ATI Med-Surg Study Guide 2021

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 = 2 | P a g e  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