Nursing Interventions for Heart Failure-A Student’s Guide

Introduction

The intervention for heart failure is often a balancing act of medications, diet, exercise, and other therapies. The goal is to help the patients with their symptoms, and improve their quality of life while also preventing complications such as arrhythmias or congestive heart failure. This post will discuss some common interventions that nurses may use when caring for patients with heart failure.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What is Heart Failure?

Heart failure is a chronic condition in which the heart can’t pump enough blood to meet the body’s needs. It occurs when the force of contraction decreases because it does not receive enough oxygen and nutrients from the blood flowing through its chambers.

Types of Heart Failure

There are two types of heart failure depending on the type of underlying disease that has caused it.  

1. Congestive Heart Failure – results from an inability of the left ventricle to fill with blood upon relaxation and a diminished stroke volume (the amount of blood ejected with each contraction). This produces increased pressure in the left ventricle and pulmonary vascular bed.  

2. Restrictive Cardiomyopathy – is caused by the loss of heart muscle, usually because of a disease or an injury.

The pathophysiology of cardiomyopathy is different from that of congestive heart failure in that it does not involve the left ventricle. Also, with cardiomyopathy, there is a decreased ventricular compliance, and the stiffness of the heart muscle increases.

Who is at Greatest Risk for Heart Failure?

Stroke, heart attack, or coronary artery disease greatly increases the risk of developing heart failure. Other diseases, such as diabetes and kidney disease, may also increase one’s risk. 

The risk of heart failure is also affected by the presence of any disease related to the kidneys, such as;

•   High blood pressure (hypertension) 

•  Diabetes mellitus and metabolic syndrome 

• Chronic kidney disease (CKD) 

Other Risk Factors for Heart Failure

Older, obese, and people with a family history of heart disease are more likely to develop it.

Signs and Symptoms of Heart Failure

The common signs and symptoms of heart failure include;

• Dyspnea

• Palpitations (awareness of the heartbeat in one’s chest) and other arrhythmias 

• Swelling in legs or feet with fluid retention  

• Tiredness that is worse at night 

•  Easy fatigue on minimal exertion (e.g., walking to the mailbox or taking out the trash) 

• Anxiety and depression 

The advanced symptoms of heart failure may include;

• Cold sweat and clammy skin 

• Dizziness and lightheadedness 

• Vomiting, nausea, and loss of appetite

• Fatigue that doesn’t improve with rest 

• Grunting breathing or orthopnea (breathless at night) 

Heart Failure Nursing Diagnosis

Several nursing diagnoses could be used when caring for patients with heart failure. Some of the more common ones include;

Anxiety – occurs because those who suffer from heart failure may have symptoms such as shortness of breath, fatigue, and palpitations, resulting in constant worry about their health. Excessive anxiety may lead to depression and may affect the ability of the individual to carry out daily activities. 

Diarrhea – because heart failure commonly causes hypoproteinemia, a deficiency of protein in the blood, it can cause an inability to control bowel movements or trouble with defecation. This may prove to be embarrassing for the patient and have a negative impact on their well-being. 

Decreased Cardiac Output – like congestive heart failure (CHF), restrictive cardiomyopathy is caused by decreased cardiac output due to impaired ventricular function, resulting in insufficient blood flow through the body. Because of this, heart failure patients may develop clinical signs such as peripheral edema and shortness of breath.  

Chronic Pain – heart failure can be associated with chronic pain due to the stress on the body from the reduced cardiac output and fluid overload (edema).

Activity intolerance– those who suffer from heart failure are often limited in the amount of physical activity they can participate in, which may severely impact their quality of life. 

Disuse syndrome – as with any chronically debilitating disease, disuse syndrome is a common reaction for patients to withdraw from participating in activities they previously enjoyed. This may lead to depression and feelings of hopelessness.  

Fluid Overload – heart failure is commonly related to fluid overload, which can be dangerous and lead to complications such as pulmonary edema. 

Chest X-ray – The doctor may order a chest X-ray to check for heart enlargement and possible fluid in the lungs. 

