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Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)

Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)

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Heart Failure (Cheatsheet)

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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
- Right-Sided
  - Left-Sided Heart Failure left untreated
  - Acute Lung Pathologies
    - Example : Pulmonary Hypertension, Pulm Embolism

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
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)
Diagnostics
- ECG
  - Dysrhythmia -Afib & Heart Block
- Echocardiogram
  - Chamber Size
  - Valve Function
  - Wall Thickness
  - Squeeze/Fill
- CXR
  - Cardiomegaly
  - Pulm Congestion

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
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
Respond
- Treating underlying cause
- Pharm, Non-Pharm
Reflect
- Symptomatics Relieved
- Hemodynamics stabilized
- Complaint

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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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Concepts Covered:

Study Plan Lessons

Adult Vital Signs (VS)

Nursing Care Plan (NCP) for Infection

Nursing Care Plan (NCP) for Impaired Gas Exchange

Vitals (VS) and Assessment

Nursing Care Plan (NCP) for Pertussis / Whooping Cough

Nursing Care Plan (NCP) for Chronic Kidney Disease

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ABGs Nursing Normal Lab Values

Adult Vital Signs (VS)

Congestive Heart Failure Concept Map

Congestive Heart Failure (CHF) Labs

Critical Thinking

Fluid Volume Overload

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Heart (Cardiac) Failure Therapeutic Management

Heart (Cardiac) Sound Locations and Auscultation

Heart (Heart) Failure Exacerbation

Heart Failure – Right Sided Nursing Mnemonic (HEAD)

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Heart Failure-Left-Sided Nursing Mnemonic (CHOP)

Isotonic Solutions (IV solutions)

Hypertonic Solutions (IV solutions)

Nursing Care and Pathophysiology for Heart Failure (CHF)

Nursing Care and Pathophysiology for Pulmonary Edema

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Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)

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Nursing Care Plan (NCP) for Impaired Gas Exchange

Nursing Care Plan (NCP) for Respiratory Failure

Time Management

Pleural Effusion for Certified Emergency Nursing (CEN)

Nursing Care Plan (NCP) for Syncope (Fainting)

Nursing Care Plan (NCP) for Risk for Fall

Nursing Care Plan (NCP) for Decreased Cardiac Output

Nursing Care Plan (NCP) for Cardiogenic Shock

Nursing Care Plan (NCP) for Cardiomyopathy

Nursing Care Plan (NCP) for Chronic Kidney Disease

Nursing Care Plan (NCP) for Activity Intolerance

Nursing Care and Pathophysiology for Cardiogenic Shock

Nitroglycerin (Nitrostat) Nursing Considerations

Disease Specific Medications

Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)

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Nursing Care Plan (NCP) for Respiratory Failure

Nutrition Assessments

Perioperative Nursing Roles

Perioperative Nursing Course Introduction

Postoperative (Postop) Complications

Post-Anesthesia Recovery

Preoperative (Preop) Nursing Priorities

Preoperative (Preop)Assessment

Preoperative (Preop) Education

Procedural Terminology

Surgical Incisions & Drain Sites

Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)

Ventilator Settings

Intraoperative (Intraop) Complications

Informed Consent

General Anesthesia

Advanced Cardiovascular Life Support (ACLS)

Dark Skin: IV Insertion

Finding Your First Nursing Job as a New Grad

Head to Toe Nursing Assessment (Physical Exam)

ICU Nurse Report to Floor Nurses

ICU Nurse Report to OR (Operating)Team

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Hypovolemic Shock Case Study (OB sim) (60 min)

Intake and Output (I&O)

Introduction to Health Assessment

Interviewing for Nursing School

IV Drip Administration & Safety Checks

Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)

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Life Support Review Course Introduction

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Menstrual Cycle

Moderate Sedation

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Neuro Terminology

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Nursing Care Plan (NCP) for Asthma

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Phases of Nurse-Client Relationship

