Essentials of Nursing Leadership and Management, 5th Edition

table 10-2

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

assessments

Medication allergies:

Patient education

Additional nursing

actions

Apical pulse,

heart/breath sounds

q8h

Cardiac rhythm

(telemetry) q4h

BP, P, R q2h until

stable, q4h

Temp q8h

I&O q8h

Weight qAM

Peripheral edema q8h

Peripheral pulses q8h

Sensorium q8h

DVT check qd

Response to activity

Response to

therapeutic

interventions

IV diuretic

ACEI, ARB, vasodialtors,

beta blocker

IV/PO potassium

Digoxin

PO/cutaneous nitrates

Morphine sulfate

Daytime/hs sedation

PO/low-dose

anticoagulant

Stool softener/laxative

Orient to unit/room

Review advance

directives

Discuss expected

outcomes,

diagnostic

tests/results

Fluid/nutritional

restrictions/needs

Bed/chair rest

Assist with physical

care

Pressure-relieving

mattress

Dysrhythmia/angina

care per protocol

Supplemental O 2

Cardiac diet

→

→

→q8h

→ → → → → → → → →

→ PO

→ → → → → → → →

Cardiac education per

protocol

Review medications:

Dose, times, route,

purpose, side effects

Progressive activity

program

Skin care

→ BPR/ambulate as

tolerated, cardiac

program

→

→

→

→

→

→bid

→D/C

→

→

→

→

→bid

→bid

→bid

→

→

→

→

→

→D/C

→

→

→D/C

→

→PO or D/C

→

Signs/symptoms to

report to health-care

provider

Plan for home-care

needs

→Up ad lib/graded

program

→

→

→

→D/C if able

→

→

→

→

→D/C

→

→qd

→D/C

→D/C

→ → → → → → →

→D/C

→

→

Provide written

instructions for

home care

Schedule for follow-up

appointments

→

→

→(send home)

→

→

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.