Hey everyone it's a registered nurse Arion calm and in this video I want to be going over part

two of heart failure this video is part of a cardiovascular NCLEX review series that I want to
be covering and in the previous video I covered part 1 of heart failure and I talked about the
path of heart failure the signs and symptoms the different types and things like that so if you
haven't watched that video be sure to
Check that out because that video builds upon this video and a card should be popping up so
you can access that so what I'm going to do in this video is I'm going to be covering the
nursing interventions and the medications given specifically in heart failure because that is
really what the ink let's examine your nursing lecture exams like to hit on because as the
nurse you need to know what your role is you need to know how to educate the patient and
Those common side effects of those medications you'll be giving in heart failure and then
after you watch this lecture be sure to go to my website register nurse orange calm and take
the free NCLEX quiz that will test you on heart failure and a card should be popping up so
you can access that so let's get started first let's recap and talk about what is heart failure heart
failure is where the heart is too weak to pump efficiently so it can't properly
Give your body the cardiac output it needs to maintain the metabolic needs so you get some
major issues going on and remember from the other video your left side of your heart or your
right side of the heart can be affected or you can have both so remember with left-sided heart
failure you're going to get the pulmonary symptoms and with right-sided heart failure you're
going to get those peripheral symptoms and the most common type of heart failure is left-
sided and
It can cause right-sided heart failure so keep those things in mind whenever we're talking
about medications and things like that so what are the nursing or ventricles cover that first
why is your role as a nurse in a nutshell what you're going to be doing is you're going to be
assessing that patient educating that patient and administering medication so first let's talk
about this sesang part what are you going to be doing okay as a nurse you are going
To be assessing assessing their symptoms how are their symptoms are they presenting worse
than before like if they're in right-sided heart failure how is that peripheral swelling is it
going down because chances are there's no male medications are they responding
appropriately to that are they getting worse left side remember you get those pulmonary
issues is the patient breathing better is there less crackles how are they doing with that next
you're
Going to be assessing the patient's responsiveness to those medications medications such as
digoxin you've got to watch that heart rate because it can slow the heart rate down beta
blockers things like that so you want to have them on continuous monitoring or be checking
their vital signs often watching their blood pressure because they're going to be on ACE
inhibitors ARBs or vasodilators and that really messes with the blood pressure and plus
Your shifting fluids out a lot either and fluid overload and you're getting rid of flutes because
they're at risk for orthostatic hypotension and you're going to be monitoring their volume
status because we're trying to diurese them trying to remove that fluid so they're going to be
on diuretics chances arm the physician will order a Foley catheter because a lot of times these
patients come in there and fluid overload they're going to be started on
IV may be loop diuretics like lasix it's very strong diuretic especially going the intravenous
route so they may need a Foley to help drain all that urine that's going to be coming out
because getting up and going to the bathroom will wear them out because they're already the
respiratory system is already compromised and just going back and forth to the bathroom puts
a lot of strain on them and you're going to be monitoring and assessing those daily
Weights every morning you're going to get them up on a scale or use the bed scale and you
want to monitor that weight because it's very important how much weight they're losing or
possibly gaining then you're going to monitor and look at those labs specifically you really
want to watch levels because a lot of the medications given in heart failure can cause
hypokalemia or hyperkalemia for instance lasix lasix is a diuretic
That wastes potassium so you really go to monitor that lasix level and especially if they're on
digoxin because if you have low potassium that can increase the chances of digoxin toxicity
hyperkalemia medications that can cause that that are sometimes prescribing heart failure or
like those potassium sparing diuretics that actually do the opposite of loop diuretics they keep
potassium like al doc dome and ACE inhibitors and ARBs they can increase
Potassium so if you have a patient on an ACE inhibitor and a lactone they are a major risk for
hyperkalemia so you have to tell the patient's watch their potassium intake also you're going
to be assessing and making sure they are following their cardiac diet and their fluid restriction
diet a lot of patients have issues with this because especially the fluid restriction diet
normally they can only have about two liters of fluid of day so you have to constantly
monitor
What they're having for breakfast for lunch and dinner and in between make sure they're not
cheating on that diet because we're getting rid of that extra fluid and we don't want to just be
