NC of Pt. with Heart Failure

Heart failure (HF) is a clinical syndrome that affects perfusion.

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With right-sided HF, blood first backs up from the left ventricle into the left atrium. Then it backs up into the four pulmonary veins and lungs. This increases pulmonary pressure, causing fluid to move into the interstitium and then into the alveoli.

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When the left ventricle fails, it does not empty normally. There is a backward buildup of blood in the systemic blood vessels. With the blood backed up from the right ventricle, right atrial and systemic venous blood volume increases.

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Symptoms of chronic HF include fatigue and weakness, dyspnea, cough, crackles and wheezing, tachycardia, chest pain, and edema.

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Treatment of HF focuses on (1) identifying and correcting the underlying cause, (2) increasing the strength of the heart’s contraction, (3) maintaining optimal water and sodium balance, and (4) decreasing the heart’s workload.

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The nurse is providing patient education. The patient asks the nurse what heart failure is. Which of the following is the nurse’s best response?

• “The heart pumps too much blood into the pulmonary veins.”

• “The heart is unable to pump enough blood for the body’s oxygen needs.”

• “Heart failure is a buildup of blood in the aorta from the heart’s left ventricle.”

• “With a failing heart, the heart stops beating, so blood is not pumped out.”

The nurse is to administer bumetanide (Bumex) to a patient but first reviews laboratory results. Which of these results requires action by the nurse?

• Potassium 3.0 meq/dL

• Sodium 135 meq/dL

• International normalized ratio 0.8

• Partial thromboplastin time 36 seconds

A patient who has been treated for heart failure is being prescribed 20 mg furosemide (Lasix) daily upon discharge from the hospital. Which of the following statements by the patient would indicate to the nurse the need for further teaching for this medication? Select all that apply.

• “I will take the Lasix in the morning.”

• “I will take the Lasix at bedtime.”

• “I will drink lots of fluids with the Lasix.”

• “I will take it with each meal.”

• “I will eat more bananas.”

The nurse is caring for a patient receiving bumetanide (Bumex) to reduce preload for heart failure. While collecting data, the nurse sees the patient has less ankle edema and jugular vein distention than earlier. The next dose of bumetanide is scheduled in 1 hour. Which of the following actions should the nurse take?

• Notify the physician.

• Hold the bumetanide.

• Give the bumetanide as scheduled.

• Give the bumetanide early.

The nurse is reinforcing teaching for a patient with chronic heart failure. Which of the following weight assessments should the nurse teach the patient to perform to monitor fluid status at home?

• Weigh daily.

• Weigh weekly.

• Weigh biweekly.

• Weigh monthly.