1. Floating Topic
2. Pathophysiology:
   1. inability of the heart topump sufficient blood to meet oxygen demands of tissues
   2. leads to pulmonary congestion and systemic edema
   3. inability of the heart to clear venous return leading to vascular congestion resulting in pulmonary and systemic edema
3. Treatments
   1. NonSurgical
      1. ACE inhibitors
         1. Examples
      2. ARBs
      3. Diuretics
      4. Cardiac Glycosides
      5. Anticoagulants
   2. Surgical
      1. heart transplant
      2. valve replacement
      3. CABG
      4. ventricular reconstructive surgeries
4. Decreased Cardiac Output
   1. S/Sx
      1. Signs and Symptoms
      2. low BP
      3. high HR
      4. low urine output
      5. decreaed peripheral pulses
      6. cold clammy skin
      7. dyspnea
      8. edema
      9. restlessness
      10. dysrhythmias
      11. extra heart sounds (S3, S4)
      12. fatigue
      13. PND, orthopnea
   2. NICs
      1. assess AP, peripheral pulses, BP, S1S2
      2. assess lungs sounds, O2 Sat,
      3. assess urine output and electrolytes, BNP
      4. weigh daily
      5. administer meds (diuretics, ACE inhibitors, beta blockers,vasodilators, inotropes, antidysrythmics)
      6. teach low sodium diet
      7. restrict fluids
5. Risk for Alteration in Electrolyte Imbalance
   1. Risk FActors
      1. Risk Factors
      2. decreased renal perfusion
      3. diuretic therapy
      4. low sodium diet
   2. NICs
      1. monitor serum electrolytes
      2. monitor fluid losses and gains
      3. monitor digoxin level and effects in presence of hypokalemia
      4. For Hyponatremia
         1. enc Na restriction as prescribed
         2. enc fluid restriction as indicated
         3. administer prescribed diuretics
      5. For Hypokalemia
         1. administer oral or IV supplements as prescribed
         2. enc daily intake of K-rich foods
      6. for hypomagnesemia
         1. administer prescribed magnesium replacement as indicated
      7. For hypernatremia
         1. carefully replace water orally or IV
         2. anticipate reduction in diuretic dosage
      8. For nonacute hyperkalemia
         1. anticipate reduction in potassium supplement
         2. provide diet with potassium restriction as prescribed
         3. discontinue potassium-sparing diuretics as prescribed
         4. instruct re: avoiding salt substitutes containing potassium
      9. for acute hyperkalemia
         1. ECG monitoring
         2. administer regular IV insulin and hypertonic dextrose
         3. sodium bicarbonate
         4. cation-exchange resins
         5. IV calcium chloride
         6. dialysis
6. Activity Tolerance
   1. S/Sx
      1. Signs/Symptoms
         1. Patient Findings
      2. fatigue and weakness
      3. inability to perform ADLs
      4. abnormal physical response to activity
      5. exertional dyspnea
   2. NICs
      1. Assess current level of activity
      2. observe response to activity
      3. monitor sleep pattern
      4. evaluate need for O2 during increased activity
      5. use slow progression of activity
      6. teach appropriate environmental aides (BSC, hand rails)
      7. teach energy conservation techniques
      8. PT consult for assistance in increasing activity
      9. teach to recognize signs of overexertion
7. Fluid Volume Excess
   1. S/Sx
      1. Signs and Symptoms
         1. Patient Findings
      2. weight gain
      3. edema
      4. crackles
      5. JVD
      6. elevated CVP & PCWP
      7. Ascites/hepatojugular reflux
      8. Decreased urine output
   2. NICs
      1. monitor weight
      2. assess presence of edema
      3. monitor urine output
      4. assess lung sounds, JVD, ascites, abdominal girth
      5. restrict sodium and fluids
      6. administer and instruct re: diuretics
      7. instruct re: meds that cause fluid retention