Nursing management :

1. Monitor vital signs and oxygen saturation

as indicated. Decrease cardiac output
stimulates the SNS to increase the heart
rate in an attempt to restore CO.
tachycardia at rest is common. Diastolic
pressure may initially be elevated because
of vasoconstriction . Oxygen saturation
levels provide a measure of gas exchange
and tissue perfusions.
2. Assess respiratory status and auscultate
lung sounds at least every 4 hours. Notify
the physician of significant changes in
conditions. Declining respiratory status
indicates worsening left heart failure
3. Administer supplement oxygen as needed.
Nasal prong 3L/min, facemask oxygen 5 –
8L/min to improve oxygenation of the
blood, decreasing the effects of hypoxia
and ischemia.
4. Encourage rest, elevate the head of the
bed 45 – 90 degree to reduce the work of
breathing.
5. Provide a bedside commode and assist
with activities of daily living (ADLs).
Instruct to avoid the Valsalva maneuver.
These measures reduce cardiac workload.
6. Promote psychological rest and decrease
anxiety. Maintain a quiet environment and
encourage expression of fears and feelings.
Psychologic rest decrease oxygen
consumption and improves cardiac output.
7. Monitor intake and output. Notify the
physician if urine output is less 3ml/h. also
monitor weight daily to measure of fluid
status. A fall in urine output may indicate
significantly reduced cardiac output and
renal ischemia.
8. Monitor and recorded hemodynamic
pressure to measure peripheral arterial
pressure or central pressure such as central
venous pressure (CVP) or right arterial
pressure to evaluate cardiac and
circulatory function and response to
interventions. Report any significant
changes and negative trends.
9. Restrict fluids as ordered. Allow choices of
fluid types and timing of intake, scheduling
most fluid intake during morning and
afternoon hours. Offer ice chips and
frequents mouth care. Provide hard
candies if allowed. Providing choices
increases the client’s sense of control. Ice
chips, hard candies and mouth care relieve
dry mouth and thirst and promote
comfort.
10.Record abdominal girth every shift. Note
complaint of a loss of appetite, abdominal
discomfort or nausea. Venous congestion
can lead to ascites and may affect
gastrointestinal function and nutritional
status.
11.Encourage small, frequent meals rather
than three heavy meals per day to provide
continuing energy resources and decrease
the work required to digest a large meal.
12. Consult with dietitian to plan and teach a
low sodium diet and if necessary for
weight control low calorie diet. Provide a
list of high sodium, high fat, high
cholesterol food to avoid. Dietary planning
and teaching increase the client’s sense of
control and participation in disease
management.
13. Plan and implement progressive activities.
Use passive and active range of motion
(ROM) exercise exercises as appropriate.
Consult with physical therapist on activity
plan. Progressive activity slowly increase
exercise capacity by strengthening and
improve cardiac function without strain.
Activity also prevent skeletal muscle
atrophy.