CHF care plan

sounds like a sick guy. i can't help you. all you listed is this man's medical diagnoses and medical treatment. nursing diagnoses are based on the abnormal assessment data obtained during a review of the patient's chart, signs and symptoms of the chf, pulmonary edema and postop heart surgery that are present, your physical assessment (example: lung sounds, heart sounds, blood pressure, etc,), ability to perform adls, and any signs, symptoms and side effects of the medications/treatments he is receiving. once you post that information i can do more for you.

by the way, where are these nursing diagnoses you came up with? i can at least prioritize the list for you. or, you can do it yourself if you like: http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

use the nursing process to help you problem solve (care plan) this.

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology of stemis, chf and pulmonary edema - what signs and symptoms of chf and pulmonary edema does the patient have?

• had a stemi a month ago
  
• chf
  
• pulmonary edema
  
• history of smoking and drinking
  
  • medical treaments
    
    • balloon pump and stenting
      
    • intubated - what specific monitoring and complications are associated with mechanical ventilation
      
    • tube feeding through an og tube - what specific monitoring and complications are associated with tube feedings
      

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data - i have oragnized the abnormal data that you posted and grouped them into the problems they are a part of. did you look up congestive heart failure? did you look up what a bnp was and what such a high result meant? with the low o2 was there any evidence of hypoxia? to have a psychosocial diagnosis there must be evidence of a psychosocial symptoms to support one. the most commonly used with heart and respiratory patients is anxiety because of their breathing problems (the sob they have). see a nursing diagnosis book for the symptoms of this diagnosis.

• rhonchi and rales
  
• cough with sputum
  
• abgs were ph-7.55, pco2-35, hco3-30.8 - this is metabolic alkalosis
  
• po2-58.7
  
• 2+ pitting edema in his lower extremities and generalized edema
  
• ejection fraction is 25%
  
• troponins positive
  
• bnp (b-type natriuretic peptide) was 3035
  
• ekg shows a 1st degree av block
  
• abdomen was slightly distended
  
• decreased appetite
  
• fever
  
• complained of decreased energy
  
• him and his family didn't realize that water was a fluid
  

step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use

• impaired gas exchange r/t ventilation perfusion imbalance aeb abnormal abgs with ph of 7.55, pco2 of 35, hco3 of 30.8, and po2 of 58.7.
  
• ineffective airway clearance r/t intubation, retained secretions and smoking aeb rhonchi and rales and a cough with sputum
  
• decreased cardiac output r/t altered stroke volume and altered electrical conduction aeb 2+ pitting edema in his lower extremities and generalized edema, ejection fraction is 25%, positive troponins, bnp (b-type natriuretic peptide) of 3035, and 1st degree av block on ekg tracings.
  
• excess fluid volume r/t impaired hydrostatic/oncotic interstitial fluid pressures aeb generalized body edema and bnp (b-type natriuretic peptide) of 3035.
  
• hyperthermia r/t increased metabolic rate aeb fever
  
• fatigue r/t stressful situation aeb patient's complaint of decreased energy
  
• deficient knowledge, fluid restriction r/t information misinterpretation aeb verbalized information from patient that he misunderstood previous discharge instructions regarding fluids allowances.
  

there is no assessment that provides diagnoses to care for the feeding tube.

decreased cardiac output r/t impaired cardiac function aeb 2+ lower extremity edema, generalized edema, and an ejection fraction of 25%.

excess fluid volume r/t impaired excretion of sodium and water aeb edema, pulmonary edema and rales.

ineffective health maintenance r/t deficient knowledge regarding self-care and treatment aeb (i still have to find a way to phrase this. but him and his family didn't realize that water was a fluid and that's one of the reasons why he was fluid overloaded when he came into er)

impaired gas exchange r/t inadequate cardiac function secondary to heart failure aeb rales and pulmonary edema.