Heart Failure Med Surg: Cardiac

Pathophysiology

• Heart fails to maintain adequate cardiac output due to impaired pumping ability.
  • HF (Heart Failure): Failure to pump blood forward.
  • HF (Heavy Fluid): Fluid backs up in lungs/body.
• Weight Gain = Water Gain

Memory Tricks

Right-Sided Heart Failure (HF)

• Right = ROCKS BODY with fluid
  • Peripheral Edema
  • Weight Gain = Water Gain
  • Jugular Venous Distention (JVD) – big neck veins
  • Abdominal Growth:
    • Ascites (fluid in the abdomen)
    • Hepatomegaly (enlarged liver)
    • Splenomegaly (enlarged spleen)
• Pulmonary Edema
  • Crackles in lungs, rales that don't clear with cough
  • Pink frothy blood-tinged sputum
  • Orthopnea – difficulty breathing when lying flat

Left-Sided Heart Failure (HF)

• Left = LUNG fluid

Causes

• Hypertension (HTN - high blood pressure)
• Pulmonary HTN
• Stiff fibrotic lungs
• Left-sided HF can lead to Right HF
  • Weak heart = weak pump
• After a heart attack (Myocardial Infarction - MI)
• Ischemic heart disease – low oxygen to heart muscles (CAD, ACS)

Priority Interventions

For Pulmonary Edema Crisis (lung fluid)

• H: HOB (Head of Bed) at 45 degrees or higher (Semi-fowler's, High fowler's, orthopneic position)
• O: Oxygen
• P: Push Furosemide + Morphine, Positive inotropes
• E: End sodium & fluids
  • No drinking fluids + STOP IV fluids

Diagnostic Tests

• Labs:
  • BNP (Brain-type Natriuretic Peptides)
    • Memory Trick: B - Broken ventricles
    • Over 900+ = SEVERE HEART FAILURE
• Echocardiogram
  • Measures Ejection Fraction (blood pumped out of heart)
  • 55-70% = normal
  • 40% or less = BAD (heart failure)
• Hemodynamic Monitoring
  • Swanz Ganz (Pulmonary Artery catheter)
  • Over 8 = NOT GREAT (normal: 2-8 mmHg)

Risk Factors

1. Hypertension (high BP) is the #1 risk factor
2. Atrial fibrillation & other dysrhythmias
3. Mitral valve regurgitation
4. Cardiomyopathy

• New, sudden, worsening, rapid symptoms
  • #1 Action is Furosemide = Body Dried

Key Words

3 Common Exam Questions

1. A client with chronic heart failure took cold medicine for her flu and presents with new productive cough with pink frothy sputum and worsening crackles. What action should the nurse take first?
2. Which food items should the heart failure patient avoid?
   • Select all that apply:
     • Fruits
     • Veggies
     • Grilled chicken & fries - NO!
     • Canned beans - NO!
     • Bread
     • Chips - NO SODIUM!
3. Patient with heart failure who is constipated: What would the nurse recommend?
   • Walking
   • Increase fiber
   • Stool Softeners
   • Drink extra water - NO!

• Assess lung sounds

• Give bumetanide IV Push - YES

• Notify the HCP

• Clock out for lunch

• New, sudden, worsening, rapid symptoms

  • #1 Action is Furosemide = Body Dried

• KEY WORDS

This document provides a comprehensive guide for understanding heart failure, its causes, symptoms, diagnostic measures, and interventions. It's crucial for preparing for exams and clinical situations involving heart failure management.