Heart Failure & Digoxin Flashcards
The following flashcards are going to be based on the simple nursing video
What is heart failure?
the heart failures to pump blood forward, so heavy fluid pumps back into the lung or the rest of the body
What are the two forms of heart failure?
Left and right sided
what is a great way to remember what left sided heart failure is?
what is a great way to remember what right sided is?
left sided- fluid goes into Lungs (pulmonary edema)
Right sided- Rocks the body with Fluid ( peripheral edema )
any form of weight gain in a patient who has heart failure is considered to be water gain from that fluid retatining.
How many pounds in a day and how many pounds in a week is considered extremely bad for our patient?
3 pounds in a day
5 pounds in a week
what are some right-sided heart failure symptoms?
peripheral edema
JVD (big neck veins)
ascites
hepatomegaly
splenomegaly
what are some left-sided heart failure symptoms?
crackles
Frothy pink sputum - pulmonary edema
Dyspnea
orthopnea - shortness of breath while laying flight
between left sided and right sided heart failure, which would you say is worse to have and why?
left sided because it directly impacts our ABC’s, or to be more specific, our lungs
Simple nursing provides a great and in depth explanation on keywords that we should look out for when talking about a patient with heart failure.
key words like
new,sudden,worsening, rapid
pink frothy, crackles, edema
all of these things can indicate what?
a priority patient that needs to be quickly treated
The number one form of treatment to aid a patient in heart failure is what?
diuretics - furosemide and bumetanide
What is the anagram that simple nursing provides on the immediate action to do when a patient with heart failure comes into the hospital for?
Hope
what does HOPE anagram stand for when It comes to the immediate interventions for a patient in heart failure ?
h - head of the bed at 45+, semi or high flowers
o - oxygen
p - push furosemide and morphine
e - end sodium and fluids
( sodium swells, NPO, Stop IV fluids )
Common nclex questions
1. how does the nurse know that the treatment is successful for a patient with heart failure?
- why would the nurse question the doctors order regarding administering fluids?
- why do you want to reassess a patient who is being transferred over to another unit? in this case talk about a heart failure patient.
- what does sodium do to the body? can you provide examples on things with high sodium?
- we are going to hear clearer lung sounds, decrease heart rate
- they have heart failure, they are not going to be able to get rid of that fluid, remember the anagram HOPE
- because we want to see if they have any worsening crackles or heart sounds
- sodium causes fluid retention so we want to avoid giving that to our patient. Some examples are package foods, salad dressings, nothing over the counter, cold or flu medicine
What is the function of the veins?
what is the function of the left-side of the heart?
veins pump deoxygenated blood back to the right side of the heart to get more oxygen from the lungs
the left side of the heart pumps that oxygen rich blood out to the body
what is the definition of cardiac output?
oxygen-rich blood OUT to the body
what is the number one risk factor for a patient developing heart failure?
hypertension!
some common others are
- valve dysfunction
- afib
- hypertrophic cm
- restrictive cm
- dilated cm
explain to me the patho a little bit more in depth on how the simple nursing video did it.
so to start off, typically left sided heart failure or in general heart failure starts after a long time having hypertension and all that tension is on the heart, or after a really big attack on the heart, like a myocardial infarction - keep going now
it can be from a MI or Coronary artery disease that patients end up developing heart failure ; so fluids will start to fill up the lungs and start to put pressure on the vein and valves.
This pressure is considered as pulmonary hypertension.
After some time, this can cause pressure on the right side of the heart and now we have right sided heart failure.
Typically right sided heart failure develops from left sided heart failure
what is another commonly used name to describe right sided heart failure?
cor pulmonale
right sided heart failure is typically caused by left sided, however the simple nursing video provides other examples on how it can be. what are those examples ?
years of smoking - COPD
obstructive sleep apnea
ironically we understand the when having heart failure, we are going to have less cardiac output, which in return means less oxygen out to the body. What does the kidneys have to say about this? think about how if anything is down, the first thing that its going to do is the kidneys will try to compensate by doing what?
so with the little cardiac output coming, meaning the kidneys are not being perfused well enough, the kidneys think that its from the fact that we have low blood pressure.
