This nursing care plan guide contains 18 nursing diagnoses and some priority aspects of clinical care for patients with heart failure. Learn about the nursing interventions and assessment cues for heart failure, including the goals, defining characteristics, and related factors for each nursing diagnosis.
What is Heart Failure?
Heart failure (HF) or Congestive Heart Failure (CHF) is a physiologic state in which the heart cannot pump enough blood to meet the body’s metabolic needs following any structural or functional impairment of ventricular filling or ejection of blood.
Heart failure results from changes in the systolic or diastolic function of the left ventricle. The heart fails when, because of intrinsic disease or structural, it cannot handle a normal blood volume or, in the absence of disease, cannot tolerate a sudden expansion in blood volume. Heart failure is a progressive and chronic condition managed by significant lifestyle changes and adjunct medical therapy to improve quality of life. Heart failure is caused by various cardiovascular conditions such as chronic hypertension, coronary artery disease, and valvular disease.
Heart failure is not a disease itself. Instead, the term refers to a clinical syndrome characterized by manifestations of volume overload, inadequate tissue perfusion, and poor exercise tolerance. Whatever the cause, pump failure results in hypoperfusion of tissues, followed by pulmonary and systemic venous congestion.
Heart failure can affect the heart’s left side, right side, or both sides. Though, it usually affects the left side first. The signs and symptoms of heart failure are defined based on which ventricle is affected—left-sided heart failure causes a different set of manifestations than right-sided heart failure.
Left-Sided Heart Failure
- Dyspnea on exertion
- Pulmonary congestion, pulmonary crackles
- Cough that is initially dry and nonproductive
- Frothy sputum that is sometimes blood-tinged
- Inadequate tissue perfusion
- Weak, thready pulse
- Oliguria, nocturia
Right-Sided Heart Failure
- Congestion of the viscera and peripheral tissues
- Edema of the lower extremities
- Enlargement of the liver (hepatomegaly)
- Anorexia, nausea
- Weight gain (fluid retention)
Because heart failure causes vascular congestion, it is often called congestive heart failure, although most cardiac specialists no longer use it. Other terms used to denote heart failure include chronic heart failure, cardiac decompensation, cardiac insufficiency, and ventricular failure.
Nursing Care Plans
Nursing care plan goals for patients with heart failure include support to improve heart pump function by various nursing interventions, prevention and identification of complications, and providing a teaching plan for lifestyle modifications. Nursing interventions include promoting activity and reducing fatigue to relieve the symptoms of fluid overload.
Here are 18 nursing care plans (NCP) and nursing diagnoses for patients with Heart Failure:
- Decreased Cardiac Output UPDATED
- Activity Intolerance UPDATED
- Excess Fluid Volume
- Risk for Impaired Skin Integrity
- Deficient Knowledge
- Acute Pain
- Ineffective Tissue Perfusion
- Ineffective Breathing Pattern
- Ineffective Airway Clearance
- Risk for Impaired Gas Exchange
- Impaired Gas Exchange
- Risk for Decreased Cardiac Tissue Perfusion
- Other Nursing Care Plans
Impaired Gas Exchange
The exchange in oxygenation and carbon dioxide gases is impeded due to the obstruction caused by the accumulation of bronchial secretions in the alveoli. Oxygen cannot diffuse easily.
- Impaired Gas Exchange
- Alveolar edema secondary to increased ventricular pressure
The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.
- Productive cough
- Crackles upon auscultation
- Difficulty of breathing
- Shortness of breath
- Pale conjunctiva, nail beds and buccal mucosa
- Metabolic acidosis
- Circumoral cyanosis
Common goals and expected outcomes:
- Patient will be able to demonstrate improvement in gas exchange as evidenced by normal breath sounds, and skin color, presence of eupnea, heart rate 100 bpm or less, and Sp02 level of 95% above.
Nursing Assessment and Rationales
The following are the nursing assessment for this heart failure nursing care plan.
1. Assess respiratory rate, use of accessory muscles, signs of air hunger, lung excursion, cyanosis, and significant changes in vital signs.
These are warning signs of increasing respiratory distress that requires immediate attention.
2. Auscultate lung fields for the presence of crackles.
Decreased breath sounds can be a sign of fluid overload or altered ventilation. Crackles signify alveolar fluid congestion and systolic dysfunctional heart failure. On the other hand, wheezing may indicate asthma or related bronchitis.
