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\author{CaitlinStaples0805}
\pdfinfo{
  /Title (care-plan-heart-failure.pdf)
  /Creator (Cheatography)
  /Author (CaitlinStaples0805)
  /Subject (CARE PLAN: HEART FAILURE Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{CARE PLAN: HEART FAILURE Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{CaitlinStaples0805} via \textcolor{DarkBackground}{\uline{cheatography.com/202822/cs/43088/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}CaitlinStaples0805 \\
  \uline{cheatography.com/caitlinstaples0805} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 18th April, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{WHAT IS HEART FAILURE?}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Accumulation of fluid throughout the entire body (R-Sided HF) and/or accumulation of fluid in the lungs (L-Sided HF).  Causes a decrease in cardiac output, that is unable to meet the metabolic needs of the body.} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{WHAT'S HAPPENING?}}} \tn 
% Row Count 6 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Na+ \& H2O retention increases workload of the heart.} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Untreated}} Heart continues to become weaker \& enlarged} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{nobreak\}\}{\bf{RESULTS IN}} Remodeling and now a {\bf{PERMANENTLY DYSFUNCTIONAL HEART}}} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{FEW FACTS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Most common nonfatal consequence of CV disorders} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{nobreak\}\}Heart Failure is {\bf{NOT}} a disease itself.  Instead a group of clinical syndromes characterized by:} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Volume Overload} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Inadequate tissue perfusion} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Poor Exercise Intolerance} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{LV {\bf{usually}} affected 1st} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Chronic HF}} may have both Left \& Right Failure} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{DIAGNOSIS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{\{\{nobreak\}\}Signs \& Symptoms determine which ventricle is being affected leading to the diagnosis of Left or Right Heart Failure} \tn 
% Row Count 3 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{{\bf{LEFT-SIDED S/S}} - Pulmonary}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{SOB while sleeping}} & Poss. apnea \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Dyspnea}} & Impaired gas exchange \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Orthopnea}} & \{\{nobreak\}\}Trouble breathing while lying down \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
{\bf{Inspiratory Crackles}}          Or  {\bf{Expiratory Wheezes}} & Pulmonary edema \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Constant Cough}} & Frothy, blood-tinged sputum \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.2534 cm} x{10.0166 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{RIGHT-SIDED S/S - Venous}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Swelling of legs \& hands} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Weight gain (2-3lbs/day) & Fluid Retention \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Pitting Edema} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
JVD & \{\{nobreak\}\}Estimates Central venous pressure = {\bf{RV Failure}} \tn 
% Row Count 7 (+ 3)
% Row 4
\SetRowColor{LightBackground}
Ascites & Increased abdominal girth \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
Enlarged liver (Hepatomegaly) & Fluid building up - may cause Nausea, anorexia, \& bloating \tn 
% Row Count 12 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{ASSESSMENT: {\bf{NON}}MODIFIABLE RISK FACTORS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Age}} - Elderly often need hospitalization} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{nobreak\}\}{\bf{Sex}} - Women tend to have condition later in life, survive longer w/ HF} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{{\bf{ASSESSMENT: MODIFIABLE RISKS}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Smoking} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{ETOH \& Drug Use} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Obesity} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{T2DM} \tn 