- ironically we have already high blood pressure, so now it’ll increase it even more.
it does this by increasing the sympathetic nervous system to increase the heart rate and constrict the blood vessels
and also by initiating the RAAS system, this helps to help retain the fluids and constrict the blood vessels
RAAS
( renin angiosensin aldosterone system )
what does the aldosterone hormone do?
the anagram is AL
simple nursing calls him MR.L
Adds sodium and water into the body
Lets potassium out of the body and into the potty
Now why would you want to get rid of Mr.L or aldosterone with medications like startans, ACE and diuretics?
however, what is the biggest downside of this?
because itll get rid of the sodium and water that is being retained in our body
now we ar going to be retaining too much potassium in our body
simple nursing provides a great way to remember that these drugs, like the startans, ace inhibitors and potassium sparing diureitcs will do what and we should be careful when we are trying to treat that aldosterone?
retain potassium!
what is the diagnostic test that helps confirm heart failure?
gold standard ^
what are some other test?
BNP
b-type natriuretic peptides
echocardiography
ejection fraction
what does the BNP typically tell us when seeing the numbers range associated with it
examples
100 or less is - normal
300 or more is - mild
600 or more is - moderate
____or more is - severe
BNP, depending on the severity tells us how bad our ventricles are. bnp think of the BULGING VENTRICLES
900+ or more is severe heart failure
what is a normal ejection fraction?
what % is bad?
55-70% is normal
40% or less is BAD
we can also do something called hemodynamic monitoring, or another term is the swan ganz cath, PAC, these guys do what?
whats the normal range for the measurement?
they measure central venous pressure (CVP)
2-8
anything over 8 is not great
what are the two ways we help treat our patient who has heart failure?
life style changes and medicine ( drugs )
what is the anagram we use to help patients remember about heart failure and life style changes ?
DR. BEDSS
what does Dr.Bedss stand for when regarding life style changes to help a patient with heart failure to remember and apply?
D - Diet low in sodium & fluid (2g/2L a day or less )
( no fried foods, always use GRILL, no canned or package )
R - risk for falls ( orthostatic hypotension )
( slow position changes )
B - BP and BNP
( should not be increasing )
E - elevate legs with pillows, high fowles
D - daily weight (3lb/1 day or 5lb/week)
S - sex ( 2 flights of stairs without SOB )
S - stocking ( decrease blood pooling, remove daily )
remember some over the counter medications contain lots of sodium for these patients. what are the 4 medications that we tell patients with heart failure to avoid?
the anaram is CAAN like canned foods with lots of salt!
C- cold and fluid medications
A - acetaminophen
A - Antacids
N - NSAIDS
( ASA, Ibuprofen, Naproxen )
patient with heart failure who is constipated! what would the nurse recommended? select all that apply?
- walking
- increase fiber
- stool softerners
- drink extra water
1,2,3
which foods item should the heart failure patient eat ? select all that apply
- chips
- fruits
- veggies
- grilled chicken and fries
- canned beans
- bread
2,3,6
if it was just grilled chicken, it would have been fine, but remember no fries!
a client with chronic heart failure took cold medicine for her fluid. She presents with new productive cough with pink frothy sputum and worsening crackles. Which action should the nurse take first?
- assess the lungs
- give bumetanide IV push
- notify the HCP
- Clock out for lunch
- give bumetanide IV push
what is the long anagram to help remember all the medications we use for patients with heart failure, its a 6 letter anagram
ABC DDD
what does ABC DDD stand for?
tell me what they all do to the body
ACE & ARBS ( prill and sartan ) - lowers bp
Beta blockers ( lol ) - lowers hr and bp
Caclium channel blockers (pine) - lowers hr and bp
Digoxin - lowers hr
dilators ( vasodilates )
diuretics ( ide) - lowers bp
ace,arbs, beta blockers, calcium channel blockes, dilators and diuretics all do what that digoxin doesn’t do?
so that’s why we teach patients what?
lowers the bp, orthostatic hypotension
slow position change
trick question
do we give ace and arb medications when the patients heart is below 60? and why or why not?
yes, because neither of these medications lower the heart rate
there is an anagram to help remember the signs and symptoms of a patient who is taking an ACE inhibitor. what is it? (4)
A - avoid pregnant
A - angioedema
C - cough
E- elevated potassium
we teach patients who are on ACE and Sartan medications to avoid food that are rich in potassium, can you give some examples of that?
