Essentials of Nursing Leadership and Management, 5th Edition

140 unit 2 | Working Within the Organization

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

output R/T:

Decreased myocardial

contractility, altered

electrical conduction,

structural changes

Fluid volume excess

R/T compromised

regulatory

mechanisms:

hypertension,

sodium/water

retention

Referrals

Diagnostic studies

Goals:

Participate in actions

to reduce cardiac

workload

Verbalize

understanding of

fluid/food restrictions

Cardiology

Dietitian

ECG, echo, Doppler

ultrasound, stress

test, cardiac scan

CXR

ABGs/pulse oximeter

Cardiac enzymes

ANP, BNP

BUN/Cr

CBC/electrolytes,

MG++

PT/aPTT

Liver function studies

Serum glucose

Albumin/total protein

Thyroid studies

Digoxin level (as

indicated)

UA

Display VS within

acceptable limits;

dysrhythmias

controlled; pulse

oximetry within

acceptable range

Meet own self-care

needs with

assistance as

necessary

Verbalize

understanding of

general condition

and health-care

needs

Breathing sounds

clearing

Urinary output

adequate

Weight loss (reflecting

fluid loss)

Cardiac rehabilitation

Occupational therapist

(for ADLs)

Social services

Home care

Echo-Doppler (if not

done day 1) or other

cardiac scans

Cardiac enzymes (if ↑)

BUN/Cr

Electrolytes

PT/aPTT (if taking anti-

coagulants)

→

Dysrhythmias

controlled or absent

Free of signs of

respiratory distress

Demonstrate

measurable

increase in activity

tolerance

Plan for lifestyle/

behavior changes

Breath sounds clear

Balanced I&O

Edema resolving

Community resources

CXR

BUN/Cr

Electrolytes

PT/aPTT (as indicated)

Repeat digoxin level (if

indicated)

→

→

→

Plan in place to meet

postdischarge needs

Weight stable or

continued loss if

edema present