as indicated. Decrease cardiac output stimulates the SNS to increase the heart rate in an attempt to restore CO. tachycardia at rest is common. Diastolic pressure may initially be elevated because of vasoconstriction . Oxygen saturation levels provide a measure of gas exchange and tissue perfusions. 2. Assess respiratory status and auscultate lung sounds at least every 4 hours. Notify the physician of significant changes in conditions. Declining respiratory status indicates worsening left heart failure 3. Administer supplement oxygen as needed. Nasal prong 3L/min, facemask oxygen 5 – 8L/min to improve oxygenation of the blood, decreasing the effects of hypoxia and ischemia. 4. Encourage rest, elevate the head of the bed 45 – 90 degree to reduce the work of breathing. 5. Provide a bedside commode and assist with activities of daily living (ADLs). Instruct to avoid the Valsalva maneuver. These measures reduce cardiac workload. 6. Promote psychological rest and decrease anxiety. Maintain a quiet environment and encourage expression of fears and feelings. Psychologic rest decrease oxygen consumption and improves cardiac output. 7. Monitor intake and output. Notify the physician if urine output is less 3ml/h. also monitor weight daily to measure of fluid status. A fall in urine output may indicate significantly reduced cardiac output and renal ischemia. 8. Monitor and recorded hemodynamic pressure to measure peripheral arterial pressure or central pressure such as central venous pressure (CVP) or right arterial pressure to evaluate cardiac and circulatory function and response to interventions. Report any significant changes and negative trends. 9. Restrict fluids as ordered. Allow choices of fluid types and timing of intake, scheduling most fluid intake during morning and afternoon hours. Offer ice chips and frequents mouth care. Provide hard candies if allowed. Providing choices increases the client’s sense of control. Ice chips, hard candies and mouth care relieve dry mouth and thirst and promote comfort. 10.Record abdominal girth every shift. Note complaint of a loss of appetite, abdominal discomfort or nausea. Venous congestion can lead to ascites and may affect gastrointestinal function and nutritional status. 11.Encourage small, frequent meals rather than three heavy meals per day to provide continuing energy resources and decrease the work required to digest a large meal. 12. Consult with dietitian to plan and teach a low sodium diet and if necessary for weight control low calorie diet. Provide a list of high sodium, high fat, high cholesterol food to avoid. Dietary planning and teaching increase the client’s sense of control and participation in disease management. 13. Plan and implement progressive activities. Use passive and active range of motion (ROM) exercise exercises as appropriate. Consult with physical therapist on activity plan. Progressive activity slowly increase exercise capacity by strengthening and improve cardiac function without strain. Activity also prevent skeletal muscle atrophy.