Medications
This herbal remedy increases cardiac contractility
Digoxin
This is a hallmark symptom of heart failure
Fluid retention
This would considered a normal EF
50-70%
DD - Name 3 diseases that put someone at risk for developing heart failure
CAD, Diabetes, HTN, Obesity, Vavular heart disease, cardiomyopathy, congenital heart disease, MI, kidney failure, A fib
Name 3 easy modifications to remove added salt from diet immediately
Never use a salt shaker
Switch all canned veggies to fresh or frozen
Avoid frequent take-out or going to restaurants
Make meals from scratch
Avoid pre-made foods, like TV dinners
Read dietary labels on food
Fluid restriction and daily weight monitoring begin to be required at this stage of Heart Failure
Stage C
What symptoms will you teach your patient to call the cardiologist for?
Shortness of breath worse than usual
Edema
Decreased endurance/fatigue
Waking up in the middle of the night feeling short of breath
Cough
Weight gain of 2lbs since yesterday or 3-5 lbs since last week
Your CHF patient is prescribed IV Lasix. Name three additional orders or nursing considerations you anticipate
Strict I&O, daily weights, fluid restriction, monitor BP, electrolytes (K+), and renal function, fall precautions
DD - This type of heart failure can cause symptoms of ascites, dependent edema, fatigue, and jugular vein distention
Right-sided heart failure
When considering physiological changes common in geriatric patients, the nurse understands that which of these factors may increase the risk of heart failure in older patients?
a. Increased myocardial contractility
b. Increased stroke volume
c. Impaired diastolic filling
d. Decreased sympathetic activity
c. Impaired diastolic filling
This disorder affects the heart muscle commonly causing tissue necrosis and/or fibrosis
What is Cardiomyopathy
Your heart failure patient is being discharged on a heart healthy, sodium restricted diet. They ask you for tips on what foods to avoid to reduce sodium intake...
Focus on fresh or frozen vegetables fruits, meats, and whole grains. Avoid processed foods (lunch meats, processed cheeses/dairy), spice mixtures/sauces/condiments/dressings that contain salt, canned goods, fast food, "convenience" foods or prepared meals (frozen dinners, mac and cheese, ramen noodles), pizza, some soups and cereals, pork products, baked goods/sweets, fried foods
Your patient is a readmit with a CHF exacerbation within 30 days. You would ensure this nursing consult was placed upon admission.
Care coordination/discharge planning
When you tell the patient they should call the cardiologist when they see a symptom, the patient states that they try to avoid calling the doctor because they will just tell them to come to the hospital. What would be your response?
By calling your cardiologist when your symptoms are mild, your cardiologist is better able to treat you at home by possibly giving you a diuretic or increasing your dose of diuretic to pull the extra fluid off quickly so that it doesn’t result in worsening fluid retention, thus leading to possible hospitalization. It is the waiting when your symptoms are mild that increase the likelihood of hospitalization.
Your heart failure patient was recently prescribed enalapril and reports a nagging cough and incident of angioedema. What would you expect this patient to be discharged home on instead?
Name 3 common symptoms of left-sided heart failure
Dyspnea at rest or on exertion, orthopnea, pulmonary, congestion, fatigue, decreased cardiac output, paroxysmal nocturnal dyspnea, cognitive impairment.
DD - In this type of left sided heart failure, the left ventricle weakens and loses its ability to contract normally, causing reduced EF and less blood pumped into circulation.
Systolic failure
An EF of 35% or less is when a heart failure patient would qualify for this life-saving device
An ICD or Life Vest
DD - Name 3 foods that should be considered as part of total fluid intake if on a fluid restriction.
Ice cream/milkshakes, jello, soup, popsicles, pudding, jelly, sauces, gravy, yogurt, ice
When obtaining a health history of a patient admitted with a diagnosis of heart failure, which statement made by the patient supports the diagnosis of heart failure?
a. "I get hot and break out in a sweat during the night."
b. "I get out of breath when I go up a flight of stairs."
c. "I sometimes feel pain the middle of my chest during exercise."
d. "I often feel pain in my lower legs when I take my walk."
b. "I get out of breath when I go up a flight of stairs."
