1. Heart Failure Amber Achman, Brittani Allen, & Nicholas Gruber
Saint Cloud State University Nursing Program

2. Learning Objectives
Staff will recognize the difference between right and left sided heart failure, various treatment methods, and signs/symptoms patients should monitor.
Staff will be able, through the information presented, to tailor their patient teaching regarding CHF to the environment the patient will be returning to such as home versus a nursing home.
Staff will understand how to perform effective discharge teaching using the Teach-Back method.

3. What is Heart Failure?
It describes the heart’s inability to pump blood throughout the body effectively
Decreased perfusion of oxygen and nutrients

4. Causes of HF HTN Valvular disease MI Pulmonary HTN CAD
Heart failure is caused by systemic hypertension in 75% of cases.
About one third of clients experiencing myocardial infarction also develop heart failure.
Structural heart changes, such as valvular dysfunction, cause pressure or volume overload on the heart.

5. Left and Right sided HF Possible for one side to fail by itself
Most HF begins with left and progresses to failure of both ventricles
Left side- decreased EF (<50%)
Blood accumulates in pulmonary circulation
Right side- R ventricle unable to completely empty
Increased volume and pressure in systemic veins
-Normal EF=50-70%
-Left sided- EF drops d/t decreased contractility (systolic) or EF remains near normal and inadequate filling occurs during diastole so not enough blood being pumped
-R side results in venous congestion and peripheral edema

6. Symptoms of L Ventricular Failure
Weakness
Fatigue
Dizziness
Confusion
Pulmonary congestion
Dyspnea on exertion (DOE)
Orthopnea
Paroxysmal nocturnal dyspnea (PND)
Oliguria
Renal Failure
Respiratory Signs & Symptoms manifest

7. Symptoms of R Ventricular Failure
Jugular distention
Enlarged liver and spleen
Anorexia and nausea
Dependent edema (legs and sacrum)
Distended abdomen
Swollen hands and fingers
Polyuria at night
Weight gain
Increased BP

8. Assessment Findings in HF
S₃ Gallop
Crackles and Wheezes
every breath and remain after cough
Weight gain
Most accurate monitor
of fluid status
Labs:
BNP increases in response to decreased CO
Renal – Cr. And BUN increase due to inadequate perfusion
ABG’s out of range
Besides the s&sx on the earlier slides may find these w/ HF

9. Medications General Guidelines NEVER skip a dose
NEVER take a medication without the Dr.’s permission
NEVER change the dosage of a medication
without the Dr.’s permission

10. ACE Inhibitors What They Do: Vasodilators
Cause the blood vessels to expand, lowering blood pressure and reducing the heart's workload
RAAS- cascade that occurs in response to low BP. Increases vascular volume by retaining Na+ and therefore fluids. = grreater stress on heart muscle

11. Diuretics; Thiazide, Loop, K+ Sparing
What They Do:
Causes the kidneys to remove more Na & H2O from the bloodstream
Decreases the heart's workload, due to less fluid needing to be pumped throughout the body
Watch labs for lyte changes

12. Beta Blockers What They Do:
Block specific receptors ("beta receptors") on the heart cells
This reduces the effects of chemical messengers that increase heart rate
Allows the heart to maintain a slower rate and lowers blood pressure
Increase contractility and CO

13. Other Heart Failure Meds
Vasodilators
Digitalis Preparations
Ca+ Channel Blockers
Angiotension II Receptor Blockers
Blood Thinners
Cholesterol Lowering Medications

14. Diet & Nutrition Why Low Sodium is a Good Thing
Sodium makes the body hold on to extra fluid
The heart has to work harder to pump the extra fluid
Increased weight
Increase in symptoms such as
swelling and SOB
Increased BP

15. Tips for A Low Sodium Diet
Remove salt shaker & use a salt substitute
Drain & rinse canned foods before eating them
Substitute fresh fruit & veggies instead of canned or frozen
Avoid convenience foods
Look at labels for “low” or “reduced” sodium…but aware of serving size
Know how much sodium is allowed in your diet & what that means
3 grams of salt = 1 teaspoon

16. Activity & Rest 30 minutes of activity 5 days a week Rest is important
Talk to Dr. about how much activity is safe for you
Vary activity to keep it interesting
Rest is important
Allows heart to rest and pump easier
Make a time every day to rest such as after lunch

17. What to Monitor Weight Fluid Intake (if recommended by Dr.) Symptoms
Same time every day
In the morning
Same type of clothes, NO shoes
SAME SCALE
Fluid Intake (if recommended by Dr.)
Symptoms
Increased SOB
Increased fatigue
Persistent cough
Shoes fitting tight…increase in edema

18. Effective Discharge Teaching
Use words your patient will understand
Caregivers and family members should be present and participate
Use different methods to teach (reading material, videos, demonstrations, role play)
Use the teach-back method
Asking the patient to “teach-back” the material that they were just taught in order to ensure understanding of the material
Used by several health care facilities. Teach-back is shown to reduce readmissions

19. Teach-Back Method
Ask what the patient already knows about the illness. This is usually done during the admission process.
This will help identify the learning needs of the patient based on their perception of the illness.
2. Clarify the illness and what symptoms brought them in the hospital.
This specifies the issues that are clearly not understood by the patient. These are issues that need to be emphasized during the discharge teaching.
3. Teach the learning material in simple the patient can understand. Each patient has different learning needs.
Use the video, reading material, and hands-on demonstrations to re-enforce the teachings
4. Ask the patient to “teach-back” the main parts of what they just learned.
Example: Ask the patient to show you how many milligrams of Lasix they will need if it is 8am in the morning as compared to 8pm at night based on their prescription.

20. Teach-Back Method
5. Re-teach the patient any material that seemed misunderstood or unclear.
A patient may state that it is ok if they can’t fit in their shoes and are slightly short of breath because they only gained 1.5lbs since yesterday. Re-teach them that it’s not all or nothing. There are several symptoms to be concerned about.
6. Again, ask the patient to teach you the new material. Repeat steps as needed.
7. Document the material taught and the patient response.

21. Helpful Hints
Use the teach-back method during medication administration to help patients learn about new meds.
Do not ask the patient “Do you understand?” This puts too much pressure on the patient and they will often say they understand, but they do not.
Assume that if the patient does not understand, you were not clear enough. Use another approach.
Encourage questions.
I know time is an issue, but it is important not to appear rushed, annoyed, or bored during these efforts—your affect must agree with your words.

22. For Further Information
Minnesota Health Literacy Partnership
Agency for Health Research & Improvement
Mosby’s Nurse Reference on CHI website

23. References http://www.ahrq.gov/
Joanna Briggs Institute
Ignatavicius, D., & Worman, L. (2006). Medical-surgical nursing: Critical thinking for collaborative care (5th ed.). SaintLouis, MO: Elsevier.