Nursing management: Heart Failure
Nursing management: Heart Failure
- Nursing Assessment
- Subjective data
- Health information
- Past health history:
- CAD (including recent MI)
- Hypertension
- Cardiomyopathy
- Valvular or Congenital heart disease
- Diabetes mellitus
- Hyperlipidemia
- Renal disease
- Thyroid or lung disease
- Rapid or irregular heart rate
- Medications:
- Use of and adherence with any heart drugs.
- Use of diuretics, estrogens, corticosteroids, nonsteroidal anti-inflammatory drugs, over-the-counter drugs, herbal supplements
- Functional health pattern
- Health perception–health management:
- Fatigue, depression, anxiety
- Nutritional-metabolic:
- Usual sodium intake. Nausea, vomiting, anorexia, stomach bloating. Weight gain, ankle swelling
- Elimination:
- Nocturia, decreased daytime urine output, constipation
- Activity-exercise:
- Dyspnea, orthopnea, cough (e.g., dry, productive). Palpitations, dizziness, fainting
- Sleep-rest:
- Number of pillows used for sleeping. Paroxysmal nocturnal dyspnea, insomnia, sleep apnea
- Cognitive-perceptual:
- Chest pain or heaviness. RUQ pain, abdominal discomfort. Behavioral changes, visual changes
- Objective data
- Integumentary
- Cool, diaphoretic skin. Cyanosis or pallor. Peripheral edema (right-sided heart failure)
- Respiratory
- Tachypnea, crackles, wheezes. Frothy, blood-tinged sputum
- Cardiovascular
- Tachycardia, S3, S4, murmurs. Pulsus alternans. PMI displaced inferiorly and posteriorly, lifts and heaves, jugular venous distention
- Gastrointestinal
- Abdominal distention, hepatosplenomegaly, ascites
- Neurologic
- Restlessness, confusion, decreased attention or memory
- Possible Diagnostic Findings
- Altered serum electrolytes (especially Na+ and K+)
- Increased BUN, creatinine, or liver function tests
- Increased NT-proBNP or BNP
- Chest x-ray demonstrating cardiomegaly, pulmonary congestion, and interstitial pulmonary edema.
- Echocardiogram showing increased chamber size, decreased wall motion, decreased EF or normal EF with evidence of diastolic failure.
- Atrial and ventricular enlargement on ECG.
- Decreased O2 saturation