You may also check Comprehensive Nursing Diagnosis for Heart Failure

Nursing Care Plan for Heart Failure

The Plan of Care for Heart failure is important because it focuses on the nursing process of assessment, diagnosis, planning, and implementation. It includes evaluation of pharmacological needs and physical and psychological considerations needed to have an effective plan of care for treating heart failure patients and family members/ loved ones.

It will also help heart failure patients cope with their feelings and the physical limitations resulting from the disease. It’s important to tailor your plan of care to each patient based on their specific needs. Some people may need medications, others may require more rest, while some may benefit from simply talking about how they feel.

• Place the patient in a semi-Fowler position to promote comfort and decrease dyspnea. The semi-Fowler is slightly elevated, which will decrease the chances of developing edema (fluid retention) because it promotes venous return and decreases venous pressure while still allowing heart failure patients to breathe normally.  

• Monitor the patient’s heart and lungs for abnormal sounds.  

• Allow the patients to rest. Discuss their feelings regarding the disease and any expectations they may have (as a nurse, this is an important part of your role in taking care of patients as you are there to facilitate communication about matters that both parties feel uncomfortable discussing).   

• Assist the heart failure patients with mobility as needed.  

• Instruct the patients on how to perform range of motion exercises regularly. This is an important part of helping them cope with heart failure because this will increase their mobility and help with the performance of ADLs. Doing these exercises will also promote feeling better about oneself

Nursing Intervention-Heart Failure Patient Assessment

Assess patient’s stable versus unstable symptoms (treatable acute exacerbation)

• Check vital signs, including blood pressure and respiratory rate. If the patient is experiencing acute discomfort, administer oxygen or have the patient sit up and lean forward with a head drop. If the patient is breathing rapidly, watch for signs of anxiety or agitation (e.g., restlessness, speaking too quickly and too loudly) and provide reassurance that a doctor will see them.

Assess pain level: verify the patient’s pain level with a 0-10 rating scale or asks “How much does it hurt?” (Be sure to specify which area of the body is being assessed) and use nonverbal cues such as facial expressions, body movements, or sighing.

Assess heart failure patient’s need for further medication or referrals: ask about the patient’s medications and inquire about any possible allergies.

Assess patient’s nutritional status: ask about meal preparation, frequency of eating, and the amount consumed at each meal. If the patient is not eating or drinking enough fluid to be clear in speech and alert, suggest that they eat more often or drink a sports beverage with electrolytes.

Assess patient’s ability to carry out ADLs and social activities: determine if the patient can prepare meals, do laundry, or go grocery shopping. If they have a decreased appetite or difficulty with eating due to heart failure, it may be necessary for the caregiver to prepare meals for them to ensure that they are maintaining adequate nutrition.

Assess patient’s exercise tolerance: determine if the patient has increased shortness of breath, fatigue, or decreased stamina and endurance while exercising (e.g., climbing stairs). If so, suggest decreasing activity level until symptoms improve or advise against performing activities altogether. Encourage patients

• Check body weight, edema and hydration status, and peripheral perfusion.

• Evaluate behavioral status (e.g., confusion) and monitor for fatigue/weakness or new onset of fever or chills due to infection.  Assess the level of anxiety by using/completing a valid measurement tool such as the State-Trait Anxiety Inventory (STAI) or the Hospital Anxiety and Depression Score (HADS).

Assess for anxiety, particularly in patients with emotional distress. And assist with obtaining a consult from the assigned care team as necessary.

• Record temperature, pulse rate per minute, and regularity of rhythm on ECG monitoring equipment if available. Collect blood pressure and analyze the data against a scale of 0-200 or use other means to quantify.

• Assess and monitor patient’s fluid intake versus output, gastrointestinal status (e.g., nausea, vomiting), and renal status (e.g., incontinence of urine). Assess for signs of infection such as temperature greater than 38 oC, chills or shakes, tachycardia, malaise, and abdominal pain. 

Heart failure patients with severe CHF usually have an increased number of comorbidities and medications that may cause confusion; therefore, the patient’s mental status should be monitored regularly. If there is any change to the level of consciousness (i.e., confusion, agitation), assess for pain. If there is increased weakness or fatigue, consider hospitalization and/or increase the frequency of assessments to every 4 hrs (before hospitalization).

