Med-Surg - Cardiovascular System, part 8: Heart Failure
October 06, 2021 Updated: December 29, 2021 4 min read
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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