a nurse is caring for a client who was admitted for treatment of left-sided heart failure This is a topic that many people are looking for. star-trek-voyager.net is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, star-trek-voyager.net would like to introduce to you Congestive Heart Failure (CHF) Pathophysiology, Nursing, Treatment, Symptoms | Heart Failure Part 1. Following along are instructions in the video below:
Everyone its saylor with register nurse rn home and in this video. I want to to be going over an ink lex review up heart failure. This video is part an ink lex series over the cardiovascular system and in this specific video.
Its going to be part one im going to be covering the pathophysiology of heart failure. The causes. The signs and symptoms the different types what triggers it how its diagnosed and things like that and im going to be giving you some clever mnemonics on how to remember this material for nclex and your nursing lecture exams and in the next video which will be part two im going to be covering specifically the nursing interventions and the pharmacological aspect of heart failure.
Which is another important part that in clecs will test you on and then after you watch this video be sure to go to my website register nurse rn calm and take the free ink lex quiz that will test you on this material and a card should be popping up so you can access that so lets get started. First lets start out. Talking about what is heart failure heart failure is where the heart is too weak to pump efficiently and because it cant pop efficiently.
What happens it cant provide the proper cardiac output that your body needs to maintain its metabolic needs. So. Whats really happening with heart failure.
Is that that heart muscle has either messed up with how it can contract and pump that blood up through those valves out through your car out through the other side of the heart or its become too stiff and were mainly talking about the ventricles of the heart. Were going to be talking about mainly our right ventricle and our left ventricle and ill go over that in depth whenever we cover the different types now what are the causes of heart failure to help you remember this remember the mnemonic failure. Were talking about heart failure.
So its easy to remember failure whatever were trying to think about what causes this condition. So first s heart. Faulty heart valves.
What does this mean well you have four different valves in your heart. You have your tricuspid and youre by custom about also called your mitral valve. Which or your abo ventricular.
Valves. And then you have your pulmonic valve and your aortic valve. Which are your semilunar valves.
Now your tricuspid valves and your tricuspid valve and your my cuspid valve can be comes to nose or it can become regurgitating and whenever it becomes stenosis. Its too narrow and whenever it becomes regurgitated it means it leaks and this can lead to heart failure. I have seen this as a nurse in the clinical setting patient comes in they have messed up heart valves may be from endocarditis and they need their heart valves.
Replaced because whenever those heart valves are messed up it causes your heart to overwork and they enter into heart failure. But whenever they get those valves replaced it fixes. The problem and theyre much better okay.
Next a arrhythmias. Um arrhythmia is like atrial fibrillation or tachycardia can send you into heart failure. And this is where for instance.
Lets talk about atrial fibrillation atrial. Fibrillation is where your atriums are quivering. Theyre not pumping efficiently so blood is like pulling in there.
And this can send a patient into heart failure a lot of times. I have seen patients come in they didnt even know theyre in afib and they had the sign of heart failure and also tachycardia. This is where you have a really fast heart rate patient may not know it its elevated for a long time that puts a lot of strain on the heart makes that muscle weak and they enter into heart failure high infarction such as my cardial infarction and you will get this with coronary artery disease myocardial infarction heart attack what happens is that they have a plaque buildup in one of those arteries that feeds that heart muscle all that nutrients that blocks that all that nutrients go into that heart muscle that heart muscle becomes ischemic and die.
And it becomes weak. So for instance like left ventricle this happens a lot whenever people get left sided heart failure. The arteries that see that mentor cold can become blocked that muscle dies sends them into heart failure l4 lineage.
This is genetic family history mom dad grandmother had it so youre more at risk for developing a congenital youre born with it family history. So that can run in families next. You uncontrolled hypertension.
We talked about in the in clecs review video of hypertension hypertension is a number one its a silent killer. Because patients dont know that they have it they dont have signs and symptoms until its too late till. Its affected.
The organs and what happens is whenever you have such that high pressure beating on that heart. It can cause those vegetables to become stiffened. So whenever they become stiffened.
They cant that those mint ripples will not feel properly with blood. And you can enter into heart failure. Our recreational drug use such as cocaine or alcohol abuse.
Patients who do cocaine or have alcohol abuse. Are more susceptible for developing heart. Failure ii.
Evaders. Such as viruses infections that get in and attack of the heart. I have seen this again a patient will come in and theyre relatively healthy.