You are teaching your patient about the importance of weighing themselves. What are 3 points you want to ensure they know about weighing themselves?
1. Weigh daily
2. Weigh upon waking, after voiding, but before eating anything at same time everyday
3. Compare your weight to the day before
4. Call cardiologist to report a weight gain of 2-3lbs since the day before and request a call back
DD - You are discharging a HF & CKD patient home and are reviewing their discharge medications.
You note that they are being sent home on: Entresto (sacubitril-valsartan) 97mg/103mg BID, metoprolol succinate 200mg daily, spironolactone 25mg daily, lisinopril 40mg daily, and Farxiga (dapagliflozin) 10mg daily.
What, if any, is your immediate concern with these discharge medications?
Patients should NOT take Entresto for at least 36 hours before or after taking an ACE Inhibitor due to an increased risk of angioedema.
Mixing lisinopril with valsartan can increase the side effects of lisinopril such as low BP, kidney function impairment and hyperkalemia.
This lab test is the key diagnostic indicator of heart failure
proBNP
This type of left sided heart failure results when the left ventricle loses its ability to relax normally because the muscle has become stiff and cannot properly fill with blood during the resting period between each beat.
Diastolic failure
The patient asks how their Afib led to their heart failure. You explain by telling them...
You explain to your patient that when they go home, they should be on a 1.5-2L fluid restriction. The patient asks how much that is. How else could you explain that amount of fluid
2L bottle of soda
Carton of OJ
DD - This symptom is often the main symptom of decompensated heart failure leading to hospitalization and could signal a progression of the disease itself
What is profound fatigue
You are providing teaching to your patient with heart failure. You are discussing the importance of exercise and their referral to cardiac rehab. Your patient questions, "It sounds like my heart is already working overtime. Wouldn't exercise put extra stress on my heart and make it explode?" You respond by explaining...
No, exercise is a great way to improve your heart's functioning. Cardiac rehab is a safe place to exercise an increase your endurance while being safely monitored by nurses and a cardiac monitor.
Patient is admitted with heart failure. His doctor prescribed him extra doses of Lasix at home over the past few days. However, he is now presenting to the ED with complaints of nausea, vomiting, diarrhea, confusion, bradycardia and visual disturbances, in addition to the shortness of breath and orthopnea he was already experiencing. Based on patient's symptoms, what medication might you be on the lookout for on his home medication list?
Digoxin.
Many diuretics cause potassium loss, which can increase the risk of digitalis toxicity for patients taking digoxin daily. Also, any problem that affects how kidneys work (including dehydration) makes digitalis toxicity more likely.
While assessing an older adult patient, the nurse notes jugular vein distention with the head of the bed elevated at 45 degrees. What does this finding indicate?
Increased right atrial pressure
The jugular veins empty into the superior vena cava and then into the right atrium, so the patient's JVD at 45 degrees sitting reflects increased right atrial pressure.
These two diagnostic tests detect coronary artery disease and cardiac ischemia
Cardiac Catheterization and Stress Tests
Why should restraints for patients with heart failure that are delirious, confused or anxious be avoided?
Patients will often resist restraints and the resistance could increase the cardiac workload
Your patient is complaining that their food is bland without salt. You recommend these 3 salt substitutes to add flavor without adding salt
Mrs. Dash or any salt-free seasoning, fresh herbs and spices/pepper, lemon or lime juice
Changes in breathing patterns are often missed by patients until their shortness of breath is severe. What are some subtle signs of dyspnea and orthopnea that the patient should watch out for?
Unable to sleep at night
Adding more pillows
Not being able to complete ADLs without resting
Breathing heavy while sitting
DD - Your patient asks, "What is the best exercise to improve ejection fraction?"
Walking can improve ejection fraction if it is done 3-5 times per week for at least 20-40 minutes per session at moderate-intensity pace