3. Monitor oxygen saturation and ABG findings.
A 92% or less pulse oximetry value, decreased PaO2, and increased PaCO2 are signs of decreasing oxygenation.
4. Observe the color of skin, mucous membranes, and nail beds, noting the presence of peripheral cyanosis.
Cyanosis of nail beds may represent vasoconstriction or the body’s response to fever/ chills.
5. Monitor potassium levels.
A possibility of hypokalemia is evident in patients taking diuretics.
Nursing Interventions and Rationales
Here are the nursing interventions for this heart failure nursing care plan.
1. Position the patient in a High Fowler’s position with the head of the bed elevated up to 90°.
Promote maximal inspiration, enhance expectoration of secretions to improve ventilation.
2. Keep back dry.
To avoid coughing
3. Promote adequate rest periods
Rest will prevent fatigue and decrease oxygen demands for metabolic demands
4. Keep the environment allergen-free
To reduce irritant effects on airways
5. Suction secretions PRN
To clear the airway when secretions are blocking the airway.
6. Administer oxygen therapy as ordered.
For patients with ADHF, high-flow oxygen is given via a non-rebreathing mask, positive airway pressure devices, or endotracheal intubation and mechanical intubation. If it improves, oxygen is titrated to maintain pulse oximetry readings greater than 92%.
7. Administer diuretics as ordered.
Diuretics promote normovolemia by decreasing fluid accumulation and blood volume. Fluid overload reduces lung perfusion leading to hypoxemia.
8. Administer vasodilators as ordered.
These medications increase venous dilation and decrease pulmonary congestion, which will enhance gas exchange.
- 8.1. ACE inhibitors (captopril, enalapril, lisinopril, ramipril)
Suppresses the effects of the renin-angiotensin system by decreasing angiotensin II and causing reduced secretion of aldosterone. These medications lower blood pressure and decrease preload and afterload, reducing work of the left ventricle.
- 8.2. Angiotensin II receptor antagonists (candesartan, losartan, telmisartan, nesiritide, valsartan)
These are given for patients with intolerance to ACE inhibitors due to cough secondary to the release of bradykinin.
- 8.3. Hydralazine
Used in conjunction with nitrates in patients who cannot tolerate medications suchs as ACE inhibitor/ARB due to renal dysfunction.
- 8.4. Nitrates
Acts as a coronary vasodilators and used in combination with hydralazing.
9. Have airway emergency equipment available at the bedside.
A likelihood of cardiac arrest for patients with severe decompensated heart failure.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for cardiovascular system disorders:
- Angina Pectoris (Coronary Artery Disease) | 4 Care Plans
- Cardiac Arrhythmia (Digitalis Toxicity) | 3 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cardiogenic Shock | 5 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Heart Failure | 18 Care Plans
- Hypertension | 6 Care Plans
- Hypovolemic Shock | 4 Care Plans
- Myocardial Infarction | 7 Care Plans
- Pacemaker Therapy | 6 Care Plans
References and Sources
Recommended journals, books, and other interesting materials to help you learn more about heart failure nursing care plans and nursing diagnosis:
- Albert, N. M. (2012). Fluid management strategies in heart failure. Critical care nurse, 32(2), 20-32.
- Albert, N., Trochelman, K., Li, J., & Lin, S. (2010). Signs and symptoms of heart failure: are you asking the right questions?. American Journal of Critical Care, 19(5), 443-452.
- Alkhawam, H., Abo-Salem, E., Zaiem, F., Ampadu, J., Rahman, A., Sulaiman, S., … & Vittorio, T. J. (2019). Effect of digitalis level on readmission and mortality rate among heart failure reduced ejection fraction patients. Heart & Lung, 48(1), 22-27.
- Allen, J. K., & Dennison, C. R. (2010). Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: systematic review. Journal of Cardiovascular Nursing, 25(3), 207-220.
- Amin, A., Garcia Reeves, A. B., Li, X., Dhamane, A., Luo, X., Di Fusco, M., … & Keshishian, A. (2019). Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure. PloS one, 14(3), e0213614.
- Austin, J., Williams, R., Ross, L., Moseley, L., & Hutchison, S. (2005). Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. European Journal of Heart Failure, 7(3), 411-417.