% Row Count 4 (+ 1)
% Row 4
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\mymulticolumn{1}{x{17.67cm}}{HTN} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{CAD} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{HEALTH HISTORY - ASK}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Signs \& Symptoms of dyspnea, SOB, fatigue, \& edema?} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Have you been experiencing unusual fatigue?} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Do you have SOB at rest, on exertion?} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{\{\{nobreak\}\}Address the patient's emotional well-being {\emph{(Chronic HF is linked to depression \& anxi)}}} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Do you have sleep disturbances? Do you ever wake up suddenly feeling SOB?} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{How many pillows do you sleep with?} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Explore patient's understanding of HF, self-management strategies (diet, exercise, smoking cessation)} \tn 
% Row Count 12 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Have you ever had a MI?} \tn 
% Row Count 13 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Have you had recent open heart surgery?} \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Do you have HTN?} \tn 
% Row Count 15 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Have you every been diagnosed with a dysrhythmia?} \tn 
% Row Count 16 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Do you take any medications {\emph{prescribed \& OTC}}?} \tn 
% Row Count 17 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Do you drink ETOH?} \tn 
% Row Count 18 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Do you smoke?} \tn 
% Row Count 19 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Do you use illicit drugs?} \tn 
% Row Count 20 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Do you exercise?} \tn 
% Row Count 21 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{What is your diet like?  Are you on any type of restrictions?} \tn 
% Row Count 23 (+ 2)
% Row 17
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Have you noticed acute weight gain?  {\emph{2-3 lbs/day}}} \tn 
% Row Count 24 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{PHYSICAL EXAM}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{SOB}} & Most common \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\{\{nobreak\}\}{\bf{Mental Confusion, Anxiety, Irritability}} & Hypoxia \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{Pale, cyanotic, cool, clammy skin}} & Poor Perfusion \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Peripheral edema}} & \{\{nobreak\}\}Ankles, feet, sacral area, or throughout body \tn 
% Row Count 9 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Inspiratory Crackles}}  {\emph{OR}}  {\bf{Expiratory Wheezes}} & Left-Sided Failure \tn 
% Row Count 12 (+ 3)
% Row 5
\SetRowColor{white}
{\bf{JVD}} & Right-Sided Failure \tn 
% Row Count 13 (+ 1)
% Row 6
\SetRowColor{LightBackground}
{\bf{Ascites}} & Passive liver congestion {\emph{R-Side Failure}} \tn 
% Row Count 16 (+ 3)
% Row 7
\SetRowColor{white}
{\bf{Tachypnea}} & Body compensating for hypoxia \& decreased CO \tn 
% Row Count 19 (+ 3)
% Row 8
\SetRowColor{LightBackground}
{\bf{Tachycardia}} & Body compensating for hypoxia \& decreased CO \tn 
% Row Count 22 (+ 3)
% Row 9
\SetRowColor{white}
{\bf{S3 or S4 Heart Sound}} Ventricular Gallop & Increased resistance to ventricular filling after atrial contraction \& early rapid ventricular filling \tn 
% Row Count 28 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{NURSING DIAGNOSIS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Impaired cardiac output}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{R/T}} & Impaired myocardial function \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{AEB}} & Fatigue, Dyspnea, Tachycardia, and/or BP \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\{\{br\}\} & \{\{br\}\} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Risk for ineffective health maintenance}}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
{\bf{R/T}} & \{\{nobreak\}\}Lack of knowledge regarding diagnostic \& lab procedures necessary for monitoring heart failure status \tn 
% Row Count 13 (+ 6)
% Row 6
\SetRowColor{LightBackground}
