Page 154 - Essentials of Nursing Leadership and Management, 5th Edition

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Sample Critical Pathway: Heart Failure, Hospital; ELOS 4 Days
Cardiology or Medical Unit—cont’d
ND and Categories
of Care Day 1 _____ Day 2 _____ Day 3 _____ Day 4 _____
Additional Apical pulse, → → bid →
assessments heart/breath sounds
q8h
Cardiac rhythm → → D/C
(telemetry) q4h
BP, P, R q2h until → q8h → →
stable, q4h
Temp q8h → → →
I&O q8h → → → D/C
Weight qAM → → →
Peripheral edema q8h → → bid → qd
Peripheral pulses q8h → → bid → D/C
Sensorium q8h → → bid → D/C
DVT check qd → → →
Response to activity → → →
Response to → → →
therapeutic
interventions
Medication allergies: IV diuretic → PO → →
ACEI, ARB, vasodialtors, → → →
beta blocker
IV/PO potassium → → D/C
Digoxin → → →
PO/cutaneous nitrates → → →
Morphine sulfate → → D/C
Daytime/hs sedation → → → D/C
PO/low-dose → → PO or D/C →
anticoagulant
Stool softener/laxative → → →
Patient education Orient to unit/room Cardiac education per Signs/symptoms to Provide written
protocol report to health-care instructions for
Review advance Review medications: provider home care
directives Dose, times, route, Plan for home-care Schedule for follow-up
purpose, side effects needs appointments
Discuss expected Progressive activity
outcomes, program
diagnostic
tests/results
Fluid/nutritional Skin care
restrictions/needs
Additional nursing Bed/chair rest → BPR/ambulate as → Up ad lib/graded →
actions tolerated, cardiac program
program
Assist with physical → → →
care
Pressure-relieving → → → (send home)
mattress
Dysrhythmia/angina → → →
care per protocol
Supplemental O → → D/C if able →
2
Cardiac diet → →
CP = critical path; ELOS = estimated length of stay; ND = nursing diagnosis.
Doenges, M.E., Moorhouse, M.F., and Geissler, A.C. (2010). Nursing Care Plans: Guidelines for Individualizing Patient Care,ed. 8. Philadelphia: FA Davis, with permission.