• Evaluate body weight changes over time: sudden gain may be a sign of fluid retention due to heart failure; weight loss, reduction in appetite, and loss of muscle mass may be due to the effects of chronic heart failure.

• Perform physical exam focusing on: checking for presence and character of peripheral edema (distribution, amount), skin turgor, capillary refill, central venous pressure (CVP), and cardiac examination including auscultation of S1 and S2, abnormal heart sounds (murmurs), irregular pulse.

• Per measures physical exam to evaluate cough reflex, respiratory function in breathing effort and lung expansion/dyspnea (feels like an elephant sitting on the patient’s chest), cardiac output by observing color and character of peripheral pulses and cardiac auscultation.

• Monitor daily weights and urinary output records, and ECG readings to assess the efficacy of the medication treatment plan in improving the patient’s status (e.g., decreasing frequency of fatigue, increasing urine output).  Monitor pulmonary function tests regularly to determine whether there is improvement or deterioration over time. 

• Educate patients on the importance of maintaining adequate fluid intake to prevent dehydration and assess for signs of dehydration, including decreased urine output, dry mouth or tongue, dark yellow coloration to urine (specific gravity <1), confusion, lethargy.

• Explain to patient/caregiver that it is important to maintain a diet rich in protein and potassium and low in sodium, phosphorus (K/Na ratio >2), and calcium.

Consider teaching heart failure patients self-monitoring techniques for pulse rate, BP, urine output, and fatigue level using a valid scale such as the Canadian Cardiovascular Society (CCS) rating system.

Regularly assess the patient’s cardiac status (e.g., S1, S2), the color of peripheral pulses, physical examination, and mental status to determine progress in recovery from acute heart failure.

• If there is deterioration in respiratory function, pulmonary edema, or any new onset symptoms such as fever/chills – re-assess the patient’s fluids intake versus output, mental status, and pulmonary status.

• For patients with one or more risk factors for heart failure (i.e., chronic hypertension, coronary artery disease, valvular heart disease), refer to a case manager/social worker/nurse in conjunction with the physician team to develop an aggressive plan of care (e.g., home health assessment, stress management, support group referral, physical therapy intervention).

• Patients with severe heart failure may experience anxiety/fear related to personal and family history of heart attacks and sudden death. Refer to a mental health professional (psychiatrist, psychologist) for this patient population. 

Prevention:  hypertension control, smoking cessation, obesity management programs.

• Educate patient/caregiver about the importance of obtaining prenatal care to manage preexisting hypertension and prevent pre-eclampsia.  Evaluate prior pregnancies (number, delivery complications) for risk factors associated with heart failure (i.e., gestational hypertension).  Educate patient/caregiver on the importance of weight loss, nutrition, and exercise in the management of pregnancy.  Evaluate prior pregnancies for hypertensive disorders, including pre-eclampsia (elevated Bp or proteinuria requiring hospitalization) for a risk factor associated with heart failure.

• It is important to assess women at risk for heart failure before pregnancy (i.e., history of pre-eclampsia, hypertension) and manage aggressively with graded rehabilitation after delivery with a follow-up plan to assess the cardiovascular status and monitor blood pressure control regularly.  Patients with elevated Systolic Bp should be referred for further workup, including echocardiography, and stress treadmill test.

• For women with elevated BP and signs/symptoms of heart failure (e.g., fatigue, dyspnea), monitor vitals frequently and refer for evaluation, including an echocardiogram to assess the status of the left ventricular function.

Postpartum Management:  high risk for infection, pulmonary edema

• Patients with known cardiac disease (e.g., MVD) are at high risk for postpartum MI and death.  Plan early discharge for higher-risk patients to minimize exposure to hospital infections, and pulmonary edema (a common cause of death after delivery). 

