Judgement
Three assessments you may find with a patient admitted with exacerbation of heart failure
excessive weight gain, orthopnea , rapid or irregular heartbeat, swelling of abdomen (ascites), cough & wheezing, crackles in lungs, edema, SOB, bloody sputum, weakness/fatigue, JVD, cyanosis
what cessation should all heart failure patients practice?
smoking cessation!
You see very swollen ankles when the patient walks in the room. Is this something associated with heart failure?
Yes. Patient is retaining fluid likely due to inability of heart to maintain homeostasis.
TRUE or FALSE
Patients with diastolic dysfunction HF usually have normal ejection fraction
True
ECHO - 50-60% is normal
True or false. Administering the highest tolerable dose of heart failure medications is the goal for prescribers?
Yes
A patient with heart failure is having trouble breathing. What position would you put them in?
high fowlers
rationale: patient might have pulmonary edema. left sided heart failure patients are most at risks for fluid overload and affect the lungs. this position helps with breathing.
priorities: high fowlers, O2, assess lungs sounds
What type of diet should you encourage your heart failure patient to be on?
heart healthy - low sodium (2-3 gm)
extra:
stay away from processed foods, eat plenty of veggies and lean cuts of meat
fluid restriction are also encouraged
Which of the following are typical S&S of heart failure? select all that apply.
A. cough
B. exertional dyspnea
C. Edema in extremities
D. Orthopnea
A, B, C, D
Which of the following is not used to diagnose heart failure?
A. Echo
B. nuclear stress test
C. Right or Left Catheterization
D. ECG/holter monitoring
D. cardiac monitoring is not a way to diagnose heart failure, it just is used to monitor the patients heart rate and rhythm
extra information:
left heart cath: help look at coronary arteries for blockages right hear cath: assess pulmonary pressures and caridac index
True or False:
Diastolic Heart failure involves a low ejection fraction and stiffening of the heart.
FALSE!
Rationale:
Diastolic heart failure does has a stiffening of the heart, but has a normal Ejection fraction.
systolic heart failure: EF is 40% or less and has enlarged/dilated/weak heart
Understanding the cause of HF is important to their plan of care.
yes
As a patient with HF.... what should you do first thing in morning after urination?
check your weight!!
Patient presents with cold skin, increased heart rate, and slight confusion. What is the body attempting to do?
Compensate
Tests that determine the ejection fraction?
echo, mri, muga
True or false.
LV remodeling is beneficial is HF
False
The patient is short of breath (SOB) when climbing stairs. What NYHA class is your patient?
III.
Two self management strategies for heart failure patients
follow medication regimen, daily weight, fluid restriction, low sodium diet, MD follow ups, smoking cessation
Patient's HR increases and has an increase in mental confusion. what might i consider as the cause.
Attempt to compensate.
Why would you check kidney labs with heart failure patients?
to determine stress on the kidneys, also assesses fluid status
rationale: when the heart isn't pumping efficiently it becomes congested and causes pressure build up in the veins connected to kidneys
Two causes of HF
CAD, a-fib (other arrhythmia's), HTN, myocarditis(inflammation), congenital heart disease, previous Heart attack, heart valve disease, diabetes, HIV, thyroid conditions, buildup or iron/protein
The patient has gained 5 pounds in 1 day. The best advice to offer to the patient is.
Call your provider
Patient had Chinese food for dinner What is your best advice for the following day?
Weigh yourself
Patient reports skipping their diuretic or "water pill" today because she had a hair appointment. What would you be looking for as you talk with this patient?
Signs of fluid overload.
What lab value would you expect in a patient with heart failure?
A. an increase in sodium levels?
C. an increase in BNP?
High BNP (100-400), low NA (below 135), high K (above 5.1)
Two factors that can cause readmission for a patient with HF
dietary non-compliance, not taking medication, not attending MD follow-ups (can be due to transportation, affordability, location of appointments), unavoidable progression of disease