PATHO BASICS
This type of heart failure occurs when the heart can't pump blood effectively out to the body.
What is systolic heart failure (HFrEF)?
Shortness of breath that occurs when lying flat.
What is orthopnea?
This "water pill" is commonly the first medication given to remove excess fluid. (in acute exacerbation)
What is furosemide (Lasix)?
Patients should weigh themselves at this time every day
What is the same time each morning after urinating?
This position helps patients with heart failure breathe more easily.
What is high Fowler's position (sitting upright)?
This compensatory mechanism causes the kidneys to retain sodium and water in heart failure.
What is activation of the renin-angiotensin-aldosterone system (RAAS)?
Weight gain of this many pounds in 24-48 hours indicates fluid retention.
What is 2-3 pounds?
Before giving what meds, you must always check apical heart rate and hold if it's below 60.
This amount of daily sodium restriction is typically recommended for heart failure patients.
What is 2-3 grams (2000-3000 mg)? 2 preferred.
You should monitor this lab value closely in pts with chest pain. 2/3
What are Electrolytes, BNP, troponin
Clinical Scenario: Your patient with heart failure has an ejection fraction of 25%. The family asks what this means. You explain this indicates which type of heart failure?
What is heart failure with reduced ejection fraction (HFrEF)?
Nausea and vomiting are the primary symptom of what cardiac drug toxicity?
Digoxin (digitalis)
Clinical Scenario: Your patient is starting lisinopril for heart failure. You teach him to change positions slowly because this medication can cause which side effect?
What is orthostatic hypotension?
Clinical Scenario: Mr. Lee asks what foods he should avoid. You teach him to limit foods high in sodium. Name three specific foods he should avoid from the SALTY SIX.
Clinical Scenario: Your heart failure patient has an oxygen saturation of 89% on room air. Besides positioning, what is your priority nursing intervention?
What is apply oxygen/notify physician?
Clinical Scenario: Mrs. Johnson has heart failure and her chest X-ray shows "fluffy" bilateral infiltrates. Her oxygen saturation is 88% on room air. This indicates fluid backup into which body system?
What is the pulmonary system (pulmonary edema from left-sided heart failure)?
Clinical Scenario: Mrs. Garcia calls the clinic saying she woke up at 2 AM "gasping for air" and had to sit up for 30 minutes before she could breathe normally. This describes which symptom?
What is paroxysmal nocturnal dyspnea (PND)?
Clinical Scenario: Mrs. Thompson is taking spironolactone 25mg daily. Her latest lab shows potassium of 5.3 mEq/L. You should be concerned about this because spironolactone is this type of diuretic.
What is a potassium-sparing diuretic?
Clinical Scenario: Mrs. Anderson calls because she gained 4 pounds over the weekend. She asks if she should take an extra water pill. What should you tell her to do first?
What is call the doctor/healthcare provider immediately (don't self-medicate)?
Clinical Scenario: During shift report, you learn your patient with heart failure had 1200 mL intake and 800 mL output yesterday. What is your priority assessment when you see this patient?
What is assess for signs of fluid overload (weight gain, edema, lung sounds, shortness of breath)?
Your heart failure patient's BNP level comes back at 850 pg/mL (normal <100). The physician explains this hormone is released when these heart structures are stretched.
What are the ventricles?
Clinical Scenario: During assessment, you note your patient's liver is enlarged and tender, he has 3+ pitting edema in both legs, and distended neck veins. These findings suggest which type of heart failure?
What is right-sided heart failure?
Clinical Scenario: Your patient with heart failure is prescribed carvedilol. The family is confused because they thought beta-blockers were "bad for the heart." You explain that in heart failure, this medication helps by doing what?
What is reducing workload on the heart/decreasing blood pressure and heart rate/improving long-term survival/blocking harmful effects of adrenaline?
Clinical Scenario: Your patient is being discharged on multiple heart failure medications. His daughter asks about activity restrictions. You teach them he should stop activity and rest if he experiences which symptoms?
What are chest pain, severe shortness of breath, dizziness, or palpitations?
Clinical Scenario: Your heart failure patient becomes increasingly confused and reports nausea. His digoxin level from this morning is 2.8 ng/mL (therapeutic range 0.5-2.0). What are your priority nursing actions?
What are hold the digoxin, notify the physician immediately, and monitor for dysrhythmias?