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Hey guys! Lets take a look at a concept map for congestive heart failure or CHF!
So in this lesson we will take a look at the components of a concept map including contributing factors, medications, lab work and the significance, patient education, and associated nursing diagnoses with interventions and evaluations!
Ok so here is a basic example of a concept map, guys there are many different variations and this is just one example. First, we start with the primary diagnosis typically in the center of the concept map which leads to nursing diagnoses and interventions and also contributing factors, medications, labwork, and patient education which are associated with the primary diagnosis. Lets jump in! Lets start with contributing factors in this upper corner. Contributing factors for heart failure often occur when there has been damage to the heart from coronary artery disease, myocardial infarction, hypertension, cardiomyopathy, valvular issues, myocarditis, congenital heart defects, and arrhythmias. Additional contributing factors include diabetes, certain medications, sleep apnea, viruses, alcohol use, tobacco use, and obesity.
In this next circle here we will add medications that are used to treat CHF. You may see your patient on enalapril (2.5 mg oral daily) which is an angiotensin-converting enzyme inhibitor or (ACE) which functions as a vasodilator to decrease workload on the heart. It is also possible for a CHF patient to be on a beta blocker like carvedilol (10-80 mg extended release tablets oral daily) which has nonselective beta-adrenoreceptor blocking activity. Furosemide (20-80 mg oral) is a common medication a CHF patient may take which is a loop diuretic that inhibits electrolyte reabsorption in the thick ascending limb of the Loop of Henle by inhbiting the Na/K/2Cl cotransporter. Finally, digoxin (10-15 mcg/kg) which is useful in increasing the contraction of the heart muscle contractions and also reduces symptoms.
Ok additional information included in a concept map is commonly patient education and significant labwork. So in this circle here lets add important patient education information including teaching the patient to recognize worsening symptoms like edema, persistent coughing or wheezing, and dyspnea. Also teach the patient the importance of weighing themselves daily, specific diet instructions like restricting sodium and alcohol. Finally, teach your patient the importance of following their medication regimen, adhereing to the activity recommendations by the provider, and also being consistent with follow-up appointments. Labwork might include BNP (B-Type natriuretic peptide) to help grade the severity of the heart failure, metabolic panel to check for electrolyte imbalances and kidney failure, and a CBC to check for anemia. Other diagnostic tests may include EKG, cardiac catheterization, stress test, echocardiogram.
Finally, in the three circles that are left we will add nursing diagnoses with interventions and evaluations for CHF. One appropriate nursing diagnosis would be activity intolerance related to the heart being unable to pump blood to meet the body’s demands. Interventions include providing assistance to patients during self-care which is evaluated by the patient completing self-care tasks without increased oxygen demands. Provide the patient with a low-stress environment which is evaluated by the patient being relaxed and help the patient to recognize tasks that could be causing fatigue which is evaluated by the patient avoiding these tasks.
Another appropriate nursing diagnosis for a CHF patient would be decreased cardiac output. One intervention would be to administer oxygen to the patient if symptoms exist and oxygenation levels are compromised which makes more oxygen available for exchange and is evaluated by increased oxygen levels and decreased symptoms in the patient. Next, encourage rest periods to the patient to conserve energy which is evaluated by decreased oxygen demands. Finally, place the patient in the high fowlers position to improve pulmonary capacity which is evaluated by decreased symptoms in the patient and improved oxygenation levels.
One last nursing diagnosis which would be appropriate excess fluid volume related to changes in glomerular filtration rate, the use of diuretics, and fluid or sodium intake. Interventions include teaching the patient to follow a low sodium diet evaluated by a decrease in fluid retention. Weighing the patient daily to identify edema and fluid imbalances is an important intervention which is evaluated by a identification of retention. Finally, auscultate lung sounds every 2 hours to note the presence of crackles or frothy sputum which is an indication of pulmonary edema which is evaluated by the absence of these issues.
Here is a look at the completed concept map for CHF.
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