Some of them are young. But theyve got some type of virus or infection. That is attacked op heart muscle may at week.
And now they are in heart failure. Now. Lets look at the different types of heart failure.
You can have you can have left or right sided or both now to help you understand the different types of heart failure. Because this is a big thing. The ink looks like staph and especially your nursing lecture exams.
Because you need to know those different signs and symptoms that a patient with left sided. Heart failure may be presenting with that someone with right sided man. So you need to know the different ones and lets look at the blood flow.
How the blood flows boat flows through the heart and the pathophysiology of it okay first lets get familiar with which side of the heart is which because that is very important when determining if youre in left sided. Or right sided heart failure. So this right here is the right side of the heart.
Where the blue donated blood is draining down into the heart. This side is the left side of the heart. Where the nice rich red oxygenated blood.
Its went through the lungs. Its going to be pumped up through the body and were specifically remember looking at these ventricles. Because thats where our problem is with heart failure.
Theyre either too sick or theyre not contracting. Properly. So first lets look at how the blood normally flows through the heart and then well go through how it can back up and cause all those signs and symptoms okay.
So you have your superior vena. Cava. And you have your inferior vena cava.
And what these do is they drain. All that blood that your body has used to become reoxygenate. It wants to send it through the one lungs.
Thats the goal of your right side to get that blood to the lungs to become oxygenated. So we can go back to your body. So it does that now no this is important later in your inferior vena cava.
Its also connected through those hepatic veins to the liver. So whatever you start getting congestion in your right side of the heart. The liver is going to be affected.
Which will go over here in a second so it drains down into your right atrium. Then it flows down through the tricuspid valve. Then to your right ventricle.
The right ventricle squeezes. It up through your pulmonic valve up through your pulmonary. Artery and out through your lungs.
And then it goes through gas exchange through those little sacs. It becomes replenished. Then its nice and oxygenated and it shoots through the heart down through the left atrium down through the bicuspid valve.
Which is also called your mitral valve. Then down into that left ventricle and remember the left ventricle has the most pumping power of all four chambers. Because it has to in order to shoot that blood up through the body.
So that left hand school will squeeze that blood shoot it up through your aortic valve up through your aorta and then through your whole body. And then the cycle starts all over again. Now with heart failure like ive said there either a contraction problem with these ventricles theyre not contracting properly.
Maybe the muscles die become ischemic or theyre not filling properly and this could be due to an uncontrolled hypertension. Where that ventricle has just become too stiff first lets talk about left sided heart failure. So.
Whats happening in left sided. Heart failure. Why do you get pulmonary symptoms.
Well with left sided heart failure. The ventricle either. Its too stiff or its not contracting.
Properly and you can have diastolic or systolic less intrical dysfunction. Which will go over here in a second. And what happens is that the blood will backflow up through your atrium and up into your lungs.
So the patient will start presenting with pulmonary symptoms. Because that blood is back flowing into there so they may have crackles a shortness of breath up orthopaedic where they cant even lay down and sleep. So theyre going to get pulmonary signs and symptoms with left sided heart failure.
Now with right sided as a side note remember this left sided. Because its over here it can increase the pressure in the right ventricle because of all this back slowing the blood up through here. And it can actually cause a patient to go into right sided heart failure as well so remember that so you can have both going on at the same time.
But sometimes you can sometimes you can just have right sided heart failure and whenever that happens on your right side watch. Where the blood would backflow. Where you have too much blood back flowing.
Because your ventricles arent pumping out properly. Wheres that blood going to go. Its going to go up into those superior inferior vena cavas out through the peripheral area so youre going to be seeing a peripheral edema excessive weight gain they may have increased abdominal girth in their belly ascites and again back to the hepatic veins.
Because all this blood is going to congest into the inferior vena cava. Its going to cause hepatomegaly can cause your liver to become enlarged and then youll get the large abdomen and just really uncomfortable so that is why you would see the certain signs and symptoms with each side so again just recap your left side you are going to see pulmonary issues because its back flowing into your lungs on the right side. Youre going to see peripheral edema and issues like that okay as i was talking about before you even have left sided.
Systolic dysfunction or you can have left sided. Diastolic dysfunction and were talking about the left side of the heart. The left ventricle.
So lets go over systolic and you can also see it as less than tricular systolic dysfunction. Okay now lets think about whats this all ik is we talked about this in the other video where we went in depth about blood flow. What is this lis systolic is the squeezing phase of your heart remember s.
