Heart Failure

How to diagnose HF

- BNP labs - chest XR - echo - cardiac cath - nuclear stress test

Diastolic left-sided HF

- fill issues bc left ventricle is too stiff - still contracts normally - EF usu. normal

Right-sided HF

- heart can't efficiently eject blood; can't accommodate all the blood returning rom venous circulation --> INC BP - also see INC pressure to venous system, including jugular vein (see JVD)

Systolic left-sided HF

- most common type - "squeezing"/contracting - low EF, <40% - heart can't squeeze oxygenated blood out; backs up into lungs

Left-sided HF

- pulmonary venous blood flow vol. & pressure INC in lungs --> forcing liquid from pulm capillaries --> pulm tissues & alveoli --> pulm edema & impaired gas exchange

BNP ranges: HF present

100-300

BNP ranges: no HF

<100

EF of patient in HF

<40%

BNP ranges: mild HF

>300

Normal EF

>50%

BNP ranges: moderate HF

>600

BNP ranges: severe HF

>900

Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza. The answers to this question are options: A, C, E. These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza)

Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation? A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.

B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. Option B is the correct answer. Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.

A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention? A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.

C. Assist the patient into High Fowler's position. The answer is C. Due to the patient being in fluid overload (especially with left-sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing easier.

A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient? A. Narcan B. Aminophylline C. Digibind D. No medication because this is a normal Digoxin level.

C. Digibind The answer is C. The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind.

A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings? A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5

C. K+ 8.0 The answer is C. Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).

Ejection fraction

Difference between amount of blood filled into left ventricle and amount of blood contracted out

Left-sided HF signs & symptoms (DROWNING)

Dyspnea Rales (crackles) Orthopnea (pt may sit up at night) Weakness Nocturnal paroxysmal dyspnea (SOB that wakes pt) Inc HR (trying to get blood to organs) Nagging cough (late stage = frothy, blood-tinged sputum) Gaining weight (2-3 lb/day or 5 lb/wk)

Causes of heart failure (FAILURE)

Faulty valves: stenosis, regurgitation (leaks) Arrythmias: a-fib (atriums not pumping efficiently), tachy (prolonged strain) Infarction: from CAD; blockage --> lack of O2, nutrient supply --> ischemia --> cell death, muscle weakness (CAD, atherosclerosis) Lineage: family history, congenital issues Uncontrolled HTN: leads to stiffening (valves can't fill properly) Recreational drug use: stimulants, EtOH Evaders: viral, bacterial

Right-sided HF signs & symptoms (SWELLING)

Swelling of legs, hands, liver Weight gain Edema (pitting) Large neck vein (jugular vein distension) Lethargic Irregular HR (a-fib) Nocturia (laying down lets fluid flow back to kidneys) Girth (abdominal size, nausea, anorexia, breathing)

How to diagnose EF

echocardiogram, cardiac cath, nuclear stress test

True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction. A. True B. False

A. True The answer is TRUE. Patient with left-sided DIASTOLIC dysfunction heart failure normally have a normal ejection fraction. However, patients with left-sided SYSTOLIC dysfunction heart failure usually do not because the heart is unable to CONTRACT efficiently rather than fill properly as with diastolic dysfunction.

Which of the following is a common side effect of Spironolactone? A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough

B. Hyperkalemia The answer is B. Spironolactone is potassium-sparing. Therefore, it can increase the potassium level (hyperkalemia).

The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority? A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level

D. Hold the dose and notify the physician about the potassium level The answer is D. Lasix is a diuretic that wastes potassium. A normal potassium level is 3.5-5.1. The nurse should hold the dose and notify the physician who will order a potassium supplement to replace the potassium deficient.

A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.

E. Options A and B are correct. The answer is E. Options A and B are classic signs and symptoms a patient may experience with heart failure exacerbation.

What is heart failure?

the heart is too weak to pump efficiently, and can't provide CO needed

Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure: A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

B. A side effect of these drugs include bradycardia. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure. The answers are B and D.

You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom? A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.

B. Assist the patient up slowing and gradually. The answer is B. The best answer for this particular question is option B. All the options are important for the nurse to perform. However, Hydralazine (vasodilator) and Isordil (nitrate) can cause orthostatic hypotension. The patient should transfer slowly and gradually to decrease dizziness and the risk of falling.

A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure? A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02

B. BNP 820 The answer is option B. BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. <100 no failure, 100-300 present, >300 pg/mL mild, >600 pg/mL >moderate, 900 pg/mL severe

Select all the correct statements about educating the patient with heart failure: A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.

B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. The answers are B, C, and D. Option A is wrong because heart failure patients should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week, and option E is wrong because exercise is important for heart failure patients to help strengthen the heart muscle...so they should exercise as tolerated.

Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply: A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea

B. Persistent cough F. Orthopnea The answers are B, D, and F. Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure.

A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action? A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient's potassium level is normal.

C. Hold the dose and notify the physician of the digoxin level. The answer is C. The patient is Digoxin toxic. A normal Digoxin level is <2 ng/mL. Therefore, the nurse should not administer the dose but hold it and notify the doctor for further orders.

You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching? A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."

D. "I will limit my consumption of frozen meals." The answer is D. Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.

A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition? A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema." Option D is the answer. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema.

These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes? A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors

D. Angiotensin-converting-enzyme inhibitors The answer is D. This is a description of ACE inhibitors (option D).

During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue? A. Lisinopril B. Losartan C. Lasix D. Digoxin

D. Digoxin The answer is D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.

Which of the following is a late sign of heart failure? A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum

D. Frothy-blood tinged sputum The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.

Which of the following tests/procedures are NOT used to diagnose heart failure? A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring

D. Holter monitoring The answer is D. Options A, B, and C are all used to diagnose heart failure...however a holter monitor is not. A holter monitor is used to monitor a patient's heart rate and rhythm.

What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction

D. Left ventricular diastolic dysfunction The answer is D. This statement describes left ventricular DIASTOLIC dysfunction.

A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure. The answer is D. Both Options A and C are correct. Option B is a finding expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart.