In this instructional video, Christina Rafano (NursingSOS) guides nursing students through creating a complete nursing care plan for left‑sided heart failure, a common med‑surg condition. She emphasizes using standardized NANDA diagnoses (e.g., Decreased Cardiac Output, Ineffective Tissue Perfusion, Excess Fluid Volume, Activity Intolerance) and stresses the three‑part structure of a nursing diagnosis: the NANDA label, the related‑to (pathophysiology) factor, and the "as evidenced by" (signs/symptoms). Rafano advises students to tailor each element to the specific patient they are assessing, citing examples of related‑to factors such as reduced myocardial contractility, decreased glomerular filtration rate, and medication side effects, and of evidence like dyspnea, crackles, tachycardia, fatigue, and abnormal EKGs. She then outlines how to set patient‑centered goals (stable vitals, improved breathing, increased activity tolerance, medication understanding) and lists concrete nursing interventions (oxygen therapy, positioning, repositioning, medication administration/monitoring, patient education). The evaluation phase is presented as a reassessment of goal attainment and plan modification. Throughout, Rafano promotes her NursingSOS membership resources (care‑plan database, concept maps, study guides) for further support. The video’s purpose is to demystify the care‑plan process, improve students’ critical‑thinking, and boost their grades.
Chapters
Hey there my friend. My name is Christina Rafano with nursingsos.com and today in this video we are walking through nursing diagnosis and a full care plan for left sided heart failure. This is a disorder for med surg that you are going to see all the time at clinical. You're going to talk about it a lot in nursing school, you're going to be tested on it a lot and you're going to have to write a lot of care plans on it. So let's walk through a full care plan for you to make it so so much easier for you to write your own. So hit that subscribe button and click the notification bell and let's dive in. So I'm actually taking our care plan straight out of our care plan database inside the nursing SOS membership community. So if you want access to my entire care plan database, my concept map database, all my study guides and cheat sheets, definitely check out the nmc. You are going to love it. I'll put the link down below in the description for you to check out the details for for that. So for left sided heart failure, what's happening here basically is the heart is really struggling to pump blood forward into the body. So that left side of the heart pumps blood to the rest of the body. Okay, so there's a really key difference here between left sided heart failure and right sided heart failure. Left sided heart failure pumps blood to the body. So we'll see as we go through this care plane, you'll see it's split specific to blood moving forward into the system. We'll walk through that. So some possible nursing diagnoses that you could use for left sided heart failure are things like decreased cardiac output because the heart's pumping blood into the body. You have a decrease in cardiac output because of this disorder. Ineffective tissue perfusion. The tissues just are not getting the blood that they need to function. Excessive fluid volume, except the body because the heart just can't pump. So it's going to kind of that you'll have see swelling or edema in the patient's body because all that fluid is just getting stagnated in the body because the heart can't pump it forward in the system. And then activity intolerance. If a patient's heart is really struggling to pump that blood, they're not going to be able to do the activities that they normally would be able to because the organs are not being perfused. So activity intolerance could be a good nursing diagnosis as well. And remember my friend, your nursing diagnosis is standardized you don't come up with these by yourself. They are actually a you pull from a standardized list, from the NANDA nursing diagnosis list. You can find that in your textbooks or through your nursing school, but you actually choose from that list, so you don't have to make those up. All you need to do is pick what best nursing diagnosis fits your patient from that standardized list. Now, I really want to make sure that as you're writing your nursing diagnosis and writing your care plan, that you are being as specific to your patient as possible in order to get the highest points possible on your care plan in nursing school, it's got to be specific to your patient, your clinical instructor, your nursing instructor. They will know if you're just pulling stuff out of thin air, I promise you. So make sure that you've actually assessed your patient, that you know what's going on with your patient and that your care plan is specific to your patient. You're not just doing like general things because your nursing instructor will catch on to that and you will lose points. So don't do that. Okay? Be as specific to your patient as you can. So now the second part of your nursing diagnosis, the first part is actually the NANDA nursing diagnosis part. The second part is what we call the related to or related to factor. Now this is really what I like to see in care plans is more like the pathophysiology, this is the why behind what's happening. So why is this heart failure happening? What is heart failure? What is causing this problem for the patient? So with your clinical instructor, with your nursing instructor, you can show them that you actually really understand what is going on with your patient through this related to factor related to section in your nursing diagnosis. Because this is the pathophysiology, this is a lot more critical thinking. So think through what's actually happening with your patient with left sided heart failure and that's causing all these problems. So here you could use things like structural changes to the cardiac muscle, changes in cardiac contractility, so the heart just can't contract it as a decrease in that contractility, reduced glomerular filtration rate that could be caused because the heart cannot perfuse the kidneys as well as it should. So the kidneys are going to reduce their function. And then with that decreased gfr, that glomerular filtration rate, then you could see that excess fluid volume because the kidneys are just holding onto more fluid, they're not going to be doing their job as well. So that could be an interesting one. To write in your care plan if that's happening with your patient, that would really show your nursing instructor that, hey, like I know what I'm talking about here. The heart's impacting the kidneys and the kidneys are leading to this increased fluid volume. So that's a really good way to put all the concepts together and critically think about it. Or medication side effects maybe that those kidneys just aren't functioning well. So it's causing all of this like decreased cardiac output or activity intolerance, or there's maybe some medication side effects that is causing the heart to have issues to perfuse the rest of the body. So those could all be good related to factors. Now the as