Prioritize CHF diagnoses: decreased cardiac output → excess fluid volume → impaired gas exchange → activity intolerance → deficient knowledge. Core interventions: HOB 30–45°, O₂ to SpO₂ ≥ 92%, IV loop diuretic with I&O + daily weight + K⁺ monitoring, GDMT (beta-blocker + ACEi/ARB/ARNI + MRA), 2 g Na diet, and daily-weight teaching (call if ↑ 2 lb overnight or 5 lb weekly).
Assessment (subjective + objective)
Subjective: dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, fatigue, weight gain.
Objective: crackles bilaterally, S3 gallop, JVD, hepatojugular reflux, dependent pitting edema, SpO₂ ↓, weight ↑ > 2 lb in 24 h, BNP > 400, EF < 40%.
Priority NANDA-I diagnoses
- Decreased cardiac output related to altered contractility AEB EF 25%, S3 gallop, SBP 92 mmHg.
- Excess fluid volume AEB 3+ pitting edema, weight ↑ 3 kg, JVD.
- Impaired gas exchange AEB SpO₂ 88%, crackles.
- Activity intolerance.
- Deficient knowledge (sodium restriction, daily weights).
NOC outcomes (SMART)
- SpO₂ ≥ 92% on ≤ 2 L NC within 24 h.
- Urine output ≥ 1,500 mL/24 h after diuresis.
- Weight loss ≥ 1 kg/24 h until euvolemic.
- Patient verbalizes ≥ 3 warning signs of worsening HF.
NIC interventions and rationale
- Elevate HOB 30–45° — reduces preload; improves diaphragmatic excursion.
- Titrate O₂ to SpO₂ ≥ 92% — corrects hypoxemia.
- IV loop diuretic; monitor I&O, daily weight, K⁺, creatinine — reduces preload.
- Continuous cardiac monitoring — HF patients prone to arrhythmia.
- Fluid restriction 1.5–2 L/day; sodium < 2 g/day.
- GDMT: beta-blocker + ACEi/ARB/ARNI + MRA — reduces mortality.
- Teach daily weight and "call if ↑ 2 lb overnight or 5 lb weekly" — prevents readmission.
- Refer to cardiac rehab and HF clinic.
Evaluation
By day 3: SpO₂ 95% RA; net negative 4 L; weight down 3 kg; lungs clear; patient demonstrates daily-weight log and lists 3 warning signs. Outcomes met.