Nursing Considerations
Why should ibuprofen/ naproxen (NSAIDs) be avoided in HF pts?
They cause water retention
what symtoms is indicates fluid in the lungs
crackles
What are the two main types of Left sided HF
1. Diastolic
2. Systolic
Namke the 4 drug classes that are used for GDMT HF treatment
1. Beta Blockers
2. SGLT2 Inhibitors
3. ACE/ARB/ARNI
4. MRA
What is the standard fluid restriction for HF pts
2L (1.5L with severe HF)
What nursing connsiderations are important to note prior to giving a HF pt IV push lasix?
1. What is their recent BP
2. What is their potassium> (potassium wasting medication)
3. What is their kidney function (lasix is nephrotoxic)
In general what are the main s/s of HF
SOB, Fluid retention (weight gain), & Edema
What type of heart failure affects the rest of the body (blood backs up into systemic veins)
Right sided HF
How do ACE/ARBs help HF pts?
Decrease BP/ Afterload/ improve heart pumping
How often should pts w/ HF weigh themselves?
Daily (in the morning/ after you urinate/ in the same clothes/ on the same scale)
You give a pt 240ml of ice chips what will you document in the chart for intake?
120ml
Name 5 s/s of right sided HF
JVD (Jugular Vein Distention)
Lower extremity edema
Hepatomegaly
Ascites
Sacral Edema
Anorexia
Nausea
Abd pain
What type of HF would a pt have if theyre EF was 35%
HFrEF (systolic HF)
How does Beta Blockers help HF pts?
1. decrease stress on heart (slower HR)
2. Improve heart pumping
3. decrease afterload
What weight changes should trigger pts to call their provider?
2-3lbs in a day or 5lbs in a week
Your patients BP is low what are some s/s of hypotension
Dizziness/ lightheadedness/ n/v/ shakiness/ fatigue/ blurred vision
What is the difference between Orthopnea and Paroxysmal nocturnal dyspnea (PND) & whta kind of HF does this indicate?
Left sided HF
Orthopnea (SOB when laying flat) (think our HF pts that have to sleep in their recliner or with extra pillows)
PND (Sudden severe SOB at night --> wakes up pt from sleepgasping for air) (fluid is in the legs during the day then when they lay down to sleep goes to their lungs)
Your HF patients EF is 55% what type of heart failure do they have?
Diastolic HF (HFpEF)
Which two drug classes are newer to GDMT HF treatment?
1. ARNI (Entresto)
2. SGL2 Inhibitors (Jardiance)
What are some risk reduction strategies for HF patients
1. Limit Alcohol / no drugs
2. Smoking cessation
3. Heart Healthy Diet
4. Stay Active
5. Use CPAP
Your pt with HF asks why they are taking Jardiance because they do not have Diabetes what do you say?
Used to treat HF because it has a dieuretic effect.
decreases preload/afterload and improves heart pumping
Low perfusion in Left sided HF can result in what symptoms?
Think major organs no longer perfused
1. kidneys (decrease UO)
2. Brain (confusion/ dizziness/ restlessness/anixety/lightheadedness)
3. Skin (pale/dusky/ cool and clammy
What type of HF has weakned LV heart muscle
Systolic
What medication is given to help fluid overload in acute decomponsated HF pts?
IV Lasix
Once stable trabsition to (PO Lasix or Toresimide)
Will see spirnolactone as well for management (but acute in hospital --> IV Lasix)
What are the two main restriction for HF pts
Salt restriction (2g) / Fluid restriction (2L or 1.5L)