Decreased participation in usual social activities
Use/misuse of cardiac medications, e.g., beta-blockers, calcium channel blockers
Recent/recurrent hospitalizationsEvidence of failure to improve
DRG projected mean length of inpatient stay: 5.5 days
Assistance with shopping, transportation, self-care needs, homemaker/maintenance tasksAlteration in medication use/therapyChanges in physical layout of home
Refer to section at end of plan for postdischarge considerations.
Ventricular or atrial hypertrophy, axis deviation, ischemia, and damage patterns may be present. Dysrhythmias,e.g., tachycardia, atrial fibrillation, conduction delays, especially left bundle branch block, frequent prematureventricular contractions (PVCs) may be present. Persistent ST-T segment abnormalities and decreased QRSamplitude may be present.
May show enlarged cardiac shadow, reflecting chamber dilation/hypertrophy, or changes in bloodvessels, reflecting increased pulmonary pressure. Abnormal contour, e.g., bulging of left cardiac border, maysuggest ventricular aneurysm.
Sonograms (echocardiogram, Doppler and transesophageal echocardiogram):
May reveal enlarged chamber dimensions, alterations in valvular function/structure, the degrees of ventricular dilation and dysfunction.
Heart scan (multigated acquisition [MUGA]):
Measures cardiac volume during both systole and diastole, measuresejection fraction, and estimates wall motion.
Exercise or pharmacological stress myocardial perfusion (e.g., Persantine or Thallium scan):
Determines presenceof myocardial ischemia and wall motion abnormalities.
Positron emission tomography (PET) scan:
Sensitive test for evaluation of myocardial ischemia/detecting viablemyocardium.
Abnormal pressures are indicative and help differentiate right- versus left-sided heart failure,as well as valve stenosis or insufficiency. Also assesses patency of coronary arteries. Contrast injected into theventricles reveals abnormal size and ejection fraction/altered contractility. Transvenous endomyocardial biopsymay be useful in some patients to determine the underlying disorder, such as myocarditis or amylodosis.
Elevated in liver congestion/failure.
Digoxin and other cardiac drug levels:
Determine therapeutic range and correlate with patient response.
Bleeding and clotting times:
Determine therapeutic range; identify those at risk for excessive clot formation.
May be altered because of fluid shifts/decreased renal function, diuretic therapy.
Oxygen saturation may be low, especially when acute HF is imposed on chronic obstructive pulmonary disease (COPD) or chronic HF.
Arterial blood gases (ABGs):
Left ventricular failure is characterized by mild respiratory alkalosis (early) or hypoxemia with an increased P
Elevated BUN suggests decreased renal perfusion. Elevation of both BUN and creatinine isindicative of renal failure.
May be decreased as a result of reduced protein intake or reduced protein synthesis incongested liver.
Complete blood count (CBC):
May reveal anemia, polycythemia, or dilutional changes indicating water retention.Levels of white blood cells (WBCs) may be elevated, reflecting recent/acute MI, pericarditis, or other inflammatory or infectious states.
May be elevated, indicating acute inflammatory reaction.
Increased thyroid activity suggests thyroid hyperactivity as precipitator of HF.
1. Improve myocardial contractility/systemic perfusion.2. Reduce fluid volume overload.3. Prevent complications.4. Provide information about disease/prognosis, therapy needs, and prevention of recurrences.