\{\{br\}\} & \{\{br\}\} \tn 
% Row Count 14 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Impaired gas exchange}}} \tn 
% Row Count 15 (+ 1)
% Row 8
\SetRowColor{LightBackground}
{\bf{R/T}} & Fluid overload \& pulmonary congestion \tn 
% Row Count 17 (+ 2)
% Row 9
\SetRowColor{white}
{\bf{AEB}} & Orthopnea, nocturnal dyspnea \& hypoxemia \tn 
% Row Count 19 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\{\{br\}\} & \{\{br\}\} \tn 
% Row Count 20 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Excess fluid volume}}} \tn 
% Row Count 21 (+ 1)
% Row 12
\SetRowColor{LightBackground}
{\bf{R/T}} & Compromised heart function \& renal perfusion \tn 
% Row Count 24 (+ 3)
% Row 13
\SetRowColor{white}
{\bf{AEB}} & Peripheral edema, ascites, \& weight gain \tn 
% Row Count 26 (+ 2)
% Row 14
\SetRowColor{LightBackground}
\{\{br\}\} & \{\{br\}\} \tn 
% Row Count 27 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Acute Pain}}} \tn 
% Row Count 28 (+ 1)
% Row 16
\SetRowColor{LightBackground}
{\bf{R/T}} & Decreased myocardial oxygenation \tn 
% Row Count 30 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{NURSING DIAGNOSIS (cont)}}  \tn
% Row 17
\SetRowColor{LightBackground}
{\bf{AEB}} & Reports of chest pain or discomfort exacerbated by physical exertion or stress \tn 
% Row Count 4 (+ 4)
% Row 18
\SetRowColor{white}
\{\{br\}\} & \{\{br\}\} \tn 
% Row Count 5 (+ 1)
% Row 19
\SetRowColor{LightBackground}
\{\{nobreak\}\}{\bf{Ineffective tissue perfusion}} & (cardiopulmonary) \tn 
% Row Count 8 (+ 3)
% Row 20
\SetRowColor{white}
{\bf{R/T}} & Decreased cardiac output \tn 
% Row Count 10 (+ 2)
% Row 21
\SetRowColor{LightBackground}
{\bf{AEB}} & Altered mental status, cool \& clammy skin, decreased urine output \tn 
% Row Count 14 (+ 4)
% Row 22
\SetRowColor{white}
\{\{br\}\} & \{\{br\}\} \tn 
% Row Count 15 (+ 1)
% Row 23
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Imbalanced nutrition: Less than body requirements}}} \tn 
% Row Count 17 (+ 2)
% Row 24
\SetRowColor{white}
{\bf{R/T}} & Dietary restrictions and fluid management in heart failure \tn 
% Row Count 20 (+ 3)
% Row 25
\SetRowColor{LightBackground}
{\bf{AEB}} & Confusion about low-sodium diet recommendations \& fluid intake limits \tn 
% Row Count 24 (+ 4)
% Row 26
\SetRowColor{white}
\{\{br\}\} & \{\{br\}\} \tn 
% Row Count 25 (+ 1)
% Row 27
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Activity intolerance}}} \tn 
% Row Count 26 (+ 1)
% Row 28
\SetRowColor{white}
{\bf{R/T}} & Imbalance between oxygen supply \& demand \tn 
% Row Count 28 (+ 2)
% Row 29
\SetRowColor{LightBackground}
{\bf{AEB}} & Reports of fatigue, dyspnea on exertion \& decreased endurance \tn 
% Row Count 32 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{NURSING DIAGNOSIS (cont)}}  \tn
% Row 30
\SetRowColor{LightBackground}
\{\{br\}\} & \{\{br\}\} \tn 
% Row Count 1 (+ 1)
% Row 31
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Anxiety}}} \tn 
% Row Count 2 (+ 1)
% Row 32
\SetRowColor{LightBackground}
{\bf{R/T}} & Changes in health status \& uncertainty about the future due to their condition, noticeable restlessness, frequent questions about their prognosis, and expressed concerns regarding the effects of their illness on family roles and responsibilities \tn 
% Row Count 15 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{\{\{nobreak\}\}INTERVENTIONS R/T NURSING DIAGNOSIS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Decrease in Cardiac Output}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{CAUSE:}}  Heart muscle weakens or becomes stiff, impairing it's ability to contract \& relax properly.} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{nobreak\}\}{\bf{Prevent the progression of the disease \& decrease the risk of complications}}} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GOAL:}}  Early recognition \& management of decreased CO improves patient outcomes \& quality of life.} \tn 
% Row Count 9 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{~} \tn 
% Row Count 10 (+ 1)
% Row 5
\SetRowColor{white}
{\bf{INTERVENTIONS}} & {\bf{RATIONAL}} \tn 
% Row Count 11 (+ 1)
% Row 6
\SetRowColor{LightBackground}
{\bf{1.}} \{\{nobreak\}\}Auscultate apical pulse \& assess HR & \{\{nobreak\}\}- Body's 1st defense to compensate for reduced CO \tn 
% Row Count 14 (+ 3)
% Row 7
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{\bf{Objective}} Tachycardia = early sign of HF & \{\{nobreak\}\}Persistent tachycardia is harmful \& may worsen HF \tn 
