The nurse is taking care of an elderly client with congestive heart failure. Which of the following are the most appropriate nursing interventions to reduce the workload of the heart and to promote comfort and rest? Select all that apply.

  • obtain daily weight
  • provide assistance with self-care activities
  • provide sensory stimulation
  • check vital signs after activity
Numbers 1 and 2 are correct.
Weight is the most accurate measure for volume retention that is a stress on the cardiac workload. Assistance with self-care activities should be done to avoid exertion. The environment should be comfortable and quiet to reduce stress. Vital signs should be checked before and after activity, especially if the client is taking vasodilators or diuretics.