Beruflich Dokumente
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CLINICAL PATHWAY
QEH/HH PCH KCMH Souris
Western Stewart Memorial O'Leary
PATIENT ID
INCLUSION CRITERIA
Primary admitting diagnosis is Congestive Heart Failure as defined by New York Heart
Association.
EXCLUSION CRITERIA
2. Place the Clinical Pathway in the nurses clinical area of the chart. All
health care professionals should fill in the master signature sheet at
the front of the Pathway. Addressograph/sticker each page of the
Pathway.
Discharge Criteria - Original to stay on patient chart
Teaching Checklist - Copy with patient in education packet
- Original to stay on patient chart
Updated April 20 2011 Adapted from Grey Bruce Health Network Review November 1 , 2011
NAME
INITIAL SIGNATURE TITLE
(Please Print)
Updated April 20 2011 Adapted from Grey Bruce Health Network Review November 1 , 2011
HEART FAILURE
CLINICAL PATHWAY
Acute Stage PATIENT ID
COMORBID CONDITIONS:
DATE DATE
PHASE 1 ____________ ____________
PROCESS (Approximately 2 days)
evening
evening
night
night
day
day
DATE
INITIAL
MET
3 Slight pitting 3 Somewhat deeper pit 3 Pit is noticeably deep 3 Pit is very deep
3 No visible distortion 3 No readably detectable 3 May last more than 1 minute 3 Lasts as long as 2-5
3 Disappears rapidly distortion 3 Dependent extremity looks minutes
3 Disappears in 10-15 seconds fuller and swollen (4-6mm) 3 Dependent extremity is
(2-4 mm indent) grossly distorted
(6-8mm)
Assessment Chart for Pitting Edema adapted from the Guelph General Hospital Congestive Heart Failure Pathway
Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
Heart Failure PATIENT ID
DATE DATE
PHASE 1 ___________ ____________
evening
evening
night
night
day
day
ADMISSION - ACUTE
Chest X-Ray on admission (next morning if after hours) Yes No
2D Echocardiagram, if ordered Yes No N/A
DIAGNOSTIC ECG if ordered
LABORATORY ECG with chest pain, notify physician
Blood work as ordered
Cardiac markers
Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
HEART FAILURE
CLINICAL PATHWAY
Acute Stage PATIENT ID
evening
evening
evening
night
night
night
day
day
day
DATE
INITIAL
MET
3 Slight pitting 3 Somewhat deeper pit 3 Pit is noticeably deep 3Pit is very deep
3 No visible distortion 3 No readably detectable 3 May last more than 1 minute 3Lasts as long as
3 Disappears rapidly distortion 3 Dependent extremity looks 2-5 minutes
3 Disappears in 10-15 seconds fuller and swollen (4-6mm) 3Dependent extremity
(2-4 mm indent) is grossly distorted
(6-8mm)
Assessment Chart for Pitting Edema adapted from the Guelph General Hospital Congestive Heart Failure Pathway
Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
Heart Failure PATIENT ID
evening
evening
evening
night
night
night
day
day
day
MAINTENANCE
Discontinue IV therapy/saline lock as
TREATMENTS/ ordered
Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November 1, 2011
HEART FAILURE
CLINICAL PATHWAY
Acute Stage PATIENT ID
CONSULTS
DIAGNOSTICS/ Electrolytes within normal limits
LABORATORY Stable renal function - Creatinine <220
Off inotropes for 48 hours
Oral medications stable for 24 hours
Patient verbalizes understanding of medications
MEDICATIONS
Determine if patient is able to pay for necessary
medications post-discharge
Discharge medication list reviewed, copy to patient
Pateint verbalizes understanding of Heart Healthy
NUTRITION Diet, salt and fluid restrictions
Patient tolerates Level 3 Activity (No dyspnea or
MOBILITY/ACTIVITY dizziness)
Patient verbalizes the Importance of Daily Weights
Patient verbalizes the symptoms of worsening Heart
Failure and when to call Physician/Clinic/Come to the
PSYCHOSOCIAL hospital
SUPPORT/ Education materials and patient pathway home
EDUCATION with patient
Teaching checklist complete
Patient questions answered
Follow up appointments with: Family Physician,
DISCHANGE Cardiac rehab, Heart Failure clinic,
PLANNING Internist/Cardiologist
Updated April 20, 2011 Adapted from Grey Bruce Health Network Review November, 1 2011