Heart Failure

Cardiac, medical surgical, med surg

Video Transcript 

Hi friends in today's video. We're going to be talking about heart failure. So if you like this video, make sure to give it a thumbs up and subscribe to the channel. We make a bunch of different nursing content to help you guys with your nursing classes and to pass and clicks. All right, let's get into it.

All right. So heart failure is what we're gonna be talking about today. So what is heart failure? It's also known as congestive heart failure and it's recognized as a clinical syndrome with signs of fluid overload or inadequate tissue perfusion. It is the inability of the heart to pump sufficient blood, to meet the needs of different tissues for their oxygen and nutrients.

The term heart failure indicates myocardial disease in which there is a problem with contraction of the heart, which is the systolic dysfunction or filling of the heart, which is diastolic dysfunction that may or may not cause pulmonary or systemic congestion. Heart failure is most often a progressive lifelong condition.

That's managed with lifestyle changes and medications that can help to prevent episodes of acute decompensation and heart failure. All right, so classification. So heart failure is classified into two types. There is left-sided heart failure and right-sided heart failure. So left sided heart failure or left ventricular failure have different manifestations than rights.

So we're going to compare the two pulmonary in left sided, heart failure, pulmonary congestion. Occurs when the left ventricle cannot effectively pump blood out at the ventricle, into the aorta and the systemic circulation. So remember that the left ventricle it's thicker than the right, because it's stronger and it's a little bigger and it's because it needs to pump that blood through the entire body.

So it is going to be stronger. So in left sided, heart failure, that left ventricle. Cannot affectively pump the blood to the rest of the body. So the blood is backing up and when the blood backs up. We are going to have pulmonary congestion. And that's because remember in anatomy, when the blood is going through the heart, it goes from the right side of the heart, to the lungs where it gets oxygenated and then goes into the left side of the heart work it's pumped throughout the body.

If the left side of the heart is not able to pump it throughout the body, It's backing up and all that fluid is backing up from the left ventricle into the lungs. So we're going to see a lot of pulmonary congestion and. This is going to lead to a pulmonary venous blood volume and pressure increases.

It's going to force fluid from the pulmonary capillaries into the pulmonary tissues and aveloi causing pulmonary interstitial edema and impaired gas exchange. Again, if we look at this little person, we're going to see that there are exhibiting signs of pulmonary congestion. So they're going to have difficulty breathing, tachycardia, exertional, dyspnea, fatigue, cyanosis the pulmonary congestion is going to lead to the cough, crackles, wheezing, blood tinge, sputum, tachypnea because again, all that fluid is in the lungs

all right. So let's take a look at right-sided heart failure. So when the right ventricle fails congestion in the peripheral tissues predominates. This means that the right side of the heart cannot object the blood and cannot accommodate all the blood that's returning from the venous systems. You have all that blood in your body, and it's all coming back into the right side.

So remember it goes right side lungs, left side. So it's backing up in the right side, therefore backing up throughout the body. And when this happens, it's because the right side of the heart can not object the. And it is increasing the venous pressure, which is leading to something called distended juggler veins and increasing capillary hydrostatic pressure throughout the venous system.

So that's why, if we look at this woman, she is having distended jugular veins, because that is the blood backing up. Making a lot of pressure in those veins. There may be anorexia or complaints of an upset stomach, swelling of hands, feet and fingers dependent edema ascites so a lot of that fluid in the belly enlarged liver or spleen fatigued and peripheral venous pressure increases.

So again, if the right side of the heart is failing, All of that blood is backing up throughout the body. So with the right side, heart failure, you're going to see that edema. You're going to see the jugular vein distension. When we talk about peripheral pulses, if you're taking someone's pulse and it's a bounding and really hard, that is the backup of the fluid into the venous circulation.

So classifications of heart failure. So we have these four different stages. Stage a is a patient at a high risk for developing left ventricular dysfunction, but without structural heart disease or system symptoms of heart failure. Stage B patients with left ventricular dysfunction or structural heart disease that have not developed symptoms of heart failure, stage C patients with left ventricular dysfunction or structural heart disease with current or prior symptoms of heart disease and stage D patients with refractory end stage heart failure requiring specialized intervention.

All right. So let's look at the pathophysiology of heart failure. So heart failure results from a variety of cardiovascular conditions, which include chronic hypertension, coronary artery disease, and valvular disease. So as heart failure develops the body activates certain compensatory mechanisms. systolic heart failure results in decreased blood volume, being ejected from the ventricle and the sympathetic nervous system is then stimulated to release epinephrin in norepinephrine, which decreases renal perfusion and causes run-in release and then promotes the formation of angiotensin one, which is converted to angiotensin two by our ACE system, which constricts the blood vessels and stimulates aldosterone release that causes sodium and fluid retention.

