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Clinical Guidelines: Heart Failure - Nurse
Management
KEY RECOMMENDATIONS
Focus: RNs & Case Managers
1) Diagnosis/Assessment
Patients undergoing evaluation for heart failure require:
- Establishment of baseline and ongoing
physical assessment with special attention to symptoms specific to
heart failure
- Assessment of functional status and
identification of NYHA severity classification
- Assessment of patient/family baseline
knowledge of disease
- Lifestyle evaluation
- Assessment of barriers to care
- Home safety evaluation
2) Patient/Family Education and
Counseling
Patients and/or appropriate family members require a structured,
customized approach to understanding and effectively managing the
disease:
- Present the benefits of
self-management
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Improved
survival |
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Improvement
in symptoms, quality of life and functional status |
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Decreased
hospitalizations |
- Present key topics
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Disease
etiology and prognosis |
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Sodium
and fluid recommendations |
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Added
load on the heart |
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Connection
to daily weight checks |
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Symptom
monitoring and management |
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Activity/exercise
progression |
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Risk
factor modification |
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End of
life/advanced care planning |
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Patient
/family role in controlling progression |
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Mental
health |
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Role
of medications in disease management |
3) Medication Therapy
Treatment is directed to relieving congestion and slowing progression of
the disease; and effectiveness is grounded in compliance,
self-management, and consistent clinician monitoring.
- Explain the expected benefits and
outcome goals for each medication
- Review side effects and appropriate
response/action
- Discuss barriers to and strategies for
taking prescribed medications
4) Patient Monitoring
Frequent contact to evaluate the treatment plan and determine the
stability of symptoms, weight and activity tolerance is necessary.
Effective monitoring includes reinforcement of the treatment plan and
daily self-management skills (daily weights, assessment for edema, and
assessment for compliance with recommended diet and fluid parameters,
activity, and prescribed medications).
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