This is an NCLEX review for heart failure. The previous NCLEX review of heart failure concentrated on the pathophysiology, signs and symptoms, different types of heart failure, and causes. This review will concentrate on the nursing interventions and medications.
Patients who have heart failure have a heart muscle that is unable to pump efficiently and this can lead to mild/severe complications. When taking care of a patient in heart failure, it is very important the nurse knows the side effects of medications, the typical medication regime for heart failure patients, and how to properly care for the patient. It is important for the NCLEX exam that the student is aware of patient education regarding heart failure and how to monitor medication treatments.
Don’t forget to take heart failure quiz.
In this NCLEX review for heart failure, you will learn the following:
- Nursing interventions for heart failure
- Mnemonic to help you remember drugs used in heart failure
- Pharmacodynamics of medications used in heart failure
- Side effects of medications used in heart failure
- Patient education regarding heart failure and medications
Lecture on Heart Failure Part 2
Nursing Interventions for Heart Failure
Role: Assessing, monitoring, intervening, and educating
- Assess patient for worsening symptoms (right-sided failure…peripheral swelling vs left-sided failure…pulmonary edema)
- Patient responsiveness to medication treatment:
- watch heart rate (Digoxin)
- respiratory status
- blood pressure (vasodilators cause hypotension)
- diuretics (strict intake and output, daily weights, monitor electrolyte levels, especially K+)
- Fluid status (may be ordered a Foley catheter, if on diuretics)
- Cardiac diet (low in salt and fats)
- Fluid restriction (no more than 2 L per day)
- Lab values: watching BNP, kidney function BUN & creatinine, troponins levels, electrolytes (especially potassium…if on Lasix: waste potassium and low potassium increases risk of digoxin toxicity)
- Edema in leg: Keep legs elevated and patient in high Fowler’s to help with breathing
- Safety (at risk for falls due to fluid stats changes, swelling in legs and feet, and orthostatic hypotension)
- Early signs and symptoms heart failure exacerbation
- Shortness of breath
- Weight gain
- Low salt (allowed 2-3 G sodium per day) and fluid restriction (no more than 2 L per day)
- Vaccination to prevent illness, such as annual flu and to be up-to-date with pneumonia vaccine
- Exercise aerobic (as tolerated)
- Daily weights (watch for no more than 2-3 lb per day and 5 lbs per week)
- Compliance with medications
- Smoking cessation
- Limiting alcohol
Know the drug categories a patient will be taking with heart failure and what drugs are included in that category, the pharmacodynamics, and side effects:
To remember the groups of drugs use this mnemonic:
Always Administer Drugs Before A Ventricle Dies!
Ace Inhibitors (angiotensin-converting-enzyme inhibitors):
- first line of treatment for heart failure with beta blockers
- end in “pril” Lisinopril, Ramipril, Enalapril, Captopril
- works by allowing more blood to get to the heart muscle which allows it to work easier. Also, blocks the conversion of Angiotensin I or Angiotensin II (this causes vasodilation, lowers blood pressure, allows kidneys to secrete sodium because it decreases aldosterone)
- side effects: dry, nagging cough and can increase potassium (inhibiting angiotensin II which decreases aldosterone in the body which causes the body to retain more potassium and excrete sodium)
ARBs (Angiotensin II receptor blockers):
- end in “sartan” like Losartan, Valsartan
- used in place of ACE inhibitors if patient can’t tolerate them
- blocks angiotensin II receptors which causes vasodilation. This lowers blood pressure and helps the kidneys to excrete sodium and water (due to the affects that blocking angiotensin II has on the kidneys…decreases aldosterone).
- side effects: increases potassium levels….NO dry nagging cough
- used along with ACE inhibitors or ARBs to decrease water and sodium retention which will decrease edema in the body and lungs. This allows the heart to pump easier.
- Patients will urinate a lot!
- Loop diuretics (most common) like Lasix or Furosemide (watch potassium level because they will waste potassium)
- Potassium-sparing diuretics like “Aldactone” (can cause hyperkalemia, especially if taking with ACE or ARBs)
- blocks norepinephrine effects on the heart muscle
- given in stable heart failure with ACE inhibitors
- end in “lol” like Metoprolol, Carvedilol and Bisoprolol
- not for acute heart failure because the negative inotropic effect on the heart. The negative inotropic effect causes decrease myocardial contractility (slows heart) and decreases cardiac work load.
- used in stable heart failure in people with ventricular systolic dysfunction (there is a contraction problem with the left ventricle) and to treat diastolic heart failure (remember there is a problem with the heart filling in diastolic dysfunction). It will help the heart rest so the stiff ventricle can fill properly and the volume of blood pumped out increases.
- side effects: check pulse (bradycardia), no grape juice; mask hypoglycemic signs in diabetics, respiratory issues in asthmatics and patients with COPD
- not used in all patients with heart failure
- Typically, used in patients with heart failure who are in a-fib because they are at risk for blood clot formation or certain scenarios of left ventricular systolic heart failure when there is a low ejection fraction of <35%.
- (arterial dilator) Hydralazine…prescribed with a nitrate like Isordil (venous dilator)
- sometimes used in place of an ACE or ARB, if patient can’t tolerate them
- this causes vasodilation in the arteries and veins to help decrease the amount of blood and fluid going back which helps decrease the work load on the heart
- side effects: low blood pressure, orthostatic hypotension
- Positive inotropic effect that increases the heart’s ability to contract stronger and it has a negative chronotropic action that causes the heart to beat slower
- So, the heart slows down and contracts stronger which allows the heart to pump more blood.
- treatment for patients with left ventricular systolic dysfunction (however, not usually the first line of treatment due to side effects and toxicity risks)…used alongside ACE/beta blockers, and diuretics
- toxicity issues: monitor patient potassium level (hypokalemia <3.5 mEq/L) because hypokalemia increases digoxin toxicity
- S & S of toxicity: nausea, vomiting, visual changes yellowish green halos
- normal Digoxin range 0.5 to 2 ng/mL
- not for patients with a second or third degree heart block
- check apical pulse before giving….>60 bpm
- antidote: Digibind
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