Heart Failure for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Heart Failure for Certified Emergency Nursing (CEN)
Outline
Heart Failure
Definition/Etiology:
Left ventricular ejection fraction (EF) is typically below 40%
- Systolic heart failure: inability to pump effectively
- Diastolic heart failure: inability to adequately fill
Can be a complication of any type of cardiac disease
Most commonly caused by CAD, chronic HTN, and diabetes
Pathophysiology:
Inadequate cardiac output and oxygen delivery to tissues
LV failure -> pulmonary HTN -> RV failure -> venous congestion
Rt sided HF most often caused by Lt sided
Clinical Presentation:
Right-sided Failure | Left-sided Failure |
Peripheral edema | Shortness of breath |
JVD | Dyspnea |
Ascites | Crackles |
Hepatomegaly | S3 heart sound |
Increased CVP | Pulmonary edema |
Collaborative Management:
Assessment:
- Chest X-ray (fluid), 12-lead EKG, labs, BNP (>100), echo
Interventions:
- Support ABCs
- continuous cardiac monitoring
- O2 (SpO2 >90%), may need BiPAP
- Initiate IV access
- Caution with fluids! Watch out for Sepsis Pts
Medication Management:
- Administer loop diuretics (get fluid off!)
- vasodilators (morphine, nitroprusside, nesiritide, ACE inhibitors) as needed (less stress on heart to push against BP)
- cardiogenic shock = positive inotropes
Evaluation | Patient Monitoring | Education:
- Level of consciousness
- Hemodynamic status
- Breath sounds and pulse ox
- Cardiac rate and rhythm
- Respiratory effort
- Intake and output
Linchpins: (Key Points)
- The pump is not pumping effectively
- Think fluid back up
- RV failure = back up right atrium to vena cava
- LV failure = back up left atrium to lungs
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2017) Emergency Nursing Core Curriculum, 7th Edition. PA: Saunders
- Nelson, N. (2017). Cardiovascular Emergencies. In CEN Online Review. Emergency Nurses Association.