putting it back in then we're going to assess the edema in the legs that goes back to the
patient's responsiveness helping keep those legs elevated whenever they're in bed will help
promote returning that extra fluid back into the vascular system hopefully being
Excreted through the kidneys and keeping them in high fowlers position to help with
respiratory that position setting up riot helps the lungs expand and helps decrease this vm
next safety this is a big issue with your heart failure patients because number one chances are
they're going to be on some vasodilators or some other blood pressure medicine and and the
body whenever they shift positions may be lying in the bed they get up they can get really
dizzy
And they're at risk for falling so you want to make sure you monitor them for that and the
extra swelling and the legs and the feet make it really hard to walk and put the feet on the
ground and it can leave to them falling okay now educating this is a big piece so remember
this stuff write it down because as the nurse we want to educate our patients with heart failure
and regardless if you're not working on a cardiac unit maybe you're
Going to work on ortho your chances are you're going to get patients with heart failure
because this affects a lot of patients so our goal with educating is that we want to prevent
readmission this disease process causes a lot of readmissions for the hospital and we want to
prevent see a heart failure exacerbation so what you want to teach your patients is the
following follow a low sodium diet guidelines are no more than 2 grams per day sometimes 3
so no
More than 2 to 3 grams of sodium per day in your diet what are the hidden salts like in
canned foods your sandwich me your frozen meals things like that that you wouldn't
normally think has a lot of sodium in but do it in soft drinks next fluid restriction the doctor
wants them on fluid restriction they need to make sure they monitor how much they drink a
day because some of these medications can make you thirsty so no more than 2 liters a day of
fluid vaccinations make
Sure that they are they need to be aware that they need to get an annual flu vaccine and that
they're up to date on their pneumonia vaccine because illnesses can exact exacerbate heart
failure because it stresses the heart out when a patient gets sick next aerobic exercises that's
like your cardiovascular exercise they need to do light to moderate exercise to keep that
muscle nice and strong and do that as tolerated once there's symptoms symptoms
Start dissipating next daily weights it is so important that they weigh themselves every day
because it is an early sign of c-h-s heart failure exacerbation if they're gaining weight so the
guideline is if they're weighing themselves make sure they're writing them down and they
need to notify their doctor if they're gaining any more than 2 to 3 pounds per day or 5 pounds
per we that is signalling hey you're starting to retain fluid something's
Going on let's go to the doctor and maybe they can prescribe some more diuretics so I don't
have to go to the hospital in readmit it so daily rates very important next compliance with
medications a lot of times especially working as a nurse I have just seen where patients have
quit taking their medicines maybe they couldn't afford their medicine so they quit taking
them and this sent them into heart failure exacerbation so very important they take
Those medicines next smoking cessation quit smoking very bad with the heart causes
vasoconstriction hard on the heart and limiting alcohol consumption next i'm teach your
patient those early signs and symptoms we just talked about the weight gain also if they
notice that all of a sudden they can't tolerate normal activities that they were doing like just
getting up and going into the kitchen they know so there's trying to get a little short of breath
or at night
Whenever they're trying to sleep that they have to put a couple pillows behind them to sleep
better look which is called ortho P neum those are some warning signs that hey I may be
going into heart failure exacerbation now let's look at the medications for heart failure when
you're studying these medications for the NCLEX or for your nursing lecture exams make
sure you know the drug categories that are given in heart failure and what drugs are
Included in that category and how they work on the body the pharmacodynamics and their
side effects and patient education very important key points you want to remember okay to
help you remember the drug categories that are given in heart failure remember this
mnemonic always administer drugs before a ventricle die in heart failure our issue is with the
ventricles they are either not pumping they're not contracting properly or they're too
Stiff so they're not filling properly so we want to make this heart work easier especially these
ventricles so that emmonak should help you remember those drugs that are included so the
first a ACE inhibitors ACE inhibitor stands for angiotensin Burdine enzyme and this is
usually the first line of treatment in patients with heart failure and it's sometimes prescribed
with a beta blocker which we'll go over a little bit later these
Drugs tend to end in PR IL and one example of a ACE inhibitor is lisinopril and how this
drug works is that it blocks the conversion of Enzi angiotensin one to angiotensin 2 so you
don't have the conversion of angiotensin one go to angiotensin 2 and what does what how
does that work well we know whatever angiotensin 2 works it causes vasoconstriction but it's
