B4 · Weak heart pumping
Actual Breathing and circulation
Definition
The heart is not moving enough blood to meet body needs, which may cause tiredness, swelling, or low blood pressure.- Heart failure
- heart attack
- weak heart muscle
- rhythm problems
- Tiredness
- swollen legs
- fast pulse
- low blood pressure
- breathless lying flat
- weight gain
📋 Scenario
A man with heart failure gains 2 kg in 3 days and cannot lie flat.
Subjective (S): "I'm so tired and my ankles are swollen. I need three pillows to sleep."
Objective (O): Weight up 2 kg in 3 days; pulse 110/min; blood pressure 92/60; pitting swelling in both ankles; crackles at the lung bases.
Assessment tools for this scenario: CP-BREATH Breathing & Circulation Check CP-SKIN Skin & Wound Score CP-FLUID Fluid Balance & Nutrition Score
Validated scales to consider: NEWS2, SpO₂, ECG, Braden Scale, TIME wound chart, MUST, fluid chart, glucose
**CarePath diagnosis:** Weak heart pumping related to heart failure, as evidenced by tiredness and swollen legs.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check pulse, blood pressure, and weight daily. | Daily pulse, blood pressure and weight show how well the heart is pumping. Quick weight gain signals fluid build-up before it becomes severe. |
| Give heart medicines as ordered. | Heart medicines strengthen the pumping, slow the heart rate or remove extra fluid, which lowers the heart's workload. |
| Limit fluid and salt if ordered. | Less salt and fluid means less water held in the body, which reduces swelling, lung congestion and strain on the heart. |
| Plan rest. | Rest lowers the heart's oxygen demand and workload, and planning it between activities saves energy for what matters. |
| Report sudden changes. | Sudden changes such as fast weight gain or worse breathlessness may mean heart failure is getting worse and needs prompt treatment. |
**Expected outcomes**
- Within 3 days: weight stable or falling toward target, pulse 60-100/min, no new swelling.
- Sleeps with no more than two pillows.
- Patient lists 3 warning signs to report.
**Linking the data to the diagnosis**
The patient has heart failure and is gaining weight fast: 2 kg in 3 days. He has a pulse of 110/min, blood pressure 92/60, pitting swelling in both ankles and crackles at the lung bases. He says he is very tired and needs three pillows to sleep. This is an actual problem because the heart is already failing to move enough blood. Fluid build-up in the body describes the extra water, but this statement names the cause, the weak pump, and so fits better. The plan aims for stable or falling weight, a pulse of 60-100/ min, no new swelling, sleep on two pillows or fewer, and three warning signs named within 3 days.
CarePath diagnosis
Weak heart pumping related to heart failure, as evidenced by tiredness and swollen legs.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Check pulse, blood pressure, and weight daily. | Daily pulse, blood pressure and weight show how well the heart is pumping. Quick weight gain signals fluid build-up before it becomes severe. |
| 2. Give heart medicines as ordered. | Heart medicines strengthen the pumping, slow the heart rate or remove extra fluid, which lowers the heart's workload. |
| 3. Limit fluid and salt if ordered. | Less salt and fluid means less water held in the body, which reduces swelling, lung congestion and strain on the heart. |
| 4. Plan rest. | Rest lowers the heart's oxygen demand and workload, and planning it between activities saves energy for what matters. |
| 5. Report sudden changes. | Sudden changes such as fast weight gain or worse breathlessness may mean heart failure is getting worse and needs prompt treatment. |
Expected outcomes
- Within 3 days: weight stable or falling toward target, pulse 60-100/min, no new swelling.
- Sleeps with no more than two pillows.
- Patient lists 3 warning signs to report.
Linking the data to the diagnosis
The patient has heart failure and is gaining weight fast: 2 kg in 3 days. He has a pulse of 110/min, blood pressure 92/60, pitting swelling in both ankles and crackles at the lung bases. He says he is very tired and needs three pillows to sleep. This is an actual problem because the heart is already failing to move enough blood. Fluid build-up in the body describes the extra water, but this statement names the cause, the weak pump, and so fits better. The plan aims for stable or falling weight, a pulse of 60-100/ min, no new swelling, sleep on two pillows or fewer, and three warning signs named within 3 days.