% Row Count 17 (+ 3)
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{\bf{2.}} Obtain a comprehensive health history focusing on HF symptoms \& self-management strategies & \{\{nobreak\}\}Understanding patient's health history helps ID S/S of worsening HF \tn 
% Row Count 22 (+ 5)
% Row 9
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 & \{\{nobreak\}\}Also IDs patient's understanding and adherence to self-management strategies \tn 
% Row Count 27 (+ 5)
% Row 10
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{\bf{3.}} Note heart sounds & An extra heart sound is caused by a large volume of fluid entering ventricle at the beginning of diastole \tn 
% Row Count 33 (+ 6)
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{\{\{nobreak\}\}INTERVENTIONS R/T NURSING DIAGNOSIS (cont)}}  \tn
% Row 11
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{\bf{Objective}} S3 (ventricular gallop) & {\bf{Indicates}} worsening HF \tn 
% Row Count 2 (+ 2)
% Row 12
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{\bf{4.}} \{\{nobreak\}\}Assess rhythm \& document dysrhythmias & A-Fib is common \& promotes thrombus formation within the atria \tn 
% Row Count 6 (+ 4)
% Row 13
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{\bf{Subjective}} "Patient reports fast HR" & {\bf{Occurrence}} increases with HF severity \tn 
% Row Count 9 (+ 3)
% Row 14
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{\bf{5.}} \{\{nobreak\}\}Assess for palpitations or fast HR & \{\{nobreak\}\}Palpitations occur due to dysrhythmias. \tn 
% Row Count 12 (+ 3)
% Row 15
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{\bf{Subjective}} "Patient reports fast HR, ""flutter" feeling" & Fast HR may be compensation mechanism trying to get more blood flow back to the heart \tn 
% Row Count 17 (+ 5)
% Row 16
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{\bf{6.}} \{\{nobreak\}\}Palpate peripheral pulses & \{\{nobreak\}\}Decreased CO may diminish radial, popliteal, dorsalis pedis, and post-tibial pulses. \tn 
% Row Count 22 (+ 5)
% Row 17
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\{\{nobreak\}\}{\bf{Objective}}  Decreased pulse volume, cool, pale or cyanotic skin = {\bf{decreased CO}} & {\bf{Evaluation}} helps determine adequacy of peripheral perfusion \tn 
% Row Count 27 (+ 5)
% Row 18
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\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 27 (+ 0)
% Row 19
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{\bf{7.}} Monitor BP & Chronic HF, BP is used as a parameter to determine the adequacy or excess dosage of meds (ACEi) \tn 
% Row Count 32 (+ 5)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{\{\{nobreak\}\}INTERVENTIONS R/T NURSING DIAGNOSIS (cont)}}  \tn
% Row 20
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{\bf{8.}} Inspect the skin for mottling & \{\{nobreak\}\}R/T decreased perfusion to the skin \tn 
% Row Count 3 (+ 3)
% Row 21
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{\bf{Objective}}blue/grey skin coloring & \{\{nobreak\}\}In chronic HF increased capillary oxygen extraction, skin appears dusky \tn 
% Row Count 8 (+ 5)
% Row 22
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{\bf{9.}} Inspect skin for pallor or cyanosis & {\bf{R/T}} to diminished perfusion \tn 
% Row Count 11 (+ 3)
% Row 23
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\mymulticolumn{2}{x{17.67cm}}{{\bf{Objective}} Cool, clammy skin} \tn 
% Row Count 12 (+ 1)
% Row 24
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{\bf{10.}} \{\{nobreak\}\}Monitor urine output, noting decreasing output \& concentrated urine & {\bf{R/T}} decreased renal perfusion \tn 
% Row Count 17 (+ 5)
% Row 25
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{\bf{Subjective}} Oliguria & \{\{nobreak\}\}Fluid shifts into tissues during the day \tn 
% Row Count 20 (+ 3)
% Row 26
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{\bf{Subjective}} Nocturia & \{\{nobreak\}\}Increased renal perfusion during supine position \tn 
% Row Count 23 (+ 3)
% Row 27
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{\bf{11.}} \{\{nobreak\}\}Examine LE for edema and rate it's severity & \{\{nobreak\}\}{\bf{Helps}} evaluate fluid status \& guide diuretic therapy \& fluid management \tn 
% Row Count 28 (+ 5)
% Row 28
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\mymulticolumn{2}{x{17.67cm}}{{\bf{Objective}} Pitting Edema} \tn 
