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NCP Knowledge Deficit — Heart Failure (CHF)

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NURSING DIAGNOSIS: Knowledge, deficient [Learning Need] regarding condition, treatment regimen, self care, and discharge needs

May be related to

  • Lack of understanding/misconceptions about interrelatedness of cardiac function/disease/failure

Possibly evidenced by

  • Questioning
  • Statements of concern/misconceptions
  • Recurrent, preventable episodes of HF

Desired Outcomes
Knowledge: Disease Process (NOC)

  • Identify relationship of ongoing therapies (treatment program) to reduction of recurrent episodes and prevention of complications.
  • List signs/symptoms that require immediate intervention.
  • Identify own stress/risk factors and some techniques for handling.
  • Initiate necessary lifestyle/behavioral changes.

Nursing Interventions & Rationale

Nursing Interventions Rationale
 Discuss normal heart function. Include information regarding patient’s variance from normal function. Explain difference between heart attack and HF.  Knowledge of disease process and expectations can facilitate adherence to prescribed treatment regimen.
 Reinforce treatment rationale. Include SO/family members in teaching as appropriate, especially for complicated regimens such as dobutamine infusion home therapy when patient does not respond to customary combination therapy or cannot be weaned from dobutamine, or those awaiting heart transplant.  Patient may believe it is acceptable to alter postdischarge regimen when feeling well and symptom-free or when feeling below par, which can increase the risk of exacerbation of symptoms. Understanding of regimen, medications, and restrictions may augment cooperation with control of symptoms. Home IV therapy requires a significant commitment by caregivers to operate/troubleshoot infusion pump, change dressing for peripherally inserted central catheter (PICC) line, monitor I&O and signs/symptoms of HF.
 Encourage developing a regular home exercise program, and provide guidelines for sexual activity.  Promotes maintenance of muscle tone and organ function for overall sense of well-being. Changing sexual habits may be difficult (e.g., sex in morning when well rested, patient on top, inclusion of other physical expressions of affection) but provides opportunity for continuing satisfying sexual relationship.
 Discuss importance of being as active as possible without becoming exhausted and of rest between activities.  Excessive physical activity or overexertion can further weaken the heart, exacerbating failure, and necessitates adjustment of exercise program.
 Discuss importance of sodium limitation. Provide list of sodium content of common foods that are to be avoided/limited. Encourage reading of labels on food and drug packages.  Dietary intake of sodium of more than 3 g/day can offset effect of diuretic. Most common source of sodium is table salt and obviously salty foods, although canned soups/vegetables, luncheon meats, and dairy products also may contain high levels of sodium.
 Refer to dietitian for counseling specific to individual needs/dietary customs.  Identifies dietary needs, especially in presence of nausea/vomiting and resulting wasting syndrome (cardiac cachexia). Eating six small meals and using liquid dietary supplements and vitamin supplements can limit inappropriate weight loss.
 Review medications, purpose, and side effects. Provide both oral and written instructions.  Understanding therapeutic needs and importance of prompt reporting of side effects can prevent occurrence of drug-related complications. Anxiety may block comprehension of input or details, and patient/SO may refer to written material at later date to refresh memory.
 Recommend taking diuretic early in morning.  Provides adequate time for drug effect before bedtime to prevent/limit interruption of sleep.
 Instruct and receive return demonstration of ability to take and record daily pulse and blood pressure and when to notify healthcare provider, e.g., parameters above/below preset rate, changes in rhythm/regularity.  Promotes self-monitoring of condition/drug effect. Early detection of changes allows for timely intervention and may prevent complications, such as digitalis toxicity.
 Explain and discuss patient’s role in control of risk factors (e.g., smoking) and precipitating or aggravating factors (e.g., high-salt diet, inactivity/overexertion, exposure to extremes in temperature).  Adds to body of knowledge, and permits patient to make informed decisions regarding control of condition and prevention of recurrence/complications. Smoking potentiates vasoconstriction; sodium intake promotes water retention/edema formation; improper balance between activity and rest and exposure to temperature extremes may result in exhaustion/increased myocardial workload and increased risk of respiratory infections. Alcohol can depress cardiac contractility. Limitation of alcohol use to social occasions or maximum of 1 drink/day may be tolerated unless cardiomyopathy is alcohol-induced (requiring complete abstinence).
 Review signs/symptoms that require immediate medical attention, e.g., rapid/significant weight gain, edema, shortness of breath, increased fatigue, cough, hemoptysis, fever.  Self-monitoring increases patient responsibility in health maintenance and aids in prevention of complications, e.g., pulmonary edema, pneumonia. Weight gain of more than 3 lb in a week requires medical evaluation/adjustment of diuretic therapy.Note: Patient should weigh self daily in morning without clothing, after voiding and before eating.
Provide opportunities for patient/SO to ask questions, discuss concerns, and make necessary lifestyle changes. Chronicity and recurrent/debilitating nature of HF often exhausts coping abilities and supportive capacity of both patient and SO, leading to depression.
Discuss general health risks (such as infection), recommending avoidance of crowds and individuals with respiratory infections, obtaining yearly influenza immunization and one-time pneumonia immunization. This population is at increased risk for infection because of circulatory compromise.
Stress importance of reporting signs/symptoms of digitalis toxicity, e.g., development of gastrointestinal (GI) and visual disturbances, changes in pulse rate/rhythm, worsening of heart failure. Early recognition of developing complications and involvement of healthcare provider may prevent toxicity/hospitalization.
Identify community resources/support groups and visiting home health nurse as indicated. May need additional assistance with self-monitoring/home management, especially when HF is progressive.
Discuss importance of advance directives and of communicating plan/wishes to family and primary care providers. Up to 50% of all deaths from heart failure are sudden, with many occurring at home, possibly without significant worsening of symptoms. If patient chooses to refuse life-support measures, an alternative contact person (rather than 911) needs to be designated, should cardiac arrest occur.