Client / Family Teaching Nursing Intervention for Decreased Cardiac Output

Client/Family Teaching

• Teach symptoms of heart failure and appropriate actions to take if client becomes symptomatic.
• Teach importance of smoking cessation and avoidance of alcohol intake. Clients who continue to smoke increase their chance of dying by at least 50%, and alcohol depresses heart contractility. Smoking cessation advice and counsel given by nurses can be effective, and should be available to clients to help stop smoking.
• Teach stress reduction (e.g., imagery, controlled breathing, muscle relaxation techniques).
• Explain necessary restrictions, including consumption of a sodium-restricted diet, guidelines on fluid intake, and the avoidance of Valsalva's maneuver. Teach the importance of pacing activities, work simplification techniques, and the need to rest between activities to prevent becoming overly fatigued. Sodium retentiion leading to fluid overload is a common cause of hospital readmission.
• Assist client in understanding the need for and how to incorporate lifestyle changes. Refer to cardiac rehabilitation for assistance with coping and adjustment. Psychoeducational programs including information on stress management and health education have been shown to reduce long term mortality and recurrence of myocardial infarction in heart patients.
• Teach client actions, side effects, and importance of consistently taking cardiovascular medications. Medications can prolong the lives of heart failure clients but often are not taken, resulting in hospital readmissions.
• Provide client/family with advance directive information to consider. Allow client to give advance directions about medical care or designates who should make medical decisions if he or she should lose decision-making capacity.
• Instruct client on importance of getting a pneumonia shot and yearly flu shots as prescribed by physician. Clients with decreased cardiac output are considered higher risk for complications or death if they do not get immunization injections.
• Instruct client/family on the need to weigh daily and keep a weight log. Ask if client has a scale at home; if not, assist in getting one. Instruct on establishing baseline weight on own scale when gets home. Weighing daily is an essential aspect of self-management. A scale is necessary. Scales vary and the client needs to establish a baseline weight on their home scale.
• Provide specific written materials and self care plan for client/caregivers to use for reference. Consult dietitian or assist client in understanding the need for a sodium-restricted diet. Provide alternatives for salt such as spices, herbs, lemon juice, or vinegar. Although the initial elimination of salt from the diet is very difficult for a person use to its taste, the taste of salt can be unlearned. The above can enhance the taste appeal of food while the preference for salt is changing.
• Instruct family regarding cardiopulmonary resuscitation.