Med-Surg - Cardiovascular System, part 8: Heart Failure
by Cathy Parkes October 06, 2021 Updated: August 09, 2023 4 min read
In this article, we cover heart failure, a critical topic to know for nursing school, for the NCLEX, and for your Med-Surg exams. The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
What is heart failure?
Heart failure occurs when the heart muscle does not pump enough blood to meet the body’s needs.
What is the pathophysiology behind heart failure?
The pathophysiology behind heart failure is that the patient has a congenital heart defect or disorder (e.g., coronary heart disease, cardiomyopathy, hypertension, or valvular disease) that damages or overworks the heart, decreasing cardiac output.
What are the signs and symptoms of heart failure?
Left = Lungs. Right = Rest of body.
The signs and symptoms of heart failure differ, depending on which side they occur, the left side or the right side.
Thinking about how blood flows through the heart will help you think critically about what signs and symptoms you can expect for either left- or right-sided heart failure — blood comes into the right side of the heart, then goes to the lungs, then goes to the left side of the heart, and then out to the rest of the body.
What are the signs and symptoms of left-sided heart failure?
Left-sided heart failure occurs when the blood backs up into the lungs, resulting in pulmonary congestion.
The signs and symptoms of left-sided heart failure, then, include dyspnea (shortness of breath), crackles (a crackling sound inside the lungs), fatigue, and frothy sputum.
What are the signs and symptoms of right-sided heart failure?
Right-sided heart failure occurs when the blood that is coming from the body to that side of the heart backs up into the body, causing systemic congestion.
The signs and symptoms of right-sided heart failure include peripheral edema (swelling), ascites (fluid accumulation in the abdomen), jugular vein distension, and hepatomegaly (enlargement of the liver).
Labs and diagnostic tools for heart failure
Labs for diagnosing heart failure
Labs we can use to diagnose heart failure include measuring the patient’s hBNP level.
hBNP is a hormone that is released by the heart in response to stretching. With heart failure, the heart is not pumping effectively and that causes a backup of blood, which stretches the heart and causes excess release of hBNP. If a patient has an hBNP level over 100 pg/mL, that is indicative of heart failure.
You can learn about labs that help diagnose heart failure, and more, with our Lab Values Study Guide & Flashcard Index, a list of lab values covered in depth in our Lab Values Flashcards for nursing students.
Diagnostic tools for diagnosing heart failure
Echocardiograms are one diagnostic tool we can use to diagnose heart failure. Echocardiograms measure the patient’s ejection fraction, which is the percentage of blood that leaves the ventricle each time it contracts. Normally, the left ventricular ejection fraction is between 55 and 70 percent. If we have an ejection fraction under 55%, that is indicative of heart failure.
Hemodynamic monitoring is another tool to diagnose heart failure. Hemodynamic monitoring will reveal an increase in central venous pressure (CVP) as well as an increase in pulmonary artery wedge pressure (PAWP) — signs of heart failure.
Treatment for heart failure
There are many medications that may be used to treat heart failure.
Diuretics are commonly administered. They help get rid of excess fluid to decrease the workload of the heart.
A patient might be administered digoxin, which will help the heart beat more efficiently and allow for stronger, slower contractions.
For more details on medications that may be administered to treat heart failure, check out our Nursing Pharmacology video series, which follows along with our Pharmacology Second Edition Flashcards and are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Nursing care for patients with heart failure
In terms of nursing care for patients with heart failure, here are some best practices:
- Monitor the patient’s weight on a daily basis
- Monitor their Is and Os
- Sit the patient upright in high Fowler’s position, which will make it easier for them to breathe
- Administer oxygen
- Restrict fluid and sodium intake as ordered
- Monitor for complications, including pulmonary edema (excess fluid in the lungs)
Hi, I'm Cathy with Level Up RN. In this video, I am going to cover heart failure, and at the end of the video, I'm going to provide you guys a little quiz to test your understanding of some of the key items I will be covering in this video. So definitely stay tuned for that. And if you have our medical surgical nursing flashcards, definitely pull those out so you can follow along with me.
