CHF exacerbation — care plan (academic case study)
Cardiac Output Alteration related to reduced left ventricular function (EF 35%).
- Monitor BP, HR, and SpO₂ q4h; document trends and report variances.
- Auscultate heart and lung sounds q shift; note S3/S4 and crackles.
- Assess for activity intolerance with ADLs.
Fluid Volume Excess related to impaired cardiac output and sodium/water retention.
- Maintain strict I&O and daily weight at the same time, same scale.
- Administer ordered diuretics; monitor electrolytes (K+, Mg) afterward.
- Assess for JVD, peripheral edema, and pulmonary crackles each shift.
- Reinforce low-sodium diet and 2L fluid restriction.
Activity Intolerance related to impaired oxygenation and decreased cardiac output.
- Cluster activities to allow rest periods.
- Monitor RR, HR, and SpO₂ before, during, and after activity.
- Coordinate with PT for graded activity progression.
Knowledge Deficit related to home self-management of CHF.
- Teach the patient to weigh daily and call provider for >2 lb in 24h or 5 lb in a week.
- Provide written medication list and review purpose of each medication.
- Reinforce smoking cessation, low-sodium diet, and follow-up scheduling.
Coordinate with cardiology, dietary, case management, and home health for discharge readiness. Use the nursing process (DPIE) to evaluate care plan effectiveness each shift.
