Page 153 - Essentials of Nursing Leadership and Management, 5th Edition

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140 unit 2 | Working Within the Organization CikguOnline
table 10-2
Sample Critical Pathway: Heart Failure, Hospital; ELOS 4 Days
Cardiology or Medical Unit
ND and Categories
of Care Day 1 _____ Day 2 _____ Day 3 _____ Day 4 _____
Decreased cardiac Goals: Display VS within → →
output R/T: Participate in actions acceptable limits; Dysrhythmias →
Decreased myocardial to reduce cardiac dysrhythmias controlled or absent
contractility, altered workload controlled; pulse Free of signs of →
electrical conduction, oximetry within respiratory distress
structural changes acceptable range
Meet own self-care Demonstrate
needs with measurable
assistance as increase in activity
necessary tolerance
Fluid volume excess Verbalize Verbalize Plan for lifestyle/ Plan in place to meet
R/T compromised understanding of understanding of behavior changes postdischarge needs
regulatory fluid/food restrictions general condition
mechanisms: and health-care
hypertension, needs
sodium/water Breathing sounds Breath sounds clear
retention clearing
Urinary output Balanced I&O
adequate
Weight loss (reflecting Edema resolving Weight stable or
fluid loss) continued loss if
edema present
Referrals Cardiology Cardiac rehabilitation Community resources
Dietitian Occupational therapist
(for ADLs)
Social services
Home care
Diagnostic studies ECG, echo, Doppler Echo-Doppler (if not
ultrasound, stress done day 1) or other
test, cardiac scan cardiac scans
CXR CXR
ABGs/pulse oximeter
Cardiac enzymes Cardiac enzymes (if ↑)
ANP, BNP
BUN/Cr BUN/Cr BUN/Cr
CBC/electrolytes, Electrolytes Electrolytes
MG++
PT/aPTT PT/aPTT (if taking anti- PT/aPTT (as indicated)
Liver function studies coagulants)
Serum glucose
Albumin/total protein
Thyroid studies
Digoxin level (as Repeat digoxin level (if
indicated) indicated)
UA