Nursing Intervention of Heart Failure Patients in Emergency Department

• Elicit Cardiac History and Physical Assessment

• Auscultation of all four cardiac sounds for rate, rhythm, and quality. (Rate 130 b/m regular rhythm with normal S1-S2).  Then auscultate for murmur grade 1 (peripheral) to 6 (central). 

• Palpation for LV hypertrophy by feeling the sternum and observing for sharp, deep systolic murmur in apex beat.  (No change felt on palpitation, no new murmur heard while auscultating patient’s heart)

• Check pulse oximetry heard 100% on room air (Patient’s saturation is at 96% on room air per monitor).

• Teaching: It is important to teach the heart failure patient and family members/ loved ones about the disorder, its prognosis, and the cause of disease projections in addition to reassurance for available treatment modalities.  It is also important to teach them about medications and their activities and the signs of toxicity, as this will lead to more effective medication management. 

Nursing Intervention- Respiratory Therapy for Heart Failure Patient

• Provide chest physiotherapy to reduce the risk of atelectasis (collapsing or partial collapse of a lung). Chest physiotherapy employs percussion, vibration, or suction to remove secretions and keep lungs open. 

• Identify the signs and symptoms of respiratory distress in patients with heart failure, including dyspnea at rest, chest pain (angina pectoris), edema, and peripheral pulse volume expansion. 

Intervention for Heart Failure Patients Using Diuretic Therapy

• Review the patient’s fluid status daily to ensure that the patient retains sufficient urine output of at least 30 ml/hr. 

• Adjust intravenous (IV) diuretic dose based on the assessment of volume status, renal function, and electrolytes with consideration to monitoring values for BUN / Cr and serum potassium levels. 

• Provide an appropriate diet for the patient with congenital heart failure

• Monitor serum electrolytes, blood glucose levels, and weight on a routine basis.  Additional laboratory tests may be ordered to monitor: potassium, sodium, calcium, and magnesium levels while on diuretics.

    Patient education about diuretic therapy:

• Explain how to monitor intake and output.  Encourage the patient to void at least every two to three hours. Tell the patient not to drink excessive amounts of water to avoid frequent urination.

• Advise the patient that he may experience fatigue, weakness, and dizziness with diuretic therapy.  Instruct him not to perform any strenuous activity until he has gained strength after being discharged from the hospital.

• Instruct the patient to report signs of kidney dysfunction, including fatigue, nausea, vomiting, excessive thirst, difficulty urinating or feeling drowsy.  Encourage him to notify the nurse if these symptoms occur immediately.

• Tell the patient that he may experience a metallic taste in his mouth with diuretic therapy.  Advise him to report any changes in mouth odor or if he experiences dry mouth.

• Inform the patient that he will be given fluid and salt supplements as prescribed by the physician until urine output returns to normal levels.  Instruct him to take these supplements with his meals and avoid taking excessive amounts of water.

• Instruct the patient to weigh himself daily and report any gain of more than two pounds in a twenty-four-hour period.  If he weighs more than two pounds above his baseline weight, tell him to notify the nurse that he may be retaining fluid. 

• Monitor fluid intake and output. 

Educate the patient about fluid retention, healthy weight, and signs of dehydration:

• Seek immediate medical care if the urine becomes dark in color or contains an unusual amount of sediment.

• Educate the patient about dietary restrictions during diuretic therapy, including avoiding excess salt in food and beverages, avoiding alcohol and caffeine (tea, coffee), and limiting consumption of foods high in potassium content (bananas, oranges, tomatoes, or tomato juice).  Instruct the client to eat a well-balanced diet and use salt substitutes, if necessary.  Encourage the patient to drink at least eight glasses of water per day.

• Educate the patient about signs and symptoms of dehydration, including thirst, dry mouth, and decreased urine output.  Encourage them to report any of these symptoms to the nurse immediately.

• Encourage the patient to weigh himself daily.  Ask them to report any additional weight of more than two pounds in a twenty-four-hour period. 

Briefly explain how the medication works and what results should be expected:

• Diuretic therapy will elevate his blood pressure, lower his heart rate and promote fluid loss through urine output and perspiration.