- Barrese, V., & Taglialatela, M. (2013). New advances in beta-blocker therapy in heart failure. Frontiers in physiology, 4, 323.
- Bikdeli, B., Strait, K. M., Dharmarajan, K., Li, S. X., Mody, P., Partovian, C., … & Krumholz, H. M. (2015). Intravenous fluids in acute decompensated heart failure. JACC: Heart Failure, 3(2), 127-133.
- Bocchi, E. A. (2001). Cardiomyoplasty for treatment of heart failure. European journal of heart failure, 3(4), 403-406.
- Bolger, A. P., Coats, A. J., & Gatzoulis, M. A. (2003). Congenital heart disease: the original heart failure syndrome. European Heart Journal, 24(10), 970-976.
- Brater, D. C. (2000). Pharmacology of diuretics. The American journal of the medical sciences, 319(1), 38-50.
- Brennan, E. J. (2018). Chronic heart failure nursing: integrated multidisciplinary care. British Journal of Nursing, 27(12), 681-688.
- Brunner, L. S. (2010). Brunner & Suddarth’s textbook of medical-surgical nursing (Vol. 1). Lippincott Williams & Wilkins.
- Butler, J., Young, J. B., Abraham, W. T., Bourge, R. C., Adams, K. F., Clare, R., … & ESCAPE Investigators. (2006). Beta-blocker use and outcomes among hospitalized heart failure patients. Journal of the American College of Cardiology, 47(12), 2462-2469.
- Cattadori, G., Segurini, C., Picozzi, A., Padeletti, L., & Anzà, C. (2018). Exercise and heart failure: an update. ESC heart failure, 5(2), 222-232.
- Chew, H. S. J., Sim, K. L. D., & Cao, X. (2019). Motivation, challenges and self-regulation in heart failure self-care: a theory-driven qualitative study. International journal of behavioral medicine, 26(5), 474-485.
- Conti, C. R. (2011). Intravenous morphine and chest pain. Clinical cardiology, 34(8), 464.
- Cowie, M. R., & Mendez, G. F. (2002). BNP and congestive heart failure. Progress in cardiovascular diseases, 44(4), 293-321.
- De Bruyne, L. K. M. (2003). Mechanisms and management of diuretic resistance in congestive heart failure. Postgraduate medical journal, 79(931), 268-271.
- De Jong, M. J., Chung, M. L., Wu, J. R., Riegel, B., Rayens, M. K., & Moser, D. K. (2011). Linkages between anxiety and outcomes in heart failure. Heart & Lung, 40(5), 393-404.
- Drazner, M. H., Rame, J. E., & Dries, D. L. (2003). Third heart sound and elevated jugular venous pressure as markers of the subsequent development of heart failure in patients with asymptomatic left ventricular dysfunction. The American journal of medicine, 114(6), 431-437.
- Elkayam, U., Akhter, M. W., Tummala, P., Khan, S., & Singh, H. (2002). Nesiritide: a new drug for the treatment of decompensated heart failure. Journal of cardiovascular pharmacology and therapeutics, 7(3), 181-194.
- Ellison, D. H., & Felker, G. M. (2017). Diuretic treatment in heart failure. New England Journal of Medicine, 377(20), 1964-1975.
- Enright, P. L. (2003). The six-minute walk test. Respiratory care, 48(8), 783-785.
- Faris, R. F., Flather, M., Purcell, H., Poole‐Wilson, P. A., & Coats, A. J. (2012). Diuretics for heart failure. Cochrane Database of Systematic Reviews, (2).
- Felker, G. M., Ellison, D. H., Mullens, W., Cox, Z. L., & Testani, J. M. (2020). Diuretic therapy for patients with heart failure: JACC state-of-the-art review. Journal of the American College of Cardiology, 75(10), 1178-1195.
- Fletcher, G. F., Balady, G. J., Amsterdam, E. A., Chaitman, B., Eckel, R., Fleg, J., … & Bazzarre, T. (2001). Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation, 104(14), 1694-1740.
- Friederich, J. A., & Butterworth, J. F. (1995). Sodium nitroprusside: twenty years and counting. Anesthesia & Analgesia, 81(1), 152-162.