Systolic. Squeezing so its the contracting phase of your heart. So there is an issue with the left ventricle contracting and squeezing that blood up through the heart.
Now with this patients are going to have a low ejection fraction usually less than 40 a less than 40. Ejection. Fraction is a diagnosis for heart failure.
And whenever that happens the heart cannot squeeze that nice fresh oxygenated blood up through all those tissues everything that needs in those bobble organs. So they dont get it and it backs up into the lungs as you just seen now. What is ejection fraction.
What does it mean. Its a calculation tool. That is used to diagnose the contracting ability of your left ventricle.
So its the amount of blood that fills inside the left ventricle that is actually being contracted out of that ventricle now for instance say that you seen that a patient had an echocardiogram because thats one of the tools used to diagnose ejection fraction and it said an ef of 38. What does that mean that means that only 38 of the blood that field inside the left ventricle is being pumped out that is bad so they are in heart failure. Now a normal ef is an ejection fraction of greater than 50.
Thats a normal healthy heart and like i said it can be diagnosed with an echocardiogram remember this this is really important not only for nclex. But whenever you work as a nurse. Whenever youre reading test results.
So an echocardiogram can give you an ejection fraction. A heart. Catheterization can give you an ejection fraction.
And a nuclear stress test can as well give you that now lets look at left sided. Diastolic dysfunction. Weve just looked at systolic and that was the squeezing part of the heart.
There was an issue with the left ventricle being able to squeeze properly with diastolic dysfunction. It is an issue with the ventricle being able to feel properly because the diastolic diastole is the filling resting phase of the heart. So the ventricle this left interval has probably became too stiff to fill with blood so now all the blood.
Thats supposed to get in there and gets in there. But it can tracks normally so it gets just a little bit of blood and it contracts beautifully so because its not an issue with contraction. Its an issue with it actually feeling your ejection.
Fraction is usually going to be normal on these patients. So theyll go for an echocardiogram and their ef comes back normal. Because theres not an issue with contraction just feeling now with your left sided heart failure just because of where that left ventricle is you are going to have pulmonary symptoms with your left sided heart failures.
Now lets look at right sided. The other type of heart failure right sided. Heart failure is not as common as left sided.
Heart failure. Funny enough left sided. Heart failure is one of the main causes of why people would enter into right sided heart failure.
Along with its also caused by a pulmonary heart disease. Col. Called cor pulmonale.
As a complication of the patient. Either has pulmonary. Hypertension or c.
Yo. Pd. So that can be other causes of it now just to recap with the right sided remember on the right ventricle just where its located and where the anatomy is and everything thats going to be affected.
It just makes sense if that if this ventricle is not contracting properly blood is back flowing its going to go peripherally. So youre going to see peripheral signs and symptoms with this with left side. Youre going to see pulmonary.
So now lets look at the signs and symptoms side by side and let me give you some clever mnemonics on how to remember them okay for right sided heart failure lets remember the mnemonic swelling and why swelling. Because remember these patients are going to have peripheral swelling everywhere. So just an easy mnemonic to help you remember.
The typical signs and symptoms and then for left sided heart failure. Were going to remember the word drowning because remember our lungs. The pulmonary system is majorly involved in this and they are literally drowning in their own fluids.
So lets remember. The word drowning okay. So lets start with right sided for the s.
Were in swelling. Were going to remember swelling of hands the legs. The liver.
Theyre gonna have a lot of congestion a lot of fluid going on with that w weight. Gain. This is going to be present with both of them.
But especially with right sided heart failure and you want to tell the patients to monitor their weights daily. Any fluctuation between 2 to 3 pounds in one day or 5 pounds. In a week is something to be alarmed about because they could be going into heart failure exacerbation a demon these patients not only will have swelling.
But they could have pitting edema in their legs. And this is where you can press on the tibia of the leg. And it will actually pit in i have seen three four plus pitting edema.
Very very interesting how much swelling these patients can have l4 large neck veins. This is is the jugular veins. If you have a video on how to do this.
But if you turn the patients neck to the right side. Theyre setting up you are laying back a little bit you can actually see a jugular venous distention. L4 lethargic.
These patients are going to be extremely tired. Extremely. They cant tolerate.