Banana
orange
kidney beans
kale
swiss chard
potato
avocado
dried apricot
collard green
what are some signs of a patient who is having hyperkalemia?
muscle spasms
heart problems - like Peak T waves or ST elevation
what is the first action by the nurse if we think or we see that potassium is too high on a patient ??
place patient on a cardiac monitor
what is normal potassium range?
3.5-5.0
what is the function of beta blockers?
lowers the heart rate in order to decrease blood pressure
what do beta blockers end in?
lol
beta blockers provides us the 3 negative
neg chronotopic
neg inotropic
neg dromotropic
what do these 3 do ?^
- lowers heart rate ( resistance )
- less force of the heart to pump ( workload )
- less beats that heart does ( cardiac output )
what are the 4’bs of beta blockers of side effects?
bradycardia ( hold hr less than 60 or less than 100 systolic )
bronchospams
bad for heart failure patient
( new edema, rapid weight gain )
Blood sugar masking ( hypoglycemia )
what two patients’ conditions do we not give beta blockers?
COPD, Asthma
what is the function of calcium channel blockers?
what does it end with?
lowers heart rate and blood pressure
pine
whats the anagram to help remember for a patient who is taking calcium channel blockers for their side effects? (3 letter)
C - count hr and bp
C - change position slowly
B - bad headache
what is the function of digoxin?
DIGs for a deep contractility, which results with less heart rate
what is the signs and symptoms of digoxin toxicity ?
halo lights
nausea and vomiting
dizziness
difficulty reading
digoxin is super toxic towards the kidney, and patients with decrease kidney function. What are the two kidney labs that we take?
creatinine and BUN
what is normal creatinine lab?
0.6-1.2
over 1.3 no pee pee
do we give patients digoxin if there heart rate is lower than 60?
no!!
why do we give dilators to patients with heart failure?
simply to decrease blood pressure, dilate vessel and decrease vascular resistance, in enhance better cardiac output
what can we not give to patients who are taking nitrates? or vasodilators?
NO VIAGRA !! - no afil
what are the 3 H’s of signs and symptoms to remember when it comes to taking nitroglycerin?
Headache
hypotension
hot flushing “facial redness”
what is the function of diuretics?
drain fluid out by urinating
what do we need to watch out about potassium-wasting diuretics?
potassium wasting, so low potassium
what do we need to watch out about potassium-sparing diuretics?
potassium sparing, so high potassium
what does licorice do?
licorice lowers potassium
when do we take diuretics? morning or night?
what type of movement should the patient do ?
do you take daily weights?
what type of diet?
sunscreen needed?
morning
slow position changing
yes
low sodium diet
yes
if furosemide is given too fast. what can happen? (2)
what if you’re giving it for too long? like periods of it (2)
ototoxic
hypotension
nephrotoxic
hypokalemia
the following is from the nclex book
when a patient has heart failure, what type of activity should we encourage?
activity with balances of rest
- avoid isometric activities
when having digoxin toxicity, what is the first thing to happen?
the gi or the visual changes?
gi - so nausea and vomiting comes first
what is the therapeutic range for digoxin?
0.5-2.0
who has a higher risk of developing digoxin toxicity?
hypokalemia
hypercalcemia
hypomagnesemia
hypothyroidism
if the pulse is lower than 60, before giving the medication what should the nurse to do properly assess the situation?
count the apical pulse for a full minute
at the 5th midclavicular intracostal space
what is the antidote to digoxin?
digoxin immune fab
