Heart Failure (CHF)
  2. Activity Intolerance — Heart Failure (CHF)
  3. Excess Fluid Volume — Heart Failure (CHF)
  4. Impaired Gas Exchange — Heart Failure (CHF)
  5. Impaired Skin Integrity — Heart Failure (CHF)
  6. Knowledge Deficit — Heart Failure (CHF)

Other Nursing Care Plans for Heart Failure

  1. Activity intolerance—poor cardiac reserve, side effects of medication, generalized weakness.
  2. Fluid Volume excess or deficient—changes in glomerular filtration rate, diuretic use, individual fluid/salt intake.
  3. Skin Integrity, impaired—decreased activity level, prolonged sitting, presence of edema, altered circulation.
  4. Therapeutic Regimen: ineffective management—complexity of regimen, economic limitations.
  5. Home Maintenance, impaired—chronic/debilitating condition, insufficient finances, inadequate support systems.
  6. Self-Care deficit—decreased strength/endurance, depression.

Diagnostic Studies

  • ECG: Ventricular or atrial hypertrophy, axis deviation, ischemia, and damage patterns may be present. Dysrhythmias, e.g., tachycardia, atrial fibrillation, conduction delays, especially left bundle branch block, frequent premature ventricular contractions (PVCs) may be present. Persistent ST-T segment abnormalities and decreased QRS amplitude may be present.
  • Chest x-ray: May show enlarged cardiac shadow, reflecting chamber dilation/hypertrophy, or changes in blood vessels, reflecting increased pulmonary pressure. Abnormal contour, e.g., bulging of left cardiac border, may suggest ventricular aneurysm.
  • Sonograms (echocardiogram, Doppler and transesophageal echocardiogram): May reveal enlarged chamber dimensions, alterations in valvular function/structure, the degrees of ventricular dilation and dysfunction.
  • Heart scan (multigated acquisition [MUGA]): Measures cardiac volume during both systole and diastole, measures ejection fraction, and estimates wall motion.
  • Exercise or pharmacological stress myocardial perfusion (e.g., Persantine or Thallium scan):Determines presence of myocardial ischemia and wall motion abnormalities.
  • Positron emission tomography (PET) scan: Sensitive test for evaluation of myocardial ischemia/detecting viable myocardium.
  • Cardiac catheterization: Abnormal pressures are indicative and help differentiate right- versus left-sided heart failure, as well as valve stenosis or insufficiency. Also assesses patency of coronary arteries. Contrast injected into the ventricles reveals abnormal size and ejection fraction/altered contractility. Transvenous endomyocardial biopsy may be useful in some patients to determine the underlying disorder, such as myocarditis or amylodosis.
  • Liver enzymes: Elevated in liver congestion/failure.
  • Digoxin and other cardiac drug levels: Determine therapeutic range and correlate with patient response.
  • Bleeding and clotting times: Determine therapeutic range; identify those at risk for excessive clot formation.
  • Electrolytes: May be altered because of fluid shifts/decreased renal function, diuretic therapy.
  • Pulse oximetry: Oxygen saturation may be low, especially when acute HF is imposed on chronic obstructive pulmonary disease (COPD) or chronic HF.
  • Arterial blood gases (ABGs): Left ventricular failure is characterized by mild respiratory alkalosis (early) or hypoxemia with an increased Pco2 (late).
  • BUN/creatinine: Elevated BUN suggests decreased renal perfusion. Elevation of both BUN and creatinine is indicative of renal failure.
  • Serum albumin/transferrin: May be decreased as a result of reduced protein intake or reduced protein synthesis in congested liver.
  • Complete blood count (CBC): May reveal anemia, polycythemia, or dilutional changes indicating water retention. Levels of white blood cells (WBCs) may be elevated, reflecting recent/acute MI, pericarditis, or other inflammatory or infectious states.
  • ESR: May be elevated, indicating acute inflammatory reaction.
  • Thyroid studies: Increased thyroid activity suggests thyroid hyperactivity as precipitator of HF.