- Gao, X., Peng, L., Adhikari, C. M., Lin, J., & Zuo, Z. (2007). Spironolactone reduced arrhythmia and maintained magnesium homeostasis in patients with congestive heart failure. Journal of cardiac failure, 13(3), 170-177.
- Giordano, F. J. (2005). Oxygen, oxidative stress, hypoxia, and heart failure. The Journal of clinical investigation, 115(3), 500-508.
- Grady, K. L., Dracup, K., Kennedy, G., Moser, D. K., Piano, M., Stevenson, L. W., & Young, J. B. (2000). Team management of patients with heart failure: a statement for healthcare professionals from the Cardiovascular Nursing Council of the American Heart Association. Circulation, 102(19), 2443-2456.
- Gulanick, M., & Myers, J. L. (2021). Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Mosby.
- Haque, W. A., Boehmer, J., Clemson, B. S., Leuenberger, U. A., Silber, D. H., & Sinoway, L. I. (1996). Hemodynamic effects of supplemental oxygen administration in congestive heart failure. Journal of the American College of Cardiology, 27(2), 353-357.
- Herman, L. L., & Tivakaran, V. S. (2017). Hydralazine.
- Hinkle, J. L., & KH, C. (2017). Brunner & Suddarth’s textbook of medical‑surgical nursing. Vol. 1.
- Holme, M. R., & Sharman, T. (2020). Sodium nitroprusside.
- Jaarsma, T., Strömberg, A., De Geest, S., Fridlund, B., Heikkila, J., Mårtensson, J., … & Thompson, D. R. (2006). Heart failure management programmes in Europe. European Journal of Cardiovascular Nursing, 5(3), 197-205.
- Jacobs, M. (1984). Mechanism of action of hydralazine on vascular smooth muscle. Biochemical pharmacology, 33(18), 2915-2919.
- Joynt, K. E., Whellan, D. J., & O’connor, C. M. (2004). Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure. Journal of cardiac failure, 10(3), 258-271.
- Jurgens, C. Y., Goodlin, S., Dolansky, M., Ahmed, A., Fonarow, G. C., Boxer, R., … & Rich, M. W. (2015). Heart failure management in skilled nursing facilities: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation: Heart Failure, 8(3), 655-687.
- Kemp, C. D., & Conte, J. V. (2012). The pathophysiology of heart failure. Cardiovascular Pathology, 21(5), 365-371.
- Kim, W., & Kim, E. J. (2018). Heart failure as a risk factor for stroke. Journal of stroke, 20(1), 33.
- Klompstra, L., Jaarsma, T., & Strömberg, A. (2018). Self-efficacy mediates the relationship between motivation and physical activity in patients with heart failure. The Journal of cardiovascular nursing, 33(3), 211.
- Krämer, B. K., Schweda, F., & Riegger, G. A. (1999). Diuretic treatment and diuretic resistance in heart failure. The American journal of medicine, 106(1), 90-96.
- Leier, C. V., & Chatterjee, K. (2007). The physical examination in heart failure—Part I. Congestive Heart Failure, 13(1), 41-47.
- Levy, P., Compton, S., Welch, R., Delgado, G., Jennett, A., Penugonda, N., … & Zalenski, R. (2007). Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Annals of emergency medicine, 50(2), 144-152.
- Lewis, P. A., Ward, D. A., & Courtney, M. D. (2009). The intra-aortic balloon pump in heart failure management: implications for nursing practice. Australian critical care, 22(3), 125-131.
- Maisel, W. H., & Stevenson, L. W. (2003). Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. The American journal of cardiology, 91(6), 2-8.
- Masip, J., Gayà, M., Páez, J., Betbesé, A., Vecilla, F., Manresa, R., & Ruíz, P. (2012). Pulse oximetry in the diagnosis of acute heart failure. Revista Española de Cardiología (English Edition), 65(10), 879-884.
- Milo-Cotter, O., Cotter, G., Kaluski, E., Rund, M. M., Felker, G. M., Adams, K. F., … & Weatherley, B. D. (2009). Rapid Clinical Assessment of Patients with Acute Heart Failure: First Blood Pressure and Oxygen Saturation–Is That All We Need?. Cardiology, 114(1), 75-82.
