Heart failure impacts quality of life and interferes with activities of . Reducing myocardial demand is a major nursing care for the individual in acute . This includes providing and undertaking the prescribed interventions to reduce cardiac work, improve contractility and manage . See also the accompanying nursing care plan for additional nursing diagnoses and interventions for the individual with heart failure. ■ the person’s heart and breath sounds regularly. and may be diminished if cardiac function is poor. A ventricular (S3) is an early sign of heart failure; atrial gallop () may also be present. are often heard in the lung bases; increasing and indicate worsening failure.

Lemone, Priscilla. Medical-Surgical Nursing (Australian Edition) Volumes 1-3 (Page 1053). P.Ed Australia. Kindle Edition.

Decreased cardiac Pump failure results in decreased upstroke and tissue . ■ Monitor the person’s vital signs and oxygen indicated. Decreased cardiac output stimulates the SNS to in an attempt to restore CO. at rest is common. blood pressure may initially be elevated because of ; in late stages, compensatory mechanisms fail and the person’s BP will . Oxygen saturation levels provide a measure of and tissue . CONSIDERATION FOR PRACTICE Report manifestations of decreased and tissue perfusion including changes in mentation, decreased output, cool, clammy skin, diminished pulses, pallor or , and arrhythmias.

Lemone, Priscilla. Medical-Surgical Nursing (Australian Edition) Volumes 1-3 (Page 1053). P.Ed Australia. Kindle Edition.

Administer supplemental as needed. This improves oxygenation of the , decreasing the effects of and ischaemia. ■ Administer prescribed medications as ordered. Drugs are used to decrease the and increase . ■ Encourage rest, explaining the rationale. the head of the bed to reduce the . Provide a bedside commode and assist with activities of daily living (ADLs). Instruct the person to avoid the Valsalva manoeuvre and encourage the use of stool softeners to reduce strain. These measures reduce cardiac workload.

Lemone, Priscilla. Medical-Surgical Nursing (Australian Edition) Volumes 1-3 (Page 1053). P.Ed Australia. Kindle Edition.

Excess As cardiac output , compensatory mechanisms cause salt and water , increasing . This increased fluid volume places additional on the already failing , making them work harder to move the fluid load. ■ Assess status and auscultate lung sounds at least every hours. Notify the doctor of in condition. respiratory status indicates worsening heart failure.

Lemone, Priscilla. Medical-Surgical Nursing (Australian Edition) Volumes 1-3 (Page 1053). P.Ed Australia. Kindle Edition.

■ Monitor the person’s . Notify the doctor if urine output is less than mL/h. daily. Careful monitoring of is important during treatment of heart failure. may reduce circulating volume, producing hypovolaemia despite persistent peripheral oedema. A fall in urine output may indicate significantly cardiac output and renal . Weight is an measure of fluid status: 1 L of fluid is equal to kg of weight. ■ Record their abdominal every shift. Note complaints of a loss of , abdominal or nausea. Venous congestion can lead to ascites and may affect function and nutritional status. ■ Monitor and record the person’s haemodynamic measurements. Report significant changes and negative trends. Haemodynamic measurements provide a means of monitoring condition and response to treatment. ■ Restrict fluids as . Offer appropriate choices of fluid type and timing of intake, scheduling most fluid intake during and hours. Offer ice chips and frequent . Providing choices increases the person’s sense of control. Ice chips and frequent mouth care relieve and thirst and promote comfort.

Lemone, Priscilla. Medical-Surgical Nursing (Australian Edition) Volumes 1-3 (Page 1054). P.Ed Australia. Kindle Edition.