Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
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Study Tools For Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Outline
Heart Failure (Acute Exacerbations, Chronic)
Definition/Etiology:
- Definition
- HF is a clinical presentation of impaired cardiac function in which one or both ventricles are unable to maintain an output adequate to meet the metabolic demands of the body.
- Types
- Acute-suddenly (maybe a PE) vs Chronic (slow like HTN)
- Etiology/Cause
- Left Sided (Systolic (Bad Squeeze/Low EF) or Diastolic (Bad Fill)
- Pathologies that affect LEFT side of the heart
- CAD/ACS,
- Cardiomyopathy
- Cardiac Tamponade
- Aorta/Mitral Valve disease
- Pathologies that affect LEFT side of the heart
- Right-Sided
- Left-Sided Heart Failure left untreated
- Acute Lung Pathologies
- Example : Pulmonary Hypertension, Pulm Embolism
- Left Sided (Systolic (Bad Squeeze/Low EF) or Diastolic (Bad Fill)
Pathophysiology:
- Analogy: Think of a car going uphill. If that car stops, it has to roll backwards. Fluid in the heart and it’s chamber behaves the same way. Symptoms are either going to be pulmonary or peripheral.
- Normal Blood Flow
- Body → Vena Cava → RA → Tricuspid → RV → Pulm Artery
→ Lungs → Pulmonary Vein → LA → LV → Aorta → Body
- Body → Vena Cava → RA → Tricuspid → RV → Pulm Artery
- Left-sided HF backs up to lungs
- Pulmonary Symptoms
- Right-sided HF backs up to body
- Peripheral Symptoms
Noticing: Assessment & Recognizing Cues:
- Subjective
- Chest Pain
- Tired/Fatigued
- “Activity Intolerance”
- Left Sided Heart Failure -Pulmonary
- Increased Pulmonary Congestion
- Pulmonary edema
- Cough
- Pink/frothy sputum
- Right-Sided Heart Failure – Periphery
- Peripheral Edema
- ↑ JVD
- ↑ Preload
- Weight Gain
- Liver / GI Congestion
Interpreting: Analyzing & Planning:
- Labs
- BNP (Brain Natriuretic Peptide – stretched ventricles)
- ↑ 400 = very specific for Heart Failure
- May Have seen Pro-BNP or BNP-T
- These are facility specific rather than PCCN test material – focus on traditional BNP levels
- CRP – marker of inflammation (not specific for HF – helpful)
- BNP (Brain Natriuretic Peptide – stretched ventricles)
- Diagnostics
- ECG
- Dysrhythmia -Afib & Heart Block
- Echocardiogram
- Chamber Size
- Valve Function
- Wall Thickness
- Squeeze/Fill
- CXR
- Cardiomegaly
- Pulm Congestion
- ECG
Responding: Patient Interventions & Taking Action:
- ABCs + Underlying Cause
- 02 Support
- Meds highly effect circulation
- Fluids or Squeeze of heart/vessels
- Pharmacological Interventions
- 02 Support
- Decrease Preload
- Diuretics – Get Fluid OUT
- Decrease Afterload
- Ace-Inhibitors – Decrease Afterload
- Contractility
- Beta-Blockers
- Digoxin
- + Inotropes/Vasopressors → ICU
- Non-Pharmacological Interventions
- Sodium Restriction
- Implanted Pacemakers/DEFIB
- Valve Replacement
- Transplant
- Adjunct Medical Therapy
- Cardiology – Plumbing
- Electrophysiologist – Electricity
Reflecting: Evaluating Patient Outcomes:
- DR – Identify underlying cause (Treat/remove)
- Nothing we do will help if not identified!
- MI?- Cath Lab
- HTN? – Antihypertensive + Diuretics
- PE?- Clot busters
- Nothing we do will help if not identified!
- HF Symptoms Relieved
- Lungs Clear/Sob Relieved
- Edema Relieved/Kidneys producing urine
- Hemodynamics stabilized
- Prognosis = Compliance
- Sodium Restriction
- Fluid Restrictions
- KCL watch related to diuretics
- Daily weight monitoring
Linchpins (Key Points):
- Notice -Symptoms
- Right vs Left sided cues
- Interpret-
- ECHOCARDIOGRAM
- Walls, Ventricles, Valves & Output
- BNP – Severity
- ECHOCARDIOGRAM
- Respond
- Treating underlying cause
- Pharm, Non-Pharm
- Reflect
- Symptomatics Relieved
- Hemodynamics stabilized
- Complaint
Transcript
References
- Awoke, M. S., Baptiste, D. L., Davidson, P., Roberts, A., & Dennison-Himmelfarb, C. (2019). A quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure. Contemporary Nurse, 55(1), 15-26.
- AACN, and Tonja Hartjes. AACN Core Curriculum for Progressive and Critical Care Nursing. Available from: Pageburstls, (8th Edition). Elsevier Health Sciences (US), [Insert Year of Publication].
- Cui, X., Zhou, X., Ma, L. L., Sun, T. W., Bishop, L., Gardiner, F. W., & Wang, L. (2019). A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China. Rural and Remote Health, 19(2), 47-54.
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
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