- Mullens, W., Abrahams, Z., Francis, G. S., Skouri, H. N., Starling, R. C., Young, J. B., … & Tang, W. W. (2008). Sodium nitroprusside for advanced low-output heart failure. Journal of the American College of Cardiology, 52(3), 200-207.
- Nicholson, C. (2007). Heart failure: A clinical nursing handbook (Vol. 31). John Wiley & Sons.
- Nyolczas, N., Dekany, M., Muk, B., & Szabo, B. (2017). Combination of hydralazine and isosorbide-dinitrate in the treatment of patients with heart failure with reduced ejection fraction. Heart Failure: From Research to Clinical Practice, 31-45.
- Oh, S. W., & Han, S. Y. (2015). Loop diuretics in clinical practice. Electrolytes & Blood Pressure, 13(1), 17-21.
- Pereira, J. D. M. V., Cavalcanti, A. C. D., Lopes, M. V. D. O., Silva, V. G. D., Souza, R. O. D., & Gonçalves, L. C. (2015). Accuracy in inference of nursing diagnoses in heart failure patients. Revista brasileira de enfermagem, 68, 690-696.
- Picano, E., Gargani, L., & Gheorghiade, M. (2010). Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications. Heart failure reviews, 15(1), 63-72.
- Piña, I. L., Apstein, C. S., Balady, G. J., Belardinelli, R., Chaitman, B. R., Duscha, B. D., … & Sullivan, M. J. (2003). Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation, 107(8), 1210-1225.
- Platz, E., Merz, A. A., Jhund, P. S., Vazir, A., Campbell, R., & McMurray, J. J. (2017). Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. European journal of heart failure, 19(9), 1154-1163.
- Qamer, S. Z., Malik, A., Bayoumi, E., Lam, P. H., Singh, S., Packer, M., … & Ahmed, A. (2019). Digoxin use and outcomes in patients with heart failure with reduced ejection fraction. The American journal of medicine, 132(11), 1311-1319.
- Redeker, N. S., Adams, L., Berkowitz, R., Blank, L., Freudenberger, R., Gilbert, M., … & Rapoport, D. (2012). Nocturia, sleep and daytime function in stable heart failure. Journal of Cardiac Failure, 18(7), 569-575.
- Reid, M. B., & Cottrell, D. (2005). Nursing care of patients receiving: Intra-aortic balloon counterpulsation. Critical care nurse, 25(5), 40-49.
- Rogers, C., & Bush, N. (2015). Heart failure: Pathophysiology, diagnosis, medical treatment guidelines, and nursing management. The Nursing Clinics of North America, 50(4), 787-799.
- Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American college of Cardiology, 48(8), 1527-1537.
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- Serber, S. L., Rinsky, B., Kumar, R., Macey, P. M., Fonarow, G. C., & Harper, R. M. (2014). Cerebral blood flow velocity and vasomotor reactivity during autonomic challenges in heart failure. Nursing research, 63(3), 194.
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Originally published on July 14, 2013.
22 thoughts on “18 Heart Failure Nursing Care Plans”
GOOD NDx keep it up`yeah jah bless
Very good work.
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Thank you! :)
Thank you are really helping me
Am a student nurse and this is really helping me a lot
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This notes are lit and helping alot thanks and keep updating especially pharmacology am astudent nurse
A very nice explanation keep it up!
Thanks much. This is a great jobe well done. Be blessed
Thank you Caleb, check out our other nursing care plans and nursing diagnoses!
I wish you would add some patient education information, sometimes it seems like it may be common knowledge, but I’d like to see specifically focused education topics! Please and thank you!
You can check the deficient knowledge nursing diagnosis for this care plan.
This is great!! I am a student nurse, currently working on my unit for Chronic health conditions. This has really helped me a lot.
this site has been very helpful for me in my studies, very grateful.
Thanks so much, I’m a student nurse currently working on my care study and it has really been helpful.
Please,can I also have a detailed pathophysiology of peripartum cardiomyopathy as well as its nursing care plans. Thanks a lot once again.
This is such a comprehensive nursing care plan for heart failure. I appreciate the author. Kudos to you!
Wow!! These are great!! I wish this site had been around when I was in school!!
Even now as an NP. These are a wonderful resource to review processes.. don’t know who came up with this site but kudos to you!!!
So much hands on information. Where can we get it as PDF info