Heart Failure
Heather Brown DNP, RN
NSG 420
12 edition-2023
Objectives for Heart Failure
Compare left and right sided heart
failure
 Identify assessment findings
 Describe pharmacological
treatments
 Prioritize care for the client

Let’s Take a Basic Look

Animation Heart Failure
Cardiac Output
Heart Rate
 Stroke Volume

CO=HR x SV
.
Risk Factors

Primary risk factors



Hypertension
CAD
Prior heart damage
Risk Factors

Contributing risk factors





Advanced age(non modifiable)
Diabetes(type 1 not modifiable type 2
modifiable
Tobacco use (modifiable)
Obesity (Modifiable)
High serum cholesterol lab to look at
tryglycerides
Pathophysiology
Heart Failure in General

Ventricular failure leads to:



Low blood pressure (BP)
Low CO
Poor renal perfusion ( check urine
output) minimum 30ml per hour
Decreased ejection
fraction(echocardiogram)
 Abrupt or subtle onset

Compensatory Mechanisms

Hypertrophy



Increase in muscle mass and cardiac
wall thickness
Initially effective
Over time leads to poor contractility,
increased O2 needs, and risk for
dysrhythmias
Hypertrophied
Heart Chambers
Fig. 35-1. A, Dilated heart chambers. B, Hypertrophied heart chambers.
Systolic vs Diastolic HF
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Case Study
N.B. is a 78-year-old woman
admitted to the hospital with
shortness of breath.
 She has a history of hypertension
and CAD.

Case Study
What factors in N.B.’s history
increase her risk for heart failure?
 Age, hypertension,CAD

What other factors might you
question N.B. about?
 Family history, tobacco use,
vapining, nicotine, i&o

Assess Your Patient
Left-Sided Heart Failure
Most common form
 Results from left ventricular
dysfunction
 Blood backs up into left atrium and
pulmonary veins
 Pulmonary congestion
 Pulmonary edema

Left Side HF
Right-Sided Heart Failure

Blood backs up into the right
atrium and venous circulation





Jugular venous distention
Hepatomegaly, splenomegaly
Vascular congestion of GI tract
Peripheral edema
Most commonly caused by leftsided HF
Right Side HF
Case Study

N.B.’s admission assessment reveals
the following:
 Alert and oriented to person, place,
and time
 Fine crackles bilateral lower lobes
 Shortness of breath on minimal
exertion
 O2 saturation 89%, room air
Heart Failure Acute Complications
Clinical Manifestations
Pulmonary edema
 Life-threatening situation – alveoli
fill with fluid
 Most commonly associated with
left-sided HF

Pulmonary Edema
Clinical Manifestations






Anxious, pale,
cyanotic
Cool and clammy
skin
Dyspnea
Orthopnea
Tachypnea
Use of accessory
muscles



Cough with
frothy, bloodtinged sputum
Crackles,
wheezes, rhonchi
Tachycardia
Pulmonary Edema

Crackles
Case Study

What interventions will you plan
for N.B.?
Pulmonary Edema Tx
Chronic Heart Failure
Clinical Manifestations
Fatigue
 Dyspnea
 Orthopnea
 Paroxysmal noctournal dyspnea
 Tachycardia

Chronic Heart Failure
Clinical Manifestations

Edema



Dependent, liver, abdominal cavity,
lungs
Edema may be pitting in nature
Sudden weight gain of >3 lb (1.4 kg) in
2 days may indicate worsening ( have
patient weight themselves every day
same time of day)
Pitting Edema
Diagnostic Studies
Echocardiography
 Ejection fraction- greater than 50% is
normal
 Chest x-ray
 EKG, stress test
 Cardiac catheterization
 BNP (NT-proBNP)
 ABGs

ADHF
Collaborative Management
Continuous monitoring and
assessment: VS, O2 saturation,
urinary output
 Lung sounds
 Supplemental oxygen
 Mechanical ventilation if unstable
 High fowlers position

RECAP
Nursing Assessment

Objective data







VITAL SIGNS (T, P, R, BP, O2 sat)
Skin color and temperature
Edema
Lung sounds
Frothy, blood-tinged sputum
Heart rate and sounds
Changes in LOC (level of
consciousness)
.
RECAP
Nursing Assessment

Objective data
 Serum electrolytes

(K+ cardiac) (Na-neuro)
BUN, creatinine
 Liver function tests
 BNP (beta natriuretic peptide)


Below 100is normal
Chest x-ray
 Ejection fraction
 Echocardiogram
 EKG/telemetry

Problems
Impaired gas exchange
 Impaired cardiac output
 Fluid imbalance
 Activity intolerance

Treatment
.
Teaching

What would you include in a
teaching plan for N.B.?
Patient Teaching
Medication compliance
 Daily weight
 BP & pulse monitoring
 Respiratory status
 Low salt & heart healthy diet
 Smoking cessation
 Weight management
 Teach S/S of worsening

Objectives Review
Compare left and right sided heart
failure
 Identify assessment findings
 Describe pharmacological
treatments
 Prioritize care for client

Audience Response Question
A patient with left-sided heart failure is prescribed
oxygen at 4 L/min per nasal cannula, furosemide (Lasix),
spironolactone (Aldactone), and enalapril (Vasotec).
Which assessment should the nurse complete to best
evaluate the patient’s response to these drugs?
a. Observe skin
turgor
b. Auscultate lung sounds
c. Measure blood pressure
d. Review intake and output
Audience Response Question
Which topics would the nurse plan to include in
discharge teaching for the patient?
SELECT ALL THAT APPLY
a. How to monitor and
record daily weight
b. Importance of stopping exercise if heart rate
increases
c. Symptoms of worsening heart failure
d. Purpose of chronic antibiotic therapy
e. How to read food labels for sodium content
f. Instructions on how to take medications
Finish with a Smile!
References
Lewis, S., Heitkemper, M., Dirkson, R., O’Brien, P., Bucher, L.
(2023). Medical-Surgical Nursing: Assessment and management
of clinical problems (12th ed.). St. Louis, MO: Elsevier.