• Advise the patient that he may experience fatigue, weakness, and dizziness with diuretic therapy.  Instruct him not to perform any strenuous activity until he has gained strength after being discharged from the hospital.

• Some of these medications may cause an increase in blood potassium levels.  The physician will monitor the patient’s serum potassium level as prescribed.

• Some of these medications may cause less urine output for several days after being started, but he should not experience any difficulty urinating or an inability to void.

• Diuretic therapy is usually initiated in the hospital and continued at home for a few days after discharge.

• Emphasize the importance of follow-up care and the frequency of appointments.

• Tell the patient that he may experience decreased urine output or a metallic taste in his mouth until home diuretic therapy is established.  Advise him to be alert for signs and symptoms of dehydration, including thirst, dry mouth, and decreased urine output.  These symptoms may occur before he notices an increase in weight. 

• Tell the patient to call his healthcare provider if there is any change or worsens his symptoms, including shortness of breath or swelling.  Emphasize that it is very important to follow up with his healthcare provider within twenty-four hours if he experiences a significant weight gain or swelling.

• Review the importance of follow-up appointments with his healthcare provider to assess the effectiveness of diuretic therapy and ensure his safety while taking this medication.

Nursing Intervention in Cardiac Catheterization Lab- Cath lab

The patient will be prepared in the dressing room and will be placed on a stretcher.  He will then be brought to the cath lab by staff members and placed on the table prepped with sterile drapes and sheets specific for cardiac catheterizations.  An EKG monitor will be attached to the patient.  The nurse (pre-procedure) or physician’s assistant (in the cath lab) will connect a medication line and secure an arterial line for blood pressure monitoring if needed.  An intravenous access site for IV medications and fluids will also be established on one of the arms for drug therapy and fluid administration. 

After the intervention has been performed, the patient will be taken back to the dressing room, where he will be discharged from the Cath Lab.  The nurse must ensure that no air bubbles are present in any line attached to the patient before discharging him from the Cath Lab.  The nurse should place a warm blanket around the patient, and he will be accompanied to his room by staff members.  The nurse will then continue monitoring vital signs, EKG and oxygen saturation, and respiratory changes using the AVPU scale (Alert, responds to Verbal stimulus, responds to Painful stimulus, Unresponsive to Verbal or Painful stimulus).    The nurse will re-assess the patient’s pain level using a verbal rating scale (VRS) of 0 to 10.  A post-procedure chest x-ray may be taken.  The cath lab nurse must remain in constant contact with the nursing staff in the ICU and cardiac floor to ensure no untoward reactions or complications.

Nursing Intervention- Lab:

• Monitor complete blood count (CBC) with differential, urinalysis, BMP, and creatinine/urinary output hourly. 

• Monitor vital signs frequently.

Nursing Intervention in Operating Room or Post Anesthesia Care Unit (PACU):

• R/T respiratory failure, oxygen therapy at 2L via nasal cannula, and 100% FiO2 will be initiated through face mask support.  Monitor oxygen status by monitoring SpO2, RR and heart rate. 

• R/T dyspnea, oxygen therapy at 2L via nasal cannula, and 100% FiO2 will be initiated through face mask support.  Monitor oxygen status by monitoring SpO2, RR and heart rate. 

Nursing Intervention in Cardiac Care Unit (CCU):

• R/T respiratory failure, oxygen therapy at 2L via nasal cannula, and 100% FiO2 will be initiated through face mask support.  Monitor oxygen status by monitoring SpO2, RR and heart rate. 

• R/T dyspnea, oxygen therapy at 2L via nasal cannula, and 100% FiO2 will be initiated through face mask support.  Monitor oxygen status by monitoring SpO2, RR and heart rate. 

Nursing Intervention in Semi-Flexible Sequence: Family Teaching/ Education

• The patient’s family should be educated regarding the target goal, the underlying cause of the heart failure, and signs of toxicity with medications.  It is also important to teach them about medications and their activities and the signs of toxicity, as this will lead to more effective medication management. 

• Teaching about medications and their activities:  It is important to teach the patient, and family members/ loved ones about heart disease, especially congestive heart failure, as this will lead to a proper understanding of their pharmacological needs. It is also important to teach them about medications and their activities and the signs of toxicity, as this will lead to more effective medication management. 