There is a reduction in the contractility of the muscle fibers of the heart and workload increases. And then there is compensation of the heart for the increased workload by increasing the thickness of the heart muscles. So I thought that. Outline was a good summary of the pathophysiology of heart failure.

So you have coronary artery disease and hypertension or valvular disease, which leads to heart failure, which leads to a decreased cardiac output and leads to the body feeling fatigued and weakness. This can, when there is decreased cardiac output. The activation of the sympathetic nervous system occurs and the activation of the renin angiotensin aldosterone system, which then increases the retention of sodium and water, which is going to show us that edema and weight gain, which is then going to lead to increase in venous pressure.

And increase in venous congestion. And then you're going to see these different signs depending on the type of heart failure that you have. So we went over this earlier, but if it's right started cited, you have the anorexia nausea pain in the upper right quadrant olguria during the day polyuria at night, when you have symptoms of left sided, heart failure, your dyspnea orthopnea Nocturnal dyspnea, cough, wheezing.

And you're also going to see some physical signs and symptoms. So maybe different types of rhythm peripheral edema. These are again, the pathophysiology of the different heart failures. So statistically, more than 5 million people in the United States have heart failure. There are over half a million cases of heart failure diagnosed each year.

It costs the United States, 33 billion annually, and it is considered an epidemic in the United States. So heart failure can affect both men and women. Although mortality is higher in women, and there's also a lot of racial differences. At all ages, death rates are higher in African-Americans than non-Hispanic whites.

And heart failure is primarily a disease of older adults affecting six to 10% of those over 65. And it is also the leading cause of hospitalization in older people. So the causes of heart failure include coronary artery disease. So at athersclerosis of the coronary arteries is the primary cause of heart failure.

And coronary artery disease is found in more than 60% of patients with heart failure. Also ischema which deprives the heart cells of oxygen and leads to acidosis from the accumulation of lactic acid. Cardiomyopathy is usually chronic and progressive. Systemic or pulmonary hypertension. So increases in the afterload result in hypertension, which increases the workload of the heart and leads to hypertrophy of the myocardium muscle fibers.

A lot of words vulva, valvular, heart disease is when the blood has. Increasingly difficult moving forward and it increases the pressure within the heart and increases cardiac workload. So again, if we have that left sided heart failure, because I can almost guarantee you guys are going to get questions left first, right on your exam.

So left-sided heart failure. You're going to see that dyspnea or shortness of breath which may happen with minimal or moderate activity. The cough that is associated with left ventricular failure, it's usually dry and nonproductive. You may have some pulmonary crackles and they can usually be also stated across all lung fields and you're going to get low oxygen saturation level.

So then right-sided heart failure. You may see enlargement of the liver accumulation of fluid in the peritoneal cavity and loss of appetite. So to prevent heart failure, we want to promote healthy diet with our patients. Avoiding the intake of fatty or salty foods will greatly improve heart health.

Encourage. Cardiovascular exercises typically about three times a week is what a lot of books will say. And smoke cessation because nicotine is a vasoconstrictor and that can increase pressure within the vessels. So complications with heart failure are typically related to diuretics or related to.

Heart failure therapy. So our treatments for heart failure is usually due to diuretics. So you may see some hypokalemia. We want to make sure to be monitoring for that because of excessive and repeated diuresis hyperkalemia is also something we need to watch for because of use with ACE inhibitors, ARBs, or other diuretics.

Again, prolonged diuretic therapy can leave to hyponatremia and result in disorientation, fatigue, apprehension, weakness, and muscle cramps. And we can also lead to dehydration and hypotension because we are depleting the volume of blood by getting rid of fluid.

All right. So our assessment and diagnostic findings. So these are some tools we can of use when we are assessing the patient. We can look at an ECG which will let us know about ventricular atrial hypertrophy. ischemia and different damaging patterns that may be present. And it can also identify dysrhythmias tachycardia, a AFib conduction delays, such as left bundle branch block.

Any PVC is, can be seen. We can also identify S T segment abnormalities and any decreasing QRS amplitude. We can use a chest x-ray, which can show enlargement of cardiac shadow can reflect chamber dilation and hypertrophy or changes in blood vessels. It can we can see an increase in pulmonary pressure based on.

