Heart Failure - Medical-Surgical (Med-Surg) - Cardiovascular System - @LevelUpRN

Cathy from Level Up RN discusses the critical topic of heart failure, emphasizing its importance for nursing students and professionals. She explains the pathophysiology of heart failure, distinguishing between left-sided and right-sided heart failure by their symptoms, such as pulmonary congestion and systemic congestion, respectively. Diagnostic tools like hBNP levels and echocardiograms are highlighted, along with key medications such as diuretics and digoxin. Cathy also outlines essential nursing care practices, including daily weight monitoring and fluid intake management, and concludes with a quiz to reinforce learning.

• Heart failure is a critical topic for nursing school, NCLEX, and practicing nurses.
• It is a common diagnosis on medical surgical floors.
• Understanding heart failure involves knowing key facts and concepts, often highlighted in educational materials like flashcards.

"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."

• Emphasizes the importance of heart failure as a fundamental topic in nursing education and practice.

• Heart failure occurs when the heart muscle does not pump enough blood to meet the body's needs.
• It can result from congenital heart defects or disorders like coronary heart disease.
• These conditions damage or overwork the heart, leading to decreased cardiac output.

"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."

• Describes the underlying mechanisms causing heart failure, highlighting the impact of heart defects and diseases on cardiac output.

• Heart failure symptoms are categorized into left-sided and right-sided heart failure.
• Recognizing these symptoms is crucial for diagnosis and management.

"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."

• Indicates the necessity of distinguishing between different types of heart failure symptoms for effective patient care.

• Blood enters the right side of the heart, moves to the lungs, then to the left side of the heart, and finally out to the body.
• Left-sided heart failure results in blood backing up into the lungs, leading to pulmonary congestion.
• Symptoms of left-sided heart failure include dyspnea, crackles, fatigue, and pink, frothy sputum.
• Right-sided heart failure causes blood to back up into the body, leading to systemic congestion.
• Symptoms of right-sided heart failure include peripheral edema, ascites, jugular vein distension, and hepatomegaly.
• Mnemonics to remember symptoms: "Left equals lung" (L and L) for left-sided heart failure, and "Right equals the rest of the body" (R and R) for right-sided heart failure.

"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."

• This quote explains the normal blood flow through the heart, crucial for understanding how heart failure disrupts this process.

"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."

• This highlights the pathophysiology of left-sided heart failure, where blood backs up into the lungs, causing specific symptoms.

"Signs and symptoms of left-sided heart failure include dyspnea, crackles, fatigue, as well as pink, frothy sputum."

• This provides the clinical manifestations of left-sided heart failure, essential for diagnosis and treatment planning.

"If the right side of the heart fails, that blood will back up into the body. So we'll end up with systemic congestion."

• This describes the mechanism of right-sided heart failure, where blood backs up into the systemic circulation.

"Signs and symptoms of right-sided heart failure include peripheral edema, ascites, jugular vein distension, and hepatomegaly."

• This lists the symptoms associated with right-sided heart failure, aiding in distinguishing it from left-sided heart failure.

• Diagnosis of heart failure involves several diagnostic tools, including laboratory tests.
• hBNP (human B-type Natriuretic Peptide) is a hormone released by the heart in response to stretching.
• Elevated hBNP levels indicate the heart is not pumping effectively, suggesting heart failure.

"For labs, we have hBNP. hBNP is a hormone that is released by the heart in response to stretching of the heart."

• This explains the role of hBNP as a biomarker for heart failure, providing insight into the heart's functional status.

"With heart failure, the heart is not pumping effectively and that causes a back up."

• This underscores the functional impairment in heart failure, leading to increased hBNP levels as a diagnostic indicator.

• hBNP Levels: Elevated hBNP levels, specifically over 100, are indicative of heart failure due to the heart being stretched and releasing excess hBNP.
• Echocardiogram: This tool measures the ejection fraction, which is the percentage of blood leaving the ventricle with each contraction. A normal left ventricular ejection fraction ranges from 55% to 70%. An ejection fraction below 55% suggests heart failure.
• Hemodynamic Monitoring: In heart failure patients, there is an increase in central venous pressure and pulmonary artery wedge pressure.

"If your patient has an hBNP level over 100, that is indicative of heart failure."

• High hBNP levels serve as a biomarker for diagnosing heart failure.

"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."

• The ejection fraction is a critical measurement in assessing heart function, with lower percentages indicating potential heart failure.

"A patient with heart failure will have an increase in central venous pressure, as well as an increase in pulmonary artery wedge pressure."

• Hemodynamic changes are significant in diagnosing heart failure, showing increased pressures in specific heart areas.

• Diuretics: Used to eliminate excess fluid, reducing the heart's workload.
• Digoxin: Helps the heart beat more efficiently with stronger, slower contractions.
• Antihypertensive Agents: Includes beta blockers, ACE inhibitors, calcium channel blockers, and angiotensin II blockers, which help manage blood pressure and heart workload.
• Other Medications: Vasodilators and anticoagulants are also utilized in the treatment of heart failure.

"Diuretics will help get rid of that excess fluid to help decrease the workload of the heart."

• Diuretics are essential for fluid management in heart failure, easing the heart's burden.

"We can also give the patient digoxin, which will help that heart beat more efficiently, so it will allow for stronger, slower contractions."

• Digoxin enhances heart efficiency by improving contraction strength and timing.

"We can also provide the patient with antihypertensive agents such as beta blockers, ace inhibitors, calcium channel blockers, and angiotensin II blockers."

• A range of antihypertensive medications is crucial for controlling blood pressure and heart strain in heart failure patients.

• Weight Monitoring: Daily monitoring of the patient's weight is vital to assess fluid retention or loss.
• Monitoring Intake and Output: Keeping track of the patient's fluid intake and output is crucial to managing heart failure effectively.

"We're going to want to closely monitor the patient's weight on a daily basis."

• Daily weight checks are essential for detecting fluid changes in heart failure management.

• High Fowler's position is recommended for patients to facilitate easier breathing.
• This position is particularly useful for patients experiencing difficulties related to heart failure.

"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."

• Sitting the patient in High Fowler's position helps alleviate breathing difficulties by using gravity to assist lung expansion.

• Restricting fluid and sodium intake may be necessary as per medical orders.
• Monitoring of these restrictions is crucial in managing heart failure symptoms.

"We may also need to restrict the patient's fluid and sodium intake as ordered."

• Limiting fluid and sodium can help prevent fluid overload and reduce strain on the heart.

• Vigilant monitoring for complications such as pulmonary edema is essential.
• Complications can arise quickly, requiring prompt attention.

"We always want to monitor for complications such as pulmonary edema."

• Pulmonary edema is a serious condition that can develop from heart failure, necessitating close observation.

• A quiz is provided to test understanding of heart failure symptoms and related concepts.
• Emphasis is placed on distinguishing between left and right sided heart failure.

"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."

• Crackles and pink frothy sputum are indicative of left sided heart failure, affecting the lungs.

"Second question. Heart failure will cause an increase in central venous pressure and pulmonary artery wedge pressure. True or false? The answer is true."

• Heart failure leads to elevated central venous and pulmonary artery wedge pressures due to compromised cardiac function.

"Third question, peripheral edema and hepatomegaly are signs of right sided heart failure. True or false? The answer is true."

• Peripheral edema and hepatomegaly are symptoms associated with right sided heart failure, due to systemic circulation issues.

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