Daily Eight: Example

📚 Daily Eight – Day 1

Date: January 01, 0000

Theme: Cardiovascular

1️⃣ Management of Care 15–21%

Scenario Type: Delegation

Setting: Med-surg unit, RN with 1 LPN and 1 UAP, 6 patients

Question: Which task can the RN delegate to the UAP for a patient with heart failure?

Rationale: UAP can obtain vital signs and daily weights. Cannot assess, teach, or administer medications. Daily weights are critical for HF monitoring but are data collection, not assessment.

2️⃣ Safety & Infection Prevention/Control 10–16%

Topic: Fall Prevention – Cardiac Patients

Key Points: Orthostatic hypotension common with cardiac meds (beta-blockers, diuretics, ACE inhibitors). Dizziness increases fall risk.

Nursing Action: Teach patient to rise slowly, dangle feet before standing, call for assistance. Ensure call light within reach. Non-skid footwear.

⚠️ NCLEX Trap: Don't choose "keep all side rails up" – this is considered a restraint and can increase injury risk.

3️⃣ Health Promotion & Maintenance 6–12%

Focus: Cardiovascular Risk Screening

Population: Adults 40-75 years

Teaching Point: Know your numbers: BP <120/80, LDL <100, fasting glucose <100, BMI 18.5-24.9. Lifestyle modifications first.

Expected vs. Concern: Expected: BP slight increase with age. Concern: BP consistently >130/80, requires follow-up.

4️⃣ Psychosocial Integrity 6–12%

Topic: Therapeutic Communication – Anxiety about Diagnosis

💬 "Patient just diagnosed with heart failure says: "I can't believe this is happening to me. My life is over.""

✓ Say: "This diagnosis is overwhelming. Tell me more about what concerns you most." (Open-ended, acknowledges feelings)

✗ Avoid: "Don't worry, lots of people live with heart failure" (minimizes feelings), "You should be grateful it's not cancer" (dismissive comparison)

5️⃣ Basic Care & Comfort 6–12%

Topic: Positioning – Heart Failure

Intervention: High Fowler's position (60-90°) or orthopneic position (leaning forward on overbed table)

Nursing Consideration: Reduces venous return, decreases preload, improves lung expansion. Monitor for skin breakdown at sacrum.

Patient Teaching: Sleep with head elevated on 2-3 pillows. Report worsening orthopnea or PND (paroxysmal nocturnal dyspnea).

6️⃣ Pharmacological & Parenteral Therapies 13–19%

💊 Drug: Furosemide (Lasix)

Class: Loop diuretic

Mechanism: Inhibits sodium/chloride reabsorption in Loop of Henle → increased urine output → decreased fluid volume and preload

⚠️ Side Effects: Hypokalemia, hypotension, ototoxicity (especially with rapid IV push), dehydration, hyponatremia

Nursing Considerations: Monitor K+ (give with K+ supplement or K+-sparing diuretic), daily weights, I&O, assess for hearing changes. IV push over 1-2 minutes.

📋 Patient Teaching: Take in morning to avoid nocturia. Eat potassium-rich foods (bananas, oranges, potatoes). Report muscle cramps, weakness, irregular heartbeat.

7️⃣ Reduction of Risk Potential 9–15%

🔬 BNP (B-type Natriuretic Peptide)

Normal:
<100 pg/mL

Critical:
>500 pg/mL indicates heart failure

Clinical Significance: Released by ventricles in response to stretching/volume overload. Higher = worse heart failure. Used to diagnose and monitor HF severity.

Nursing Response: Elevated BNP: assess for fluid overload (edema, JVD, crackles, weight gain). Anticipate diuretics, oxygen, possible medication adjustment.

8️⃣ Physiological Adaptation 11–17%

🩺 Heart Failure (HF)

Pathophysiology: Heart cannot pump effectively → decreased cardiac output → backup of blood → pulmonary congestion (left-sided) or peripheral edema (right-sided). Triggers compensatory mechanisms that worsen condition over time.

Signs/Symptoms: Left-sided: dyspnea, orthopnea, crackles, cough, fatigue. Right-sided: JVD, peripheral edema, hepatomegaly, weight gain. Both: decreased urine output, activity intolerance.

⭐ Priority Interventions: Oxygen, position (high Fowler's), diuretics, daily weights, I&O, sodium/fluid restriction, monitor BNP and electrolytes. Medications: ACE inhibitors, beta-blockers, diuretics.

⚠️ Complications: Pulmonary edema, cardiogenic shock, renal failure, dysrhythmias, thromboembolism