What the heart looks like in our chest. X-ray we can look for abnormal contour, such as bulging of the left cardiac border, which can suggest ventricular aneurism. We can use sonograms such as an echocardiography, a Doppler and a transesophogeal. Echocardiography which can reveal enlargement chamber dimensions, alteration in valvular function and structure and the degrees of ventricular dilation and dysfunction.

We can also look at a heart scan, which measures cardiac volume during both systole and diastole. It measures ejection, fraction and estimates. wall motion, we can use something called a stress test, and then these can be administered in two different ways. So you can do an exercise stress test. So they'll hook the patient up to a monitor, have them walk on a treadmill and monitor the heart.

Or they'll use a pharmacological stress test. So they'll give them a medication that will create the same and, increase in heart stress that someone might get from exercising to be able to look at myocardial ischemia and wall motion abnormality. They can also use something called positional emission tomography or a pet scan, which is a sensitive test for evaluating the myocardial ischemia or detecting viable myocardium, or they might use a cardiac catheterization.

So abnormal pressure are indicated. Help differentiating right versus left sided heart failure, as well as that valve stenosis or insufficiency also assesses patency of coronary arteries. They may use a contrast injected into the ventricles to reveal abnormal size and ejection fraction in alterations in contractility.

And they can even do a biopsies to determine any underlying disorders such as myocarditis. We can also look at some labs. So when looking at labs, we may evaluate liver enzymes, which can show elevation in liver congestion or failure. So if those liver enzymes are elevated that could indicate the liver congestion or failure we can also look at levels of cardiac drugs to make sure we're in the correct range.

digoxin we can look at bleeding and clotting times to determine if the therapeutic range is correct, or if the patient is at risk for clot formation, look at electrolytes, which can be altered due to decrease in renal function or diuretic therapy. We will use a pulse oximeter to assess for oxygen saturation of the blood, especially in acute heart failure.

Or if somebody has heart failure with C O P D or chronic heart failure, this is just a really good, easy test that we can do. We can look at arterial blood gases. Left ventricular failure is characterized by mild respiratory alkalosis during the early stages or hypoxemia with an increased PCO two in late.

So we can look and see those levels in the blood carbon dioxide. And. Alkalosis, we can look at the bun and creatinine. So an elevated bun suggest decreased renal perfusion, and an elevation of both bun and creatinine is indicated of renal failure. And we can look at serum albumin and transferrin, which may be decreased as a result of reduced protein intake or reduce protein synthesis in congestion liver.

And we can look at a complete CBC, which may reveal anemia, any dilation changes that are indicative of water retention. We can look at the white blood cells to see if they're elevated, which can reflect a recent or acute MI, pericarditis, or other inflammatory or infectious states. We can look at the ESR, which may be elevated, indicating acute inflammatory reactions.

And we can even look at some thyroid levels because increased thyroid activity suggests thyroid hyperactivity is a precursor of heart failure management of heart failure. The overall goal of managing heart failure is to relieve patient's symptoms, improve the functional status and quality of life and extend survival.

So pharmacological therapy things. We may use our ACE inhibitors, which slow the progression of heart failure, improve exercise tolerance, decrease the number of hospitalizations for heart failure and promote vasodilation. And diarrhesis by decreasing afterload and pre. And we can also might be giving these patients angiotensin two receptor blockers.

They block the conversion of angiotensin one to angiotensin two, remember in our pathophysiology and this causes a decrease in blood pressure, a decrease in systemic vascular resistance and improved cardiac output. We may be giving some beta blockers to reduce the adverse effects from the. Constant stimulation of the sympathetic nervous system, maybe giving diuretics to remove that excess, extra cellular fluid.

And we may be giving some calcium channel blockers, which cause vasodilation and reduce systemic vascular resistance by, but is contraindicated in patients with systolic heart failure.

All right. So nutritional therapy, we may be putting these patients on a sodium restriction. So a low sodium diet of two to three grams a day reduces fluid retention and symptoms of peripheral and pulmonary congestion and decreases the amount of circulating blood volume, which decreases myocardial work.

We also want to look at patients' compliance. It's important because dietary. Indiscretions may result in severe exacerbation of heart failure requiring hospitalization. So we can put patients on these diets, but we also want to make sure they're being compliant with them and let them know that if they're not, that can be very troublesome.

So additional therapies, we may have these patients on supplemental oxygen. Based on the degree of pulmonary congestion and resulting hypoxia, they may be on cardiac resynchronization therapy, which involves the use of a biventricle pacemaker to treat electrical conduction defects. These patients might be on ultra filtration.

