- Activity Intolerance related to Imbalance between oxygen supply and demand and Sedentary lifestyle as evidenced by Dyspnoea and Chest pain on exertion
Diaphoresis - Decreased Cardiac Output Related to Altered heart rate/rhythm and Altered contractility as evidenced by Dysrhythmias and decreased peripheral pulses, Decreased urine output
- Decreased Cardiac Tissue Perfusion Related to Difficulty of the heart muscle to pump and Inability to contract and relax effectively as evidenced by Decreased cardiac output and Ejection fraction less than 40%
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: -Patient’s report of decreased activity/weakness -Shortness of breath with exertion -Fatigue -Exertional discomfort Objective data: -Abnormal blood pressure and heart rate response to activity -Changes to ECG -Signs of pain with movement/activity -Difficulty engaging in activity -Increased oxygen demands | Activity Intolerance related to Imbalance between oxygen supply and demand and Sedentary lifestyle as evidenced by Dyspnoea and Chest pain on exertion Diaphoresis | Patient will perform activities within their limitations so as not to stress cardiac workload. Patient will alternate between work and rest periods to complete ADLs. Patient will demonstrate vital signs and heart rhythm within normal limits during activity. | 1. Provide a calm environment. Dyspnea from HF can result in anxiety and restlessness. Provide the patient with a cool, dimly lit space free from clutter and stimulation. Assist the patient in taking slow, controlled breaths and provide emotional support so they feel in control. 2. Encourage participation. Even a patient with chronic HF and severe activity intolerance can assist with care to some extent. Provide toiletries at the bedside so the patient can brush their teeth or comb their hair. Have the patient assist with turning themselves in bed. A patient who becomes immobile from a sedentary lifestyle is at an increased risk for other complications such as skin breakdown, deep vein thrombosis (DVT), and pneumonia. 3. Teach methods to conserve energy. Group tasks together, sit when possible when performing ADLs, plan rest periods, promote restful sleep, do not rush activities, and avoid activities in hot or cold temperatures. 4. Recommend cardiac rehabilitation. This is a medically supervised outpatient program that teaches a patient with a cardiac history how to reduce their risk of heart problems through exercise, heart-healthy diets, stress reduction, and management of chronic conditions. This is a team-based approach working with providers, nurses who specialize in cardiac care, PT and OT, and dieticians. | Patient performed activities within their limitations so as not to stress cardiac workload. Patient alternated between work and rest periods to complete ADLs. Patient demonstrated vital signs and heart rhythm within normal limits during activity. |
| Subjective data: -Verbalizes unbale to do any activity -Feeling Tiredness Objective data: -Dysrhythmias -Fatigue -Shortness of breath -Anxiety -Orthopnea -Jugular vein distention; edema -Central venous pressure changes -Murmurs -Decreased peripheral pulses -Decreased urine output -Skin pallor, mottling, or cyanosis | Decreased Cardiac Output Related to Altered heart rate/rhythm and Altered contractility as evidenced by Dysrhythmias and decreased peripheral pulses, Decreased urine output | Patient will display hemodynamic stability with vital signs, cardiac output, and renal perfusion within normal limits. Patient will participate in activities that reduce the workload of the heart. Patient will report an absence of chest pain or shortness of breath. | 1. Apply oxygen. Patients with low oxygen saturation may need supplemental oxygen due to the heart’s inability to pump oxygen-rich blood to the body. Patients with chronic HF may require oxygen therapy at home. 2. Administer medications. Vasodilators open arteries and veins to allow for decreased vascular resistance, increasing cardiac output and reducing ventricular workload. Morphine and anti-anxiety medications help with relaxing and calming the patient which can reduce cardiac workload. Angiotensin receptor blockers (ARBs) lower blood pressure and make pumping blood easier for the heart. 3. Instruct on ways to reduce the workload of the heart. Depending on the severity of the patient’s HF, they may need to modify daily activities. They may need assistance with ADLs, plenty of rest periods, and reduced exercise regimens. 4. Educate on risk factors and lifestyle modifications. Patients who are not yet diagnosed with HF or only have mild HF should be educated on prevention. Educate patients on risk factors such as hypertension, diabetes, atherosclerosis, and myocardial infarction that increase the risk of developing heart failure. Modifiable risk factors like smoking, obesity, sedentary lifestyle, and diets high in fat also increase the risk. | Patient displayed hemodynamic stability with vital signs, cardiac output, and renal perfusion within normal limits. Patient participated in activities that reduce the workload of the heart. Patient reported an absence of chest pain or shortness of breath. |
| Subjective data: -Verbalizes can feel the heart beats -Shortness of breath Objective data: -Decreased cardiac output -Decreased blood pressure (hypotension) -Decreased peripheral pulses -Increased central venous pressure (CVP) -Increased pulmonary artery pressure (PAP) -Tachycardia -Dysrhythmias -Ejection fraction less than 40% -Decreased oxygen saturation -Presence of abnormal S3 and S4 heart sounds upon auscultation Chest pain | Decreased Cardiac Tissue Perfusion Related to Difficulty of the heart muscle to pump and Inability to contract and relax effectively as evidenced by Decreased cardiac output and Ejection fraction less than 40% | Patient will manifest pulse rate and rhythm within normal limits. Patient will demonstrate ejection fraction >40%. Patient will maintain palpable peripheral pulses. | 1. Set the goal with the patient. Therapy aims to increase survival and symptoms, shorten hospital stays and avoid HF readmission, minimize morbidity, prevent HF-related organ damage, and suppress symptoms in patients with asymptomatic heart failure. 2. Administer medications as ordered. The following medications are included in the pharmacologic treatment of HF: Diuretics Angiotensin system blockers (ACE inhibitors, ARBs, or ARNIs) Hydralazine with nitrate as an alternative if angiotensin system blockers are not tolerable Beta-blockers 3. Instruct on lifestyle modifications. Behavioral and lifestyle modifications include the following: Dietary and nutritional consultation Limit sodium to 2 to 3 g/day Fluid restriction to 2 L/day Weight monitoring Aerobic exercise training Control of existing risk factors (such as DM and lipid disorders) Smoking/alcohol/illicit drug use cessation 4. Consider device therapy. Device therapies include cardiac resynchronization treatment (CRT) and implanted cardioverter-defibrillators (ICD). Patients should receive ACE inhibitors/ARB plus beta-blockers for at least three months prior to surgery. 5. Anticipate the possibility of surgery. Heart transplantation, heart valve replacement, catheter ablation, and more are procedures to remodel, repair, or replace all or part of the heart’s function in treating HF. Surgery is often considered when medications aren’t effective. | Patient manifested pulse rate and rhythm within normal limits. Patient demonstrated ejection fraction >40%. Patient maintained palpable peripheral pulses. |