Med-Surg Study Guide 2021
Heart Failure (HF) (10)
S/S left HF and S/S right HF
Signs & Symptoms
Left sided failure (blood backing up in lungs) Right sided failure (blood backing
o up Venus system = edema)
*Dyspnea, orthopnea (shortness of breath while *Jugular vein distention
...
1 | p a g e med surg study guide 2021 heart failure hf 10 ss left hf and ss right hf signs amp symptoms left sided failure blood backing up in lungs right sided failure blood backing
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Med-Surg Study Guide 2021
Heart Failure (HF) (10)
S/S left HF and S/S right HF
Signs & Symptoms
Left sided failure (blood backing up in lungs) Right sided failure (blood backing
o up Venus system = edema)
*Dyspnea, orthopnea (shortness of breath while *Jugular vein distention
Lying down), nocturnal dyspnea *Ascending dependent edema (legs,
*Fatigue ankles, sacrum)
*Displaced apical pulse (hypertrophy) *Abdominal distention, ascites
*S3 heart sound (gallop) *Fatigue, weakness
*Pulmonary congestions (dyspnea, cough, *Nausea and anorexia
Bibasilar crackles) *Polyuria at rest (nocturnal)
*Frothy sputum (can be blood-tinged) *Liver enlargement (hepatomegaly)
*Altered mental status and tenderness
*Manifestations of organ failure, such as *Weight Gain
Oliguria (decrease in urine output)
Treatment
o Diuretics
o Ace inhibitors = Valsartan
o ARB’s
o CCB;s
o Digoxin = strengthens heart
o Beta Blockers
o Vasodilators = Nitro
o Warfarin, Plavix, blood thinner
How to monitor HF – patient education
o Daily weight
o Diet = low sodium
o Smoking cessation
o Position: high fowlers
o Monitor VS
o Monitor lab work
o Heart rate = below 60 do not administer digitalis = listen to apical for a full
minute
Nursing actions/interactions associated with monitoring HF
o AROM
o Fluid restriction
o Low sodium diet
o Weights
o I&O
o Medications =
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, diuretics
digitalis = increase myocardial contraction which slows conduction
normal 0.5 -2
Ace inhibitors = biggest side effects = cough
Dobutamine for severe heart failure
Digoxin = decrease in potassium
Toxic s/s = halos, vision changes, arrythmias, N/V
Oxygen above 92%
o Monitor labs
o Administer medications
Patient Education
o Low sodium diet
o Emotional support
o Effective breathing techniques
o Daily weight at same time everyday notify dr. if more than 2lbs in a day or 5lb
in a week.
o Report swelling of feet or ankles
o Report shortness of breath
o Common adverse effects of medication
Key assessments with meds associated with HF
o Respiratory assessment
o Auscultation
o Urinary output
o Weight
o I&O
o Blood Pressure
o Ascites
Patient education on meds used to treat HF
o Lisinopril
Hypotension
Increased serum potassium
Worsening renal function
Cough
o Losartan
Hypotension
Increased serum potassium
Worsening renal function
o Hydralazine
Hypotension
o Metoprolol
Decreased heart rate
Hypotension
Dizziness
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, Fatigue
o Diuretics
Electrolyte imbalances
Renal dysfunction
Decreased
BP
I&O
Daily weights
Hypokalemia
Hypernatremia
o Spironolactone
Hyperkalemia
Hyponatremia
o Digoxin
Bradycardia
Toxicity
Hemophilia (6)
Both types of hemophilia are inherited as X linked traits so mostly men are
affected
o Hemophilia A (factor VIII deficiency) measured by aPTT (intrinsic Pathway)
o Hemophilia B (Christmas Disease, factor IX deficiency) measured by aPTT
(intrinsic Pathway)
Treatment
o Replacement of the missing factor VIII or IX
o Fresh frozen plasma
o Recumbent (manmade) factor treatment
o aPTT = 30 - 35
Nursing actions/interventions when caring for hemophiliac
o Sign/Symptoms
Lethargy
Joint pain
o Prevent bleeding
o Safety precautions (fall precautions)
o Avoid IM injections
o Avoid meds that may encourage bleeding
o Monitor for internal bleeding
Coffee ground emesis
Cola colored urine
Tarry stools
Patient education on living with hemophiliac
o Can’t take aspirin/NSaids
o Before dentist replace factors
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