It's an alternative intervention for patients with severe fluid overload. They may be on a cardiac transplant. So if they're an end stage heart failure, really, this is the only treatment option for them. So our nursing assessment. We're going to focus on observing the effectiveness of therapy for the patient's ability to understand and implement self-management strategies.

So do this. We first want to take a health history. We want to assess signs and symptoms such as just dyspnea shortness of breath, fatigue, edema. We want to assess for those sleep disturbances. Do they have to get up in the middle of the night because of shortness of breath? And we want to explore their understanding of heart failure, what their current self management strategies are and the ability and willingness to adhere to our recommendations.

So a physical exam is going to incorporate also rotating the lungs for presence of crackles and wheezes. We're going to auscultate take the heart for the presence of an S3 heart sound. We're going to assess for that juggler vein distension

we're also going to evaluate. Their level of consciousness, their mental status. Remember mental status can indicate electrolyte changes, especially hyponatremia. Anything with sodium is usually going to affect the brain. That was I remember a big thing when studying for an clocks in nursing school.

We know that. Potassium affects the heart, but sodium typically affects the brain. So if you're getting a question with mental status changes, it is most likely a sodium issue evaluate or assess the dependent parts of the patient's body perf for perfusion. And edema, we're going to assess the liver for.

Hepatojugular reflex. We're going to measure the urinary output carefully to establish a baseline against which to assess the effectiveness of the diuretic therapy. We want to weigh the patient daily in the hospital or at home, because again, weights are going to indicate the fluid volume loss. So these are different diagnoses that are nursing diagnoses.

We can give our patients. Activities. Intolerance related to decreased cardiac output, excessive fluid volume related to heart failure syndrome, anxiety related to breathlessness from inadequate oxidization powerlessness related to chronic illness and hospitalization. An ineffective therapeutic regimen management related to lack of knowledge.

So our planning and goals should include promoting physical activities, reducing fatigue, relieving fluid overload symptoms, decreasing anxiety, increasing the patient's ability to managing anxiety, treating the patients about self care programs, encouraging the patient to verbalize his or her ability to make decisions and influence outcomes, nursing interventions.

So we want. Promote activity tolerance. We want to manage fluid volume. We want to control anxiety, and we want to minimize powerlessness. So to do this, to promote activity tolerance, a total of 30 minutes of physical activity everyday should be encouraged and the nurse should collaborate with the interdisciplinary team to schedule and promote pacing and prioritization of activity.

By men to manage food overload, the patient's fluid status should be monitored closely by also auscultate the lungs monitoring daily body weights and assisting the patient to adhere to a low sodium diet controlling anxiety. When the patient exhibits anxiety, the nurse should promote physical comfort and provide psychological support and begin teaching ways to control anxiety and avoid anxiety provoking situations.

And to minimize powerlessness, we want to encourage the patient to verbalize their concerns and provide the patient with decision-making opportunities. Trauma informed care. Very important. Nurse priorities should be to improve myocardial, contractility and systemic profusion. Reduce fluid volume overload, prevent complications, provide information about disease, prognosis therapy, needs, and prevention of reoccurrences.

Our evaluation. So these again are what we're evaluating based on our diagnoses and our interventions. This may not necessarily be what you have evaluated. These are just some examples. So demonstrated of tolerance for increased activity maintained a fluid balance, less anxiety decides soundly regarding care and treatment and adherence to self care regimen.

Discharge and home care. So big one, always patient education. So we're going to teach the patient and their families about medication management, low sodium diets, activity, and exercise recommendations, smoke cessation, and learning to recognize the signs and symptoms of worsening heart failure. And we're going to encourage the patient and their family to ask questions.

So information can be clarified and understanding enhances. So these are our goals for discharge. And again, these are just some examples, cardiac output, adequate for individual needs, complications prevented or resolved, optimal level of activity and functioning, functioning attained, decreased progress in prognosis and therapeutic regimen.

Understood plan in place to meet needs after discharge. And these are our documentation guidelines. So we want to document our assessment findings that I know fluid balance, D degree of fluid retention, results of laboratory tests and diagnostic studies response to interventions and teachings and actions performed and attainment or progress towards desired outcomes.

All right. So that is the lecture or. Information on heart failure. If you guys enjoyed this video, make sure to give it a thumbs up and subscribe below. We have nursing content for nursing school and to help you guys understand and also make sure to check out the website and the links below. I do have an NCLEX study guide, and I'll be putting these PowerPoint slides up if you want to use them as a study reference.

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