not allowed to do that so in turn you're going to get vasodilation which is going to decrease
The blood pressure and you're going to get kidney excretion of sodium think back whenever
an Ziya angiotensin is being blocked what's going to happen is this going to cause your old
Ostrom levels to decrease what does aldosterone do aldosterone whenever it's being
decreased it will cause your kidneys to keep the tascam but excrete sodium which is what we
want in heart failure we're trying to get rid of all that extra sodium and fluid in the body and
this
Drug is helping us get rid of that extra sodium however because it's doing that it's going to
keep the potassium the get rid of the sodium we have to watch out for side effects of
hyperkalemia high potassium levels and for some reason with this drug these patients can
develop a nagging dry cough and I have seen this as a nurse it's for real and it really does
happen they will literally call every three to four minutes just this just over and over and
Over and it drives them crazy and the jobs with people around them crazy so some people
can't tolerate this drug next drug ARBs they if the patient cannot tolerate an ACE inhibitor
they'll be placed on an ARB and how do arms work arm stands for angiotensin ii after
blockers so they're a little bit similar so let's look ok these like I said are used in place of ACE
inhibitors they in in Sartain sa RTA n type of drug of this is losartan can they work by
Blocking angiotensin ii receptors so instead of blocking the conversion of angiotensin one
angiotensin ii like the ACE inhibitors did this works by just blocking the receptor so again
you're going to get some phase out dilation and it's going to have the same effects on the
body as your ACE inhibitors because you're going to have that decrease aldosterone and the
patient's going to keep potassium but excrete sodium however a side effect with this is
Hyperkalemia just like with ACE inhibitors but they will not get that dry hacking cough okay
our other driver diuretics d these either patient will be prescribed on loop diuretics or
potassium sparing diuretics and these diuretics are used in a combination with these ACE
inhibitors or an ARB they're used together and what your diuretics do is it helps your body
get rid of that water and that sodium retention because in heart failure what we're doing is
We're taking all this water we got edema everywhere retaining sodium so it helps us to
excrete that decrease that edema and it helps the heart pump easier because it doesn't have all
that fluid volume in its chambers trying to pump so it's getting rid of that however a side
effect of this is that this patient will urinate a lot so as a nurse you want to be monitoring that
your an output very very closely and you want to monitor their bu in and create and making
sure
We're not die erasing them too much and put too much strain on those kidneys okay an
example of a loop diuretic is lasix member with lasix or live diuretics they waste potassium
so before you get potassium I mean before you give lasix check those potassium levels to
make sure that they're good because you go in and give some lasix number tossing levels
already too you're going to bottom that out even more saying a lot of times for physicians will
prescribe
Potassium supplements along with lasix and potassium sparing drugs a drug al and what
things do they do opposite of loop diuretics they keep potassium so you have to watch out for
educate the patient not to consume foods that are high in potassium and to especially watch if
your patient is on an ace or an ARB because remember they keep potassium and if they're
taking a lactone you have a double risk of increasing that potassium level next beta-blockers
how
Do beta blockers work they work by blocking the norepinephrine effects on the heart muscles
so norepinephrine will naturally increase your heart rate so we're going to block that from
happening so beta blockers are going to slow down the heart rate they have a negative
inotropic effect which decreases my cardio contraction hence a fancy word for slow in the
heart rate which will in turn decrease your heart's workload because it is overworked and
heart
Failure these drugs end in lol typical ones used in heart failure or metoprolol carbonyl and vis
brawl now typically the way that these beta blockers work they slow down your heart so they
weaken the heart's contraction so in some forms of heart failure especially acute heart failure
that deals with systolic dysfunction you don't initially want to use these beta blockers because
let's think back to the other lecture what is systolic
Ventricular dysfunction systolic that is the squeezing phase of the heart so there is an issue
with this ventricle being able to squeeze that blood out so if we throw if this patient is an
acute systolic dysfunction we throw a beta blocker on them it's going to weaken that heart
contraction even more and we don't want to do that because we have a contraction problem
so it will sometimes the beta blockers will be used in stable systolic dysfunction and a lot of
times
These beta blockers are prescribed with ACE inhibitors or those ARBs in combination now a
lot of times beta blockers are used and despot a diastolic dysfunction heart failure and what
was been tricular diastolic dysfunction that was where remember diastole is the filling phase
of the heart the resting phase and there's an issue with the ventricle maybe it's too stiff and it
doesn't feel properly with all that blood it needs to
