Honan One Minute Nurse: Heart Failure and Hypotension

A nurse is administering a beta blocker to a patient who has heart failure. Which statement may be part of the nurse's patient education?

"This medication will improve your survival and symptoms of heart failure." Rationale:Beta blockers improve symptoms of heart failure and extend survival. Beta blockers lower heart rates and help do more than managing symptoms. Diuretics may be used to get rid of extra fluid in the body.

Which serum lab value can assist in diagnosing heart failure?

Brain natriuretic peptide (BNP) Rationale:A BNP level over 100 suggests heart failure. BUN is not specific to heart failure, and blood pressure and cardiac catheterization are not serum lab values.

Which is a symptom of hypotension?

Dizziness Rationale:Dizziness from not getting enough blood to the brain is a symptom of low blood pressure. Increased energy, polyuria, and dilated pupils are not symptoms associated with hypotension.

Which blood pressure reading is considered hypotensive?

86/42 mmHg Rationale:86/42 mm Hg is the lowest of these readings and considered hypotensive. Any blood pressure below 90/60 mm Hg is considered hypotensive.

Which is not a cause of hypotension?

Activation of the sympathetic nervous system. Rationale:Activating the sympathetic nervous system would increase blood pressure and heart rate rather than decreasing blood pressure. A vagal response, shock, and hypovolemia would all cause low blood pressure.

A patient has a baseline blood pressure of 86/42 mmHg and is resting comfortably in their room talking on their phone. Their current blood pressure is 84/42 mmHg. What is the nurse's best course of action?

Continue to monitor the patient. Rationale:This patient is comfortable, not in distress, and has a blood pressure consistent with their baseline. Although this patient is hypotensive, they are stable, and the most appropriate action is continuing to monitor them.

Which is not a common cause of heart failure?

Hypothyroidism Rationale: Hypothyroidism is not a cause of heart failure. CAD, MI, and hypertension can all lead to heart failure.

What is the first intervention when working with a patient who is hypotensive?

Ensure the patient is safe. Rationale:Ensuring safety is the first priority since hypotension can put a patient at risk for falls. The nurse should make sure the patient is lying down and out of harm's way before proceeding with other interventions.

A patient has an ejection fraction (EF) of 35%. What does this indicate?

The patient is in systolic heart failure. Rationale:An EF less than 40% indicates decreased cardiac output and pump failure, which means they have systolic heart failure. EF is preserved in diastolic heart failure. The heart is not optimally functioning, and the patient has already developed heart failure.

Upon assessment, the nurse notes a patient has crackles and dyspnea. What does this indicate?

The patient's left side of the heart is affected. Rationale: Crackles and dyspnea result from a poorly functioning left side of the heart. If the right side is affected, fluid will back up into the rest of the body leading to an enlarged liver and spleen, ascites, and dependent edema. Crackles and dyspnea do not indicate if heart failure is systolic or diastolic.