Pharmacology Course Introduction

R – Real-Life

Questions To Ask Before Applying To A Nursing Program

Respiratory Structure & Function

Surgical Incisions & Drain Sites

Surgical Counts for Certified Perioperative Nurse (CNOR)

Test Taking Course Introduction

Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)

Tuberculosis (TB) Case Study (60 min)

Process of Labor – Mom Nursing Mnemonic (4 P’s)

Prealbumin (PAB) Lab Values

Personality Disorders

Pediatric Advanced Life Support (PALS)

Patients with Communication Difficulties

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Nursing Care Plan (NCP) for Nutrition Imbalance

Nursing Care Plan (NCP) for Glaucoma

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Heart Failure for Certified Emergency Nursing (CEN)

Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)

Heart (Cardiac) Failure Therapeutic Management

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Drawing Pictures

Disease Specific Medications

Disasters & Bioterrorism

Day in the Life of a NICU Nurse

Day in the Life of an ICU (Intensive Care Unit) Nurse

Congestive Heart Failure (CHF) Labs

Communication of Patient Outcomes (Continuum of Care) for Certified Perioperative Nurse (CNOR)

Common Pathogens for UTI Nursing Mnemonic (KEEPS)

Cognitive Impairment Disorders

Cardiopulmonary Arrest

Cardiac Terminology

Cardiac Anatomy

Cardiac (Heart) Physiology

Body System Assessments

Blood Flow Through The Heart

Blood Pressure (BP) Control

Attention Deficit Hyperactivity Disorder (ADHD)

Advocating For Your Patient

Advanced Cardiovascular Life Support (ACLS)

3rd Degree AV Heart Block (Complete Heart Block)

2nd Degree AV Heart Block Type 2 (Mobitz II)

2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)

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Overview of the Nursing Process

Nursing Process – Diagnose

Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)

Nursing Care Plan (NCP) for Tuberculosis

Nursing Care Plan (NCP) for Impaired Gas Exchange

Nursing Care Plan (NCP) for Infection

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How to Write A Nursing Progress Note

How to Write a Nursing Care Plan

Health Promotion Assessments

Intraoperative Nursing Priorities

Hypertension (HTN) Concept Map

Maslow’s Hierarchy of Needs in Nursing

MSN (Masters) vs. DNP (Doctorate)

Nurse-Patient Relationship

Nursing Process – Plan

Nursing Process – Evaluate

Our Goals for Teaching

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Pain and Nonpharmacological Comfort Measures

Perioperative Nursing Roles

Phases of Nurse-Client Relationship

Preoperative (Preop) Nursing Priorities

Preoperative (Preop)Assessment

Program Planning

Purpose of Nursing Care Plans

Identifying Interventions per Nursing Diagnoses for Certified Perioperative Nurse (CNOR)

Health Promotion & Disease Prevention

Health Promotion Model

Erikson’s Theory of Psychosocial Development

Continuity of Care

Community Health Education

Communicating with Other Nurses

Depression Concept Map

Disease Specific Medications

Advocating For Your Patient

Breast Cancer Concept Map

Intro to Community Health

Depression Concept Map

Congestive Heart Failure Concept Map

Concept Map Course Introduction

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Maslow’s Hierarchy of Needs in Nursing

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Aneurysm & Dissection

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Respiratory Infections Module Intro

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Nursing Care and Pathophysiology for Tuberculosis (TB)

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Communicable Diseases

Anti-Infective – Antitubercular

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Casting & Splinting

Care of Vulnerable Populations

Complications of Immobility

Head to Toe Nursing Assessment (Physical Exam)

Mechanical Aids

Mobility & Assistive Devices

Musculoskeletal Terminology

Introduction to Health Assessment

Preload and Afterload

Sympatholytics (Alpha & Beta Blockers)

Heart Failure Case Study (45 min)

Congestive Heart Failure Concept Map