Medical-Surgical Nursing
Heart Failure Care
Overview
Heart Failure is a clinical syndrome resulting from the heart's inability to pump sufficient blood to meet metabolic needs. It results in decreased cardiac output and increased venous pressure. Nursing management focuses on improving oxygenation, reducing fluid volume, and monitoring hemodynamic stability.
Key nursing concepts
- Left-sided heart failure causes pulmonary edema and respiratory distress.
- Right-sided heart failure results in systemic venous congestion and peripheral edema.
- Systolic failure is a pumping problem; diastolic failure is a filling problem.
- Compensatory mechanisms include the RAAS system and sympathetic nervous system activation.
- BNP is secreted by the ventricles in response to increased pressure.
- ACE inhibitors are used to decrease afterload and prevent cardiac remodeling.
Important nursing considerations
- Auscultate for crackles starting at the lung bases.
- Monitor for jugular venous distention (JVD) at a 45-degree angle.
- Assess for pitting edema in dependent extremities.
- Check serum digoxin levels if the patient is on digitalis therapy.
- Maintain the patient in High-Fowler's position to ease breathing.
- Monitor for orthostatic hypotension when initiating ACE inhibitors or diuretics.
Patient teaching
- Instruct the patient to adhere to a low-sodium diet (usually 2g per day).
- Teach the patient to take their diuretic in the morning to prevent nocturia.
- Explain the importance of balancing activity with frequent rest periods.
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