evidenced by section of your care plan of your nursing diagnosis is the signs and symptoms. So again, we want to make these specific to your patient as possible. So what are the signs and symptoms that your specific patient is displaying? So when you go and assess your patient at clinical, what do you see with this patient? Do they have dyspnea? Is there crackles in their lungs because of all that fluid buildup? Do they have tachycardia? Is the heart rate elevated? Are they fatigued? Do they have that activity intolerance? Are they having a hard time doing their activities of daily living, their ADL's? Do they have a cough? Do they had have altered cardiac function? Have there been any testing? Do they have any EKG results that are abnormal? So you would want to write down those signs and symptoms that are specific to your patient in this, as evidenced by the AEB section of your nursing diagnosis. Now we want to show your nursing instructor, right, that you actually assessed your patient and you know what you're talking about. So again, don't pull things out of thin air. We're not going to do that. Be specific to your patient. So now the next step of your care plan is your patient goals. So now this is what will the patient do? So this is not what you will do as a nurse. This is what the patient will do to help get better. We want to help improve their condition. We want to set goals that are achievable for them that can help them improve. So some possible patient goals that you might include in your care plan for left sided heart failure could be something like the patient will demonstrate adequate cardiac output through like example, stable vital signs. Maybe we're decreasing their heart rate, maybe we're helping keep their blood pressure stable, something like that. The patient will have improved work of breathing or decreased dyspnea episodes. So they're they're not struggling to breathe as much. Another one could be the patient will maintain an improved tolerance to activity activities. So increasing their activity tolerance while keeping stable vital signs, that could be a really good one, especially for patients with heart failure because it is difficult to do those ADL sometimes the activities of daily living and actually have a higher activity tolerance simply because the heart isn't able to perfuse all those organs. The patient will maintain the ability to perform ADLs and you could also add independently if that's a possibility for them. And then the patient understands the medications that they're taking and the importance of those medications. So that's a really good patient education point is making sure that you are educating your patient on what medications they are taking and why they need to be taking them, which will help them adhere to it. We want, we want them to follow the prescribed medication regimen that we, that they're prescribed so that they can help to get better. So that all starts with patient education, making sure that your patient understands the medications and why they're taking them. Now, the next part of your nursing care plan is the interventions. Now this is what you will do as the nurse or nursing student to help your patient reach their goals. So for the care plan, we've got the nursing diagnosis that has three parts. We've got the nano nursing diagnosis, we've got that related two factor and then we have the as evidenced by then we've got our patient goals. So patient goals. Goals are what the patient will do. And now we're into what you will do as the nurse or nursing student to help your patient reach those goals. So the nursing interventions are things that you're going to do to help. So these could be things like the nurse will maintain adequate oxygen levels for the patient with supplemental oxygen as needed. The nurse will encourage a restful environment, keeping it quiet, keeping it, you know, just more distraction free so that the patient can rest adequately. The nurse will encourage the patient to sit in a high Fowler's position with legs elevated. Now this can help to really help decrease that edema. We want to also decrease the. Any, any. If there's any edema or swelling happening in the lungs, we want to help the patient breathe. So you would need to make sure that that's specific for your patient. If your patient is having a hard time with that swelling or any swelling in the lungs. If you're hearing crackles in the lungs and fluid in the lungs, then you would want them in that high Fowler's position to Help them breathe easier. Another possibility is the nurse will encourage repositioning at least every two hours. We want to keep that patient moving, decrease that risk for pressure ulcers. Also make sure that we're, we're helping to improve circulation and reduce the swelling, that kind of fluid, fluid excess in our patient. And then another possibility, the nurse will administer and monitor medications as needed. And you can also write out on your care plan specific medications that your patient is taking. Let's say they're taking whatever cardiac medications or maybe they're taking a diuretic. You could write those things in your nursing interventions that you will give these things and monitor whatever signs and symptoms, because those are things that you would do as the nursing student. And the next part of your nursing care plan is the evaluation section. Now, this is basically just a reassessment of your patient to see how the care plan went and what changes need to be made. So this is not a very complicated process. This is really just like, hey, did the patient meet their goals or not? If they did meet their goals, great. If they didn't meet their goals, you'll want to write out why they didn't meet their goals and what you're going to change in the care plan to the next time to help your patient reach their goals. Do you maybe need to work with the doctor to get some different prescribed medications? Do we need to do more like, different activities, like get your patient up and walking more frequently, things like that? What are you going to change to help your patient reach whatever goal that they had set or what you had set for them? Now, of course, the key, key part of your nursing care plan is the nursing diagnosis. Like that is a, a huge part of this. It is a major part. And it's also a major part that your nursing instructors are looking for. Like we talked about, you've got those three parts to it. The nursing diagnosis, the related to, and the as evidenced by. But that can be pretty tricky to write, especially when you're writing different care plans for different patients and for different disorders. So definitely check out this video here where I walk you through, step by step, how to write a perfect nursing diagnosis. I think that video is going to be so, so helpful for as you write all your care plans in nursing school. And of course, if you liked this video, hit that like button. Write love in the comments below because that is what we do around here. We love, love, love writing love in the comments. And as always, my friend, go become the nurse that God created only you to be. And I will see you over there in that next video.
