20.7: Heart Failure VII: Nursing Interventions

The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.

Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.

Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs, including blood pressure, respiratory rate, and oxygen saturation.

Diagnostic Tests: Evaluate diagnostic test reports such as ECG to detect cardiac abnormalities, echocardiography to assess cardiac function and structure, chest X-ray to evaluate heart size and pulmonary congestion, and blood tests, including B-type natriuretic peptide (BNP) to determine the severity of heart failure, along with liver and kidney function tests.

Nursing Diagnosis: Next, the nurse formulates the nursing diagnosis and goals based on the assessment and the patient's clinical problems.

• Impaired cardiac output related to decreased myocardial contractility secondary to heart failure, as evidenced by reduced ejection fraction, peripheral edema, and fatigue.
• Excess fluid volume related to increased sodium and water retention secondary to heart failure, as evidenced by peripheral edema and weight gain.
• Activity intolerance related to reduced cardiac output secondary to heart failure, as evidenced by fatigue and dyspnea on exertion.

Goals: Based on the nursing diagnosis, nursing goals are formulated.

• Maintaining optimal fluid balance
• Achieving adequate tissue perfusion
• Preventing complications

Nursing Interventions: Nursing interventions for patients with heart failure include the following:

Improving Cardiac Output

• Regularly assess heart rate, blood pressure, and oxygen saturation.
• Monitor for signs of decreased cardiac output, such as changes in mental status, cool extremities, and decreased urine output.
• Administer prescribed medications (e.g., ACE inhibitors, beta-blockers, diuretics) to improve cardiac output and reduce preload/afterload.
• Monitor for medication side effects and therapeutic effects.
• Restrict fluids as prescribed to manage fluid overload.
• Encourage periods of rest to decrease cardiac workload.
• Teach clinical manifestations of worsening heart failure, when to seek medical attention, and emphasize medication adherence.

Managing Fluid Volume

• Measure and record daily weights and intake/output.
• Assess for manifestations of fluid overload, such as edema, shortness of breath, jugular venous distention, and lung auscultation.
• Administer prescribed diuretics to promote fluid excretion.
• Discuss medication timing, especially for older patients with urinary urgency or incontinence.
• Monitor electrolytes and renal function regularly.
• Educate the patient on fluid and sodium restrictions and recognize signs of fluid overload.
• Assist in developing a dietary plan to limit sodium intake.
• Elevate the head of the bed to reduce dyspnea.
• Encourage leg elevation to reduce peripheral edema.

Promoting Activity Tolerance

• Monitor response to activity, including vital signs before, during, and after activities.
• Ensure adequate rest periods between activities to prevent overexertion.
• Educate on balancing activity with rest.
• Utilize a structured exercise program tailored to the patient's tolerance level.
• Encourage low-intensity activities such as walking.
• Teach energy conservation techniques, such as sitting while performing tasks and organizing workspaces.
• Encourage the use of assistive devices if needed.
• Educate the patient and family on maintaining a balance between activity and rest.
• Provide information on recognizing signs of activity intolerance and when to seek medical attention.

Evaluation: Continuously evaluate the patient's condition and modify the care plan as needed.