The patient’s family should be educated regarding the target goal, underlying cause for procedures such as pericardiocentesis, and complications.  It is also important to teach them about medications and their activities and the signs of toxicity, as this will lead to more effective medication management. 

Nursing Intervention in the Long-term Phase of the Patient’s Life

• Assess for signs of discomfort and pain especially related to heart failure.  This includes measuring the patient’s weight and body mass index, observing respiration rate and depth or lungs sounds, and palpating the abdomen for distention or bowel sounds. 

• Evaluate skin changes such as the color of the skin, presence of edema, and loss of adherent areas that are present on the leg.  Assess for the presence of peripheral vascular disease as this will lead to more effective management of pharmacological needs. 

• Assess heart rate and rhythm on an hourly basis with auscultation throughout the day. The nurse should give aspirin to prevent clotting events; however, if there is a history of a bleeding disorder, the patient should be given clopidogrel and warfarin.  

• Assess medications as prescribed and monitor for any changes in condition.  If the patient is on aspirin, it is important to check for blood in the stool which may indicate gastrointestinal bleeding. 

Nursing Intervention-Physical Therapy Exercises

Respiratory Rehabilitation Phase

• Provide physical therapy as prescribed to heart failure patients.  If there are any concerns with PO2 and PCO2, a pulmonary function test should be taken along with blood gases.  This phase of physical therapy is important to help loosen chest muscles used for breathing.  

Nursing Intervention-Pericardiocentesis

• Pericardiocentesis is carried out to remove fluid from the pericardial sack and help relieve the pain. If fluid builds up in the sac (called a pericardial effusion), it can put pressure on your heart and surrounding tissues. Pressure on the heart can cause chest pain, and fluid in the chest could lead to breathing problems and heart failure because your heart isn’t able to pump blood effectively. 

• The heart failure procedure is carried out in order to relieve pressure off of the patient’s heart and to increase cardiac output. Often, this procedure is done in patients with left ventricular heart disease, and effusion has developed due to volume overload. The patient should be kept under strict bed rest approximately 4 to 24 hours before the actual procedure to carry out procedure. 

This allows fluid back up into the pericardial sac but decreases blood pressure to a safer level.  Then the procedure can be carried out by accessing the pericardial sac through a small incision in front of the heart or through a larger incision in the chest (thoracotomy).

• The physician may prescribe intravenous diuretics and administer heparin to prevent clotting.  Then, the sac is drained with a needle connected to a syringe.  Once this procedure is carried out, it should be followed by appropriate physiotherapy exercises as directed by the physician.

• Complications in pericardiocentesis include infection of the heart or drainage tube, fluid leakage from the heart, and bleeding from the procedure. 

Before Procedure

Prior to this procedure, cardiologists may assess the patient’s heart failure medical history, medications, and their possible interactions.  They may perform an electrocardiogram (ECG) and echocardiogram to assess the patient’s heart condition. 

During Procedure

During this procedure, the cardiology team will be present in the room for monitoring and assistance.  One of the most important parts of this procedure is to keep the patient calm.  As such, the nursing staff will give him sedation as prescribed by the cardiologist to relieve anxiety and discomfort. 

Status post pericardiocentesis

Pericardiocentesis relieves pain often associated with effusion. However, it usually lasts only a few days to a week. As such patient should be given medications as prescribed to relieve discomfort post pericardiocentesis. If the patient is on beta-blockers, he should be monitored for bradycardia as these are heart medications that lower heart rate and contractility of the heart.

Administering IV fluids and medications to prevent complications

As the patient is placed on bed rest before this procedure, it will be important to monitor for any infections. If the patient develops a fever and purulent drainage from the chest tube or pericardial sac, he may have developed an infection.  If this occurs, antibiotics should be administered as prescribed by the physician. 

Post pericardiocentesis pain relief 

When patients are on strict bed rest before the procedure, they should be provided with appropriate comfort measures.  If they develop xerostomia and if symptoms from the earache last more than 7 to 10 days, then a soft hat or a scarf should be given to the patient. 