% Row Count 29 (+ 1)
% Row 29
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{\bf{12.}} Assess the abdomen for tenderness, hepatomegaly, and ascites & {\bf{Provides}} info on potential complications, guides interventions \& Tx \tn 
% Row Count 33 (+ 4)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{\{\{nobreak\}\}INTERVENTIONS R/T NURSING DIAGNOSIS (cont)}}  \tn
% Row 30
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{\bf{13.}} Assess jugular vein distention & \{\{nobreak\}\}{\bf{Estimates}} central venous pressure \& IDs RV failure. \tn 
% Row Count 4 (+ 4)
% Row 31
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\mymulticolumn{2}{x{17.67cm}}{{\bf{Objective}} Distention greater than 4 cm} \tn 
% Row Count 5 (+ 1)
% Row 32
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{\bf{14.}} Monitor Labs \& Diagnostics & {\bf{Goal}} in diagnosis is to find the underlying cause of HF \& patient's response to Tx \tn 
% Row Count 10 (+ 5)
% Row 33
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{\bf{15.}} Monitor O2 sats \& ABGs & {\bf{Useful}} in establishing Dx \& severity of HF \tn 
% Row Count 13 (+ 3)
% Row 34
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 & {\bf{Provides}} info regarding the heart's ability to perfuse distal tissues w/ O2 blood \tn 
% Row Count 18 (+ 5)
% Row 35
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{\bf{16.}} Give O2 as indicated by the patient's symptoms, O2 sats, \& ABGs & {\bf{Increases}} O2 availability to the myocardium \tn 
% Row Count 22 (+ 4)
% Row 36
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 & {\bf{Helps}} relieve symptoms of hypoxemia, ischemia, \& subsequent activity intolerance \tn 
% Row Count 27 (+ 5)
% Row 37
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{\bf{17.}} Provide a restful environment & {\bf{Minimizing}} controllable stressors \& unnecessary disturbances reduces the cardiac workload \tn 
% Row Count 32 (+ 5)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{\{\{nobreak\}\}INTERVENTIONS R/T NURSING DIAGNOSIS (cont)}}  \tn
% Row 38
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 & {\bf{Providing}} physical \& emotional rest allows patient to conserve energy \tn 
% Row Count 4 (+ 4)
% Row 39
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{\bf{18.}} Assist the patient into a High-Fowler's position & {\bf{Allows}} better chest expansion = improved pulmonary capacity \tn 
% Row Count 8 (+ 4)
% Row 40
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 & {\bf{Reduced}} venous return to the heart \tn 
% Row Count 10 (+ 2)
% Row 41
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 & {\bf{Relieves}} pulmonary congestion \tn 
% Row Count 12 (+ 2)
% Row 42
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 & {\bf{Minimizes}} pressure on the diaphragm \tn 
% Row Count 14 (+ 2)
% Row 43
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{\bf{19.}} Check for calf tenderness, diminished pedal pulses, swelling, local redness or pallor of extremity & {\bf{Prolonged}} sedentary position increases the risk of thrombophlebitis, reduces CO, and increases venous pooling \tn 
% Row Count 20 (+ 6)
% Row 44
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{\bf{20.}} Encourage activity as tolerated & **Chronic HF patient's should aim for 30 mins of physical activity daily \tn 
% Row Count 24 (+ 4)
% Row 45
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\mymulticolumn{2}{x{17.67cm}}{{\bf{21.}} Monitor for S/S of:} \tn 
% Row Count 25 (+ 1)
% Row 46
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Fluid Imbalance & Fluid shifts \& diuretics can cause excessive diuresis, leading to HYPOKALEMIA \tn 
% Row Count 29 (+ 4)
% Row 47
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Electrolyte Imbalances & S/S HYPOKALEMIA: VTach, Hypotension, Gen. weakness \tn 
% Row Count 32 (+ 3)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{\{\{nobreak\}\}INTERVENTIONS R/T NURSING DIAGNOSIS (cont)}}  \tn
% Row 48
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 & ACEi \& ARBs can cause HYPERKALEMIA \tn 
% Row Count 2 (+ 2)
% Row 49
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{\bf{22.}} Monitor Tele monitor \& CXR & Can indicate underlying cause of HF \tn 
% Row Count 4 (+ 2)
% Row 50
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 & CXR:  May show enlarged heart \& pulmonary congestion \tn 
% Row Count 7 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\end{document}