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

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

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

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

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

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

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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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).