Patient Education after Pericardiocentesis

Patients and caregivers need to know that while pericardiocentesis can greatly improve the quality of life, it does not cure heart failure.  Effusions may recur in some patients, and they will need more procedures in the future.  Furthermore, other medications and treatments will be necessary for the patient to maintain quality of life.

Patient Lifestyle Changes

Because this procedure can have significant side effects, patients with heart failure should take care to prevent fluid overload from developing again. They should eat a low sodium diet and avoid alcohol, coffee, and tobacco.  

Preventing complications of pericardiocentesis

Unless the patient is on a special diet before this procedure, he should be encouraged to eat a healthy diet after pericardiocentesis.  He should also increase his activity level gradually as it can help maintain cardiac function.  As such, the patient should be encouraged to walk around outside each day for 15 to 30 minutes.

Encourage Normal Activity Level

The physician may advise that patients follow a low sodium diet and tobacco cessation program post pericardiocentesis.  As such, patients should not go back to their normal work schedule till they have fully recovered from the procedure and completely stopped smoking.  

Respiratory Therapy 

As this procedure can cause fluid accumulation in the lungs due to fluid leakage from the pericardial sac, respiratory therapy may be prescribed.  A respiratory therapist will work closely with the cardiology team while providing patient post-pericardiocentesis care.

Oxygen Administration 

The physician will ask the patient to lie on his left side, and in some cases, patients may be given oxygen prior to the procedure.  Oxygen therapy should be provided as prescribed by the physician. 

Bedside intravenous access for the administration of medications 

Most patients undergoing this procedure will require bedside IV access as they have to be placed on strict bed rest before and after the procedure.  The physician may also prescribe medication that need to be given via IV; therefore, nurses should place the patient in a semi-reclined position and place his arm in a venipuncture elbow position if he is not already in that position.

Monitor for pericardial effusion 

The most common side effect of pericardiocentesis is post-pericardiacus effusion. It occurs when a tear or hole in the pericardium allows leakage of fluid into the space around the heart.  It can be detected by listening to the patient’s lungs for any increase in crackles or dullness on percussion.  

It should not hinder normal gas exchange, but if there is a progressive deterioration of respiratory conditions post pericardiocentesis, then the patient may require further evaluation and treatment. 

The patient should be monitored for early signs and symptoms of post pericardiac effusion such as tachycardia, breathlessness, decreased oxygen saturation, increased respiratory rate, pulmonary edema or crackles on auscultation.  

Checking heart sounds and listening to breathing sounds 

The nurse should check the patient’s heart sounds and breath sounds every 1 to 2 hours post pericardiocentesis.  If there are signs or symptoms of respiratory impairment, then the cardiologist will be contacted immediately.  The physician may also request a pulmonary X-ray if he has concerns about fluid accumulation in the lungs.  

Monitoring cardiac rhythm 

The nurse should monitor the patient’s cardiac rhythm and heart sounds every 30 to 60 minutes post pericardiocentesis.  The procedure may result in atrial fibrillation or ventricular tachycardia, which can increase the risk of thromboembolism.  The patient should be monitored for any change in pulse rate, breath sounds, or respiratory distress. 

Keep an eye on oxygen saturation levels 

Depending on the rate of fluid leakage, the patient may require more oxygen therapy during the procedure to maintain adequate oxygen saturation levels.   The patient may require oxygen therapy to maintain adequate sat levels post pericardiocentesis as well.  The nurse should administer oxygen according to the physician’s orders post-procedure and continue till Sat levels are within normal range. 

Elevating the affected area to heart level 

Patients are advised to elevate the affected area above heart level post pericardiocentesis. This will help in reducing the pressure around the heart and may help in relieving respiratory distress. 

Depending on the physician’s orders, the patient can be asked to lie down in the left lateral decubitus position or be placed in a semi-reclined position with a pillow underneath the knees.  If the patient has a cardiac arrest or occurs new arrhythmia, then he should be placed in a semi-reclined position to help maintain patency of his airway and placed on oxygen therapy. 

