Question

Please l need a nursing care plan of congestive heart failure using  rubric bellow:

Medical Diagnosis:

1) Definition of medical diagnosis                                                  ___________________________5

Etiology/pathophysiology

2) Common sign/symptoms ___________________________5

3) Potential complications                                                               ___________________________5

4) Expected assessment findings:                                                 __________________________10

            Head to toe assessment

5) Diagnostic studies/labs __________________________5       Normal values

   Expected abnormalities

6) All NANDA Nursing Diagnoses _________________________10

7) Develop 3 NANDA Priority Nursing diagnosis __________________________10

8) State patient goals/plan                                                           

            nursing diagnosis                                                                  __________________________10

9) Write interventions for your plan __________________________10

10) Scientific rationale for interventions __________________________5

11) Write how you would evaluate your plan

            what potentially may need

            revision                                                                                  __________________________10

12) List of medications typical for the __________________________15

            medical diagnosis

            usual dosage

            side effect

            educational considerations

Answer 1

1. Defination of medical diagnosis congestive heart failure - It is the inability of the heart to pump sufficient blood to meet the demands of tissue for oxygen and nutrients . It is of two types :-

- Right sided heart failure

- Left sided heart failure

2. Common signs and symptoms of congestive heart failure depending upon the side affected are :-

Left side heart failure :-

- dyspnea

- cough

- crackles

- extra heart sounds

- orthopnoea

- paroxysmal nocturnal dyspnea

- frothy sputum

- oliguria

- nocturia

- dizziness

- lightheadedness

- confusion

- anxiety

- pale skin

- restlessness

- cool and clammy skin

- tachycardia

- weak ,thready pulse

- fatigue

Right side heart failure :-

- edema of lower extremity

- ascitis

- anorexia

- nausea

- weakness

- weight gain

- hepatomegaly

- splenomegaly

- juglur vein distension

3. Potenty complications of congestive heart failure are :-

- Hypotension

- Poor perfusion

- Cardiogenic shock

- Dysarythmias

- Thromboembolism

- Pericardial effusion

- Cardiac tamponade

4. Expected assessment findings include :-

- Ask patient about edema , abdominal symptoms , altered mental status , activities of daily living and the activities that cause tiredness

- Ask the patient for sleep disturbances due to shortness of breath .

- Auscultate lungs for crackles , assess the rate and rythm of respiration

- Auscultate for extra heart sounds and assess the heart rate and rythm

- Assess the sensorium and level of consciousness

- Assess dependent parts of the body for perfusion ,edema etc .

- Assess for hepatomegaly , juglar vein distension , splenomegaly

- Measure the intake and output to detect oliguria or anuria

- Assessment of weight