Clinical Findings: Left-sided HF

Neuro: Anxiety, restlessness, dizziness, confusion, decreased LOC.

Resp: SOB, respiratory distress, dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), nonproductive cough, pulmonary crackles, wheezes, frothy, pink-tinged sputum, hemoptysis, pulmonary edema.

CV: CP, chest pressure, palpitations, tachycardia, thready pulse, JVD, S₃ gallop, hypertension, hypotension.

Skin: Coolness, pallor, diaphoresis.

GI/GU: Nausea and vomiting, UO <30 mL/hr.

MS: Weakness, fatigue.

Clinical Findings: Right-sided HF

Neuro: Generally alert and oriented.

Resp: Generally, in no distress.

CV: HTN, JVD, hepatojugular reflux.

Skin: Peripheral edema, initially dependent then pitting, anasarca.

GI/GU: Nausea, nocturia

MS: RUQ pain, weight gain, hepatomegaly, ascites, anorexia

Collaborative Management

• Primary goal in managing HF is to maintain CO.
• Secondary goal is to decrease venous (capillary) pressure to limit edema.
• Monitor cardiac, respiratory, renal, and neurological status.
• Position Pt in Fowler’s position.
• Monitor SpO₂. Administer O₂, prepare to assist with intubation. Consider noninvasive positive pressure ventilation first.
• Provide continuous ECG monitoring.
• Monitor hemodynamic status.
• Weigh daily and assess edema.
• Enforce sodium and fluid restrictions.
• Assess fluid and electrolyte balance.
• Provide maximum rest. Cluster activities.
• Administer medications as ordered to control edema and fluid retention.
• Avoid NSAIDs and calcium channel blockers, which may exacerbate HF.
• Obtain IV access and administer IVF as ordered.
• Administer STAT medications as ordered.
• Notify HCP of change in Pt status.
• Transfer to ICU if condition continues or worsens.