So heart failure is a critical topic that you need to know for nursing school. You need to know it for NCLEX, and you also need to know it as a practicing nurse. So on the medical surgical floor, we frequently get patients with heart failure. It's a very common diagnosis. So you're definitely going to need to know this condition inside and out, and you'll notice on our flashcards we have lots of bold red text. So that means these are important facts and concepts that you will definitely want to review.
With heart failure, the heart muscle does not pump enough blood to effectively meet the body's needs, and the pathophysiology behind heart failure is that the patient has a congenital heart defect or some other disorder, such as coronary heart disease, which damages or overworks the heart, such that we have a decrease in cardiac output.
In terms of the signs and symptoms of heart failure, we have left sided heart failure signs and symptoms and right sided heart failure signs and symptoms. And if you think about the blood flow through the heart, it will help you think critically about what signs and symptoms you can expect. So blood will come into the right side of the heart and then it will go to the lungs and then to the left side of the heart and then out to the body.
So if we have left sided heart failure, where does the blood back up? It backs up into the lungs, so we will end up with pulmonary congestion.
So signs and symptoms of left sided heart failure include dyspnea, crackles, fatigue, as well as pink, frothy sputum.
What about if we have right sided heart failure? So remember, blood is coming from the body into the right side of the heart. If the right side of the heart fails, that blood will back up into the body. So we'll end up with systemic congestion.
So signs and symptoms of right sided heart failure include peripheral edema, ascites, jugular vein distension, and hepatomegaly. So enlargement of the liver.
So we do have a little cool chicken hint here on the card to help you remember which symptoms go with which side. So left equals lung. So L and L. And right equals the rest of the body, R and R.
In terms of diagnosis of heart failure, there's a number of diagnostic tools that we can use.
So for labs, we have hBNP. hBNP is a hormone that is released by the heart in response to stretching of the heart. So with heart failure, the heart is not pumping effectively and that causes a back up of blood. So the heart is definitely being stretched, which causes excess release of hBNP. So if your patient has an hBNP level over 100, that is indicative of heart failure.
Another diagnostic tool is an echocardiogram, and with this tool, we can measure the patient's ejection fraction, which is the percentage of blood that leaves the ventricle each time it contracts. And normally left ventricular ejection fraction is between 55 and 70 percent. If we have an ejection fraction which is under 55%, then that is indicative of heart failure.
We can also use hemodynamic monitoring as a diagnostic tool. So a patient with heart failure will have an increase in central venous pressure, as well as an increase in pulmonary artery wedge pressure.
For medications, diuretics are commonly used. Diuretics will help get rid of that excess fluid to help decrease the workload of the heart. We can also give the patient digoxin, which will help that heart beat more efficiently, so it will allow for stronger, slower contractions. We can also provide the patient with antihypertensive agents such as beta blockers, ace inhibitors, calcium channel blockers, and angiotensin II blockers. Other medications used for heart failure include vasodilators as well as anticoagulants.
In terms of nursing care, we're going to want to closely monitor the patient's weight on a daily basis, and we're going to want to monitor their Is and Os as well. We're going to want to sit the patient up into High Fowler's position because it'll be easier for them to breathe in that position. We may also need to restrict the patient's fluid and sodium intake as ordered, and then we always want to monitor for complications such as pulmonary edema.
Okay, you guys ready for a quiz? I have three questions for you. First question. Crackles and pink frothy sputum are signs of a right sided heart failure. True or false? The answer is false. These are signs and symptoms of left sided heart failure. So remember, with left sided heart failure, we have symptoms in the lungs. Okay, second question. Heart failure will cause an increase in central venous pressure and pulmonary artery wedge pressure. True or false? The answer is true. Third question, peripheral edema and hepatomegaly are signs of right sided heart failure. True or false? The answer is true.
All right. I hope you did well with that quiz. If you're enjoying our videos and you're enjoying these little quizzes at the end of the videos, definitely give this video a thumbs up and definitely leave me a comment. Take care and good luck with studying.
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