Its hard for them to even get up from the bed to the bedside chair. They get very winded because of all this extra fluid. Theyre carrying and their heart is just so weak.
It cant pump efficiently to get that blood going everywhere i for irregular heart rate. A lot of times whenever patients come in with congestive heart failure. They can flip into a regular heart rate like atrial fibrillation.
Another thing is knock knock yuria in the end and this is very interesting. This is where they have all of a sudden frequent urination in the middle of the night them at the time. They dont want to have it and this is because normally a patient people are up moving around.
But at night. Whenever youre laying down your legs are elevated it allows that fluid to enter back into the vascular system goes to the kidneys. So your kidneys try to start putting out that fluid so thats why there may have excessive urination at night with this and g4 girth.
The abdominal girth of their belly can be increased and this is because remember of the hepatomegaly where all this congested fluid is going to the liver. So they can have that whenever they have that they have this big belly of extra fluid it can cause them not to breathe. Very well theyll have difficulty breathing because its pushing on those lungs.
And its also going to be pushing on the stomach. So they could have anorexia just dont feel like eating and they can feel nauseous with this now left sided heart failure. Were drowning because we got pulmonary issues going on first d.
Rimmer dis. Via. This is because of all that fluid backing up into that lungs causing that patient not to breathe very well our four rails.
This is another word for crackles. This is when you listen with your stethoscope. And you can hear in the lungs.
This crackling noise. How i like to do is take your hair. And take it.
By your ear. And thats what it sounds like oh for ortho kini. This is one of the tell tale signs of a patient tells you and to have a history of congestive heart failure at night.
Ive been having to use some pillows to set up to sleep and breathe. Because i just cant breathe that as a warning find them they may be going in to see it to heart failure exacerbation. So thats what that is and then w for weakness.
Again just like with right sided heart failure. Theyre going to be extremely weak. Just because that heart cannot put out the cardiac output.
It needs to to meet your bodys metabolic needs in for nocturnal proximal dis pm. This is where at night they will just wake up all of a sudden. Breathing difficulty just cant breathe at all its very frightening for them.
And this is one of the things that going to happen left sided heart failure. Because youre having those pulmonary issues. I for increased heart rate.
And the reason they have increased heart rates because they have the heart. The body says. Its how we have all this blood in the heart.
But we need to get out to the organs. So its just staying there so that heart will increase that heart rate and make it become tacky. So it can pump it out to get to those vital organs.
In for nagging cough. Again thats you have the lung issues. Going on to have this persistent nagging call.
And sometimes it can become frothy or blood. Tinged sputum and if this happens. This is a really really bad sign that something horrible is going on you need to get them diaries.
Fast because they have some major fluid overload. So. If you see that thats usually a late sign g for gaining weight again.
Just with right sided. Heart failure. And they if they gain more than 2 to 3 pounds in a day or 5 pounds in a week that is a red flag okay lets look at real fast how heart failure is diagnosed in the hospital setting.
Okay. A lot of times. Physicians will order a lab.
Result called a b in p stands for b type naturally. Mek peptide. We call it b and p.
And what it is its a biomarker thats released by your ventricle. When theres excessive pressure on the heart due to heart failure and readings. If you have less than 100.
Theres no heart failure going on and if you have a hundred to three hundred reading its present greater than 300. Its mild greater than 600. Its moderate and greater than 900.
Its severe and i have seen these in the 2000s with heart failure. Patients. Other things that are used to diagnose this.
A chest x. Ray looking to see if there is any congestion in those lungs leaning at the heart to see if its enlarged and an echocardiogram. Im a heart cath and a nuclear stress test.
Which is what we talked about earlier with the ejection fraction. Now heart. Failure can be maintained for patients.
And they can take medications. They can do diet regimen and other treatments. So they can maintain it however.
A heart failure can go into exacerbation where it comes out in full force. And some things that can trigger that or maybe. The patient isnt compliant with their diet.
They eat a lot of fast food a lot of sodium. They dont restrict their fluids. They drink a lot of soda.
A lot of water that can trigger them to go into heart failure infection. They get really sick stresses. The heart out go into heart failure.
Uncontrolled atrial. Fibrillation or renal failure. Because renal patients have issues with fluid overload.
Already. And that can put more stress on the heart. That already is more susceptible to heart failure.
So in the next video be sure to check out part 2. Because im going to be going over nursing. Interventions and all those medications to use to treat heart failure.
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