Fill with but what a beta blocker can do is slow down that heart rate let that ventricle rest a
little bit longer and feel more with blood so it can squeeze it out because it's squeezing
mechanisms GRA it's just the feeling so sometimes it will be used to treat a ventricular
diastolic dysfunction now side effects of your beta blockers remember this and bradycardia
so before you give a beta blocker check the heart rate make sure they're not too bright of
kardec and it
Can mask hypoglycemic signs and symptoms in diabetics a lot of times a diabetic knows
when their Sugar's low because they may get tachycardic hence you're not going to get
tachycardic with bradycardia with beta blockers because it slows the heart rate down or they
can get sweaty things like that and that masks those symptoms so you need to your diabetics
fat and beta blockers can cause respiratory issues so they're typically not prescribed
especially the
Ones that aren't selected for patients with COPD or asthma because it could cause
bronchoconstriction and whenever the patients take these tell them not to take them with any
type of juices especially grapefruit juice because it can interfere with your body's absorption
of the beta blockers okay next let's look at a for anticoagulants these are not used in every
patient with heart failures so typically it's going to be used in heart failure patients who
A lot of times heart failure and atrial fibrillation go hand-in-hand and you know with afib
those atrium are just quivering blood is pulling in there when blood pools that's not good
because a clot can form can shoot through the heart and we can have an embolism so if
patients in afib with heart failure they may be started on anticoagulant or they have a history
of blood clots or they have an ejection in less than 35% we talk about we talked
About another video what ejection fraction was and this is where your heart is not squeezing
all that blood out properly so contraction isn't good and if it's not squeezing all that blood out
that's normally going in there with systolic dysfunction you're going to have more blood pool
in there so there's a increased chance of developing a clot and shooting it through the heart
okay next V for vaso dilators a lot of times these are prescribed if a patient can't
Tolerate an ACE inhibitor or an arm because it worked by causing dilation and um one drug
which is an arterial dilator is hydralazine and it's a lot of time sometimes prescribed with a
nitrite called ice or dill and that is a venous die later hydralazine is a specific drug that acts
specifically on your arteries and I so deal is what acts on your vein so what happens is that
you get dilation going on of those arteries and veins what how does this work how does it
Benefit the heart it decreases blood and fluid going back to the heart because of a card is
already overloaded in heart failure with all this blood and all this food so we got all this nice
donation going on I know will decrease the amount of fluid that's going back and the
workload that your heart has to undergo however side effects with this are hypotension
because anytime you have dilation going on the patient is at risk for hypertension so you want
to measure
That blood pressure make sure it's good before you get it and they're at risk for orthostatic
hypotension so say your patients on these medications they're laying in bed they need to get
up to go to the bathroom you want to get them up slowly and gradually because they can get
dizzy they can pass out and fall so you want to watch safety issues with that next d4 digoxin
how does digoxin work on the body I would remember this for sure okay it has
A positive inotropic mechanism which means that it has that the heart has an increased ability
to humph stronger however it has a negative chrono trophic mechanism that allows it to beat
slower so it's a win-win it beats slower but it pumps more efficiently so this allows the heart
to rest and pump more blood which is great if you've had less than tricular systolic
dysfunction which is what this drug is sometimes you sin however it's
Not uses first-line treatment for heart failure and it's going to be used alongside with your
ACE inhibitors or your diuretics because digoxin can be a nasty drug it has toxicity issues
and if a patient and has a low potassium level goes into hypokalemia chassie level less than
3.5 they can go into digoxin toxicity so with this drug you want to monitor the drug levels
and I would remember this a normal digoxin level is 0.5 to 2 nanograms per milliliter this
Is where you want that patient to hang out anything higher than 2 is bad digoxin toxicity in
signs and symptoms of ditch talks is City classic I have seen this this does happen and they'll
have nausea and vomiting and they'll report some vision changes they may all of a sudden
start seeing some yellowish green halos they can be braids of Kartik as well and what would
happen you notify the physician immediately don't give another dose of digoxin and the
Physician will probably order the antidote for digoxin which is digibind very easy to
remember it tells you what it is digibind eigi be IND matches digoxin that is the antidote for
that and whenever you are giving the dachshund as a nurse you always want to check that
apical pulse and make sure it's greater than 60 beats per minute before giving the dose okay
so that is a review the part to review of heart failure be sure to go to my website
Register nurse orient calm and take that free quiz and thank you so much for watching and
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