Monitoring for hypotension 

Patients who have undergone this procedure are at high risk of developing hypotension due to fluid volume loss or bleeding and may require a blood transfusion.  The nurse should monitor the patient’s vitals frequently, and if signs or symptoms of hypotension are observed, he should be given IV fluids, vasopressors or placed in the Trendelenburg position.  

Monitoring for bleeding 

The nurse should check the draining tube and pad every hour post pericardiocentesis to monitor for any signs of bleeding.  If blood is noted in drainage, then the cardiologist should be contacted immediately. 

Providing emotional support 

Please do not leave the patient alone as he may be in distress due to decreased sat levels and may need a family member’s or a significant other’s support.  The patients should be kept informed about the procedure and its possible risks and complications. 

Preparing a patient for discharge 

If the patient is stable, then he can be discharged home after a post-procedure checkup.  Discharge planning should include information about a change in diet, expected outcome, follow-up appointment schedule, including vital signs at home before leaving the hospital. 

Monitoring for Complications 

The patient should inform the medical team of the following signs or symptoms till hospital discharge:  Fatigue, Tachycardia, Dizziness, and Nausea.  Any new onset post-procedure or persistent post-procedure complication should be immediately reported to the medics as they are the ones who manage such complications.

Following discharge orders 

When a patient is discharged from the hospital, he should be given instructions and a follow-up appointment scheduled, including vital signs before leaving the hospital.  Order for blood transfusion in case of need should also be included in the discharge plan to avoid delay due to a hospital’s blood shortage. 

The nurse should consider monitoring for new-onset cardiac symptoms.

The patient may develop a new onset of cardiac symptoms and warning signs post pericardiocentesis. These include; dyspnea, palpitations, chest pain with radiation to the arm, epigastric discomfort due to ASD causing lung congestion, pericardial effusion causing pleuritic chest pain, and myocardial ischemia or infarction. These symptoms should be reported to the health care providers, who will then manage such complications.

Follow up for any new diagnosis of heart disease 

Treatment for Heart Failure

The treatment for heart failure is preventative and aimed at slowing down its progression. If the patient feels well, he or she should:

• Continue with a healthy diet that includes fruits, veggies, and whole grains.

• Increase physical activity such as walking or gentle swimming but avoid competitive sports like tennis. Check with a doctor before doing any type of physical activity. 

• If the heart failure patient is over 40 years old, they should have an echocardiogram and stress test once every 2 years.

If the patient has heart failure, treatment includes medications as well as lifestyle changes. The medications may include;

Beta-blockers – these drugs relax the blood vessels, slowing the heart rate and reducing blood pressure. This makes it easier for the heart to pump blood throughout your body. These may be used if you are experiencing palpitations (awareness of your heartbeat) or arrhythmias, which are irregular heartbeats.

Dopamine agonists, such as Nesiritide may also be prescribed.  Nesiritide is a synthetic form of the hormone norepinephrine that stimulates heart muscle contractions and increases blood flow to the heart. When given by injection, it improves the symptoms of acute decompensation.

Diuretics – These drugs eliminate fluids from your body by increasing urine output. They may be used to treat shortness of breath upon exertion and swelling in the legs or feet.

ACE inhibitors – these drugs relax your blood vessels, slowing heart rate and reducing blood pressure. They also block the formation of certain chemicals within the walls of your arteries that may damage them over time. These medications help improve the quality of life by preventing further coronary artery disease and congestive heart failure complications.

For those who have restrictions in their activity, lifestyle changes like quitting smoking and following a healthy diet can help improve symptoms of worsening heart disease and prevent further progression.

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Summary

Heart failure refers to a group of symptoms such as fatigue, shortness of breath (orthopnea), and swelling in the ankles or legs. Uncontrolled diabetes is one cause that should be considered when you are experiencing symptoms of heart failure. 

Symptoms of heart failure commonly include shortness of breath (dyspnea), swollen ankles, fatigue, and chest pain.

If you experience any of these symptoms, it is important to take them seriously and report them immediately to your health care provider.

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