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The Child with Congestive Heart Failure Being Cared for at Home


1. Altered Growth and Development related to effects of physical disability. NIC Priority Intervention: Developmental Enhancement: Teaching parents to facilitate optimal gross motor, fine motor, language, cognitive, social, and emotional growth of preschool children. The child will meet developmental milestones for age group.

NOC Suggested Outcome: Child Development (2 years): Milestones of physical, cognitive, and psychosocial progression by 2 years of age.

Perform baseline developmental assessment.

Assessment provides comparison for later assessments and basis for planning specific games, toys, and activities. Short play periods maintain energy and facilitate play. Play activities facilitate learning and mastery of developmental tasks.

The child displays normal language, fine motor, and gross motor activity.

Plan for short play periods after rest. Introduce age-appropriate toys and activities such as rattles and blocks for infants and art projects for older children. Plan for interactions with healthy children.

Social skills are learned through contact with others.

2. Ineffective Management of Therapeutic Regimen (Family) related to complexity of therapeutic regimen. NIC Priority Intervention: Family Involvement: Facilitating family participation in the emotional and physical care of the patient. Parents will demonstrate correct administration of medications. Parents will state side effects of medications and symptoms of congestive heart failure.

NOC Suggested Outcome: Not yet developed.

Demonstrate administration of digoxin, diuretics, and other medications. Have parents administer them under supervision of nurse. Describe side effects of medications. Give parents handouts with telephone number to call to ask questions or report side effects. Describe subtle onset of congestive heart failure and its symptoms (increasing weakness, exhaustion, irritability, difficulty feeding, cough, or difficult respirations, edema).

Demonstration with return demonstration is an excellent method of learning psychomotor skills. If side effects are understood, serious complications can be avoided. Parents can evaluate child regularly and note subtle changes requiring medical management.

Parents report that child continues to demonstrate improvement and adequate cardiac output with absence of congestive heart failure.

3. Altered Nutrition: Less Than Body Requirements related to chronic illness and tiring while feeding. NIC Priority Intervention: Weight Gain Assistance: Facilitation of body weight gain. NOC Suggested Outcome: Nutritional Status: Food and Fluid Intake: Amount of flood and fluid taken into the body over a 24-hour period.

The infant or child will demonstrate normal weight gain for age.

Teach parents methods to promote food intake related to positioning, size of feedings, food choices. Observe feeding during home visit.

Positioning, frequency of feedings, size of feedings, and use of highcalorie foods can enhance nutritional intake. Feedback can assist parents in integrating positive feeding techniques.

The infant or child shows normal weight gain.

Parents report and demonstrate successful feedings of child. (continued)



The Child with Congestive Heart Failure Being Cared for at Home (continued)


4. Activity Intolerance (Child) related to poor cardiac output. NIC Priority Intervention: Energy Management: Regulating energy use to treat or prevent fatigue and optimize function. The child will perform all necessary activities of daily living without undue tiring.

NOC Suggested Outcome: Energy Conservation: Extent of active management of energy to initiate or sustain activity.

Help parents alternate activities and rest throughout the childs day. Have parents limit childs exposure to persons with contagious disease. Help family plan quiet surroundings to provide for childs rest.

Activities to promote development must be alternated with rest due to decreased cardiac output. When the child is ill and tired, the immune system can be compromised. Home setting may need to be altered to promote rest.

The child performs necessary activities and rests frequently each day.

5. Caregiver Role Strain (Parent) related to 24-hour responsibility for childs care. NIC Priority Intervention: Caregiver Support: Provision of the necessary information, advocacy, and support to facilitate primary patient care by someone other than a health care professional. Parents will express ability to meet own needs.

NOC Suggested Outcome: Caregiver Endurance Potential: Factors that promote family care provider continuance over an extended period of time.

Assess family and community supports. Provide information related to respite care. Encourage parents to seek activities to meet personal needs.

Variable family and community supports are available. Parents need time to meet own personal needs in order to successfully care for child.

Parents report some time away from the child and report renewal in caring for the child.