Congestive Heart Failure (CHF) for Nursing & NCLEX

hey guys nurse Mike here and welcome to simple nursing comm now before we get today's lecture started please remember to access your free quiz and preview our cool nifty new study guides not here on YouTube click the link right up here at any time during this video all right guys let's begin jumpin up heart failure guys so make this super simple heart failure think H F for heart failure H F for heavy fluid since the heart fails to pump blood forward and now heavy fluid backs up into the lung and our body now this is super deadly since the patient ends up drowning in their own fluid now for right-sided heart failure think are four rocks the body with fluid also called peripheral edema and L for left-sided heart failure think L four lungs also called pulmonary edema now the problem here is the fluid guys so any weight gain we have to think water game and on the NCLEX the key word here over three pounds in one day or five pounds in seven days is very bad write that down so words like new sudden rapid or worsening usually indicates a priority patient so guys if the body gets Rockler fluid we usually see edema or pitting edema basically fluid buildup in the extremities usually the lower legs JBD or jugular vein distension and even abdominal growth from that fluid buildup now this is called ascites and even hepatomegaly or splenomegaly now left-sided heart failure l for lungs also called pulmonary edema now this one is more serious since it always affects our ABCs the airway and breathing so we always hear crackles or what's called Rawls or rails which is fluid buildup in the lungs now guys this is not rhonchi or wheezes crackles sound a lot like this [Music] now two other keywords for left-sided heart failure guys write this down frothy pink or blood tin sputum always a classic sign of pulmonary edema and the to piñas so think P for pulmonary like dyspnea which is difficulty breathing or ortho Pina shortness of breath while lying flat now a little side note here guys typically we have no chest pain with heart failure unless the coronary arteries are clogged but usually the NCLEX couples that with heart attack and not heart failure here now speaking of worsening patients guys the NCLEX commonly gives those worst case scenarios so key words write these down sudden new worsening or even rapid guys and that new pink frothy sputum or worsening crackles and even rapid weight gain technically as rapid water gain or any even new peripheral edema guys this is a huge emergency since the lungs are fluid filled which compromises the ABCs so write this down the number one treatment is always I'd ending drugs like furosemide and this be one guys both end and I'd so think the body is dried so any patient with worsening heart failure we use the acronym hope for art NCLEX key terms H for head of the bed that's 40 to 90 degrees basically we raise the head of the bed this is called semi Fowler's or high fellers and even orthopedic position o is for oxygen P is for we push furosemide and even morphine which also decreases the workload on the heart now he is for ending all sodium and fluids aka sodium and fluid restriction so no drinking extra fluids and guys were stopping all IV fluids now for common NCLEX questions for worsening heart failure guys be sure to know these number one how does the nurse know if the treatment is successful guys we're gonna hear clearer lung sounds with decreased heart rate huge NCLEX key words here here's another one guys number two always question any doctor order that wants to give fluids guys even maintenance IV fluids huge nono for that worsening heart number three when you're transferring a heart failure patient to another unit guys we're always reassessing those heart and lung sounds guys reassessed any patient that's transferred to another floor in this case worsening crackles in the lungs always those ABCs lastly guys number four remember sodium swells the body so nothing from a package that means no chips no packaged foods not even salad dressings or sauces or meats and cheeses and here's another key word here guys nothing over the counter so no cold or flu medicine not even those antacid tums or even a Siddha Mehta fitting that tylenol but guys we cover more that in the treatment section now for the path oh and causes usually not a big focus on the NCLEX but it does show up a lot on nursing school exam this will help understand the why behind the drugs like ACE inhibitors and diuretics which is huge on the NCLEX so let's understand how the body normally functions really quick as you know the veins vacuum deoxygenated blood back to the right side of the heart to get more oxygen from the lungs and the left side of the heart pumps that oxygen-rich blood out to the body this is what's called cardiac output meaning oxygen-rich blood out to the body now the number one risk factor is always hypertension that high high blood pressure or that high tension on the hearts but usually heart failure results from anything that causes a dysfunctional pump and this can cause fluid to back up like in valvular malfunctions or even dysrhythmias like atrial fibrillation and even all the cardiomyopathies guys whatever the cause the heart fails to pump blood forward effectively and that's when things start really messing up now more specifically for the NCLEX left-sided heart failure develops from damage to the myocardium heart muscle making the heart weak causing a weak or pump usually from M eyes guys where the heart muscle dies and now can't contract at all so we commonly get a heart failure after a big mi heart attack or in a scheme ik heart disease before a heart attack like in C ad or ACS where plaque narrows the oxygen tubes or the coronary arteries resulting in the left ventricle sort of suffocating from that lack of oxygen which again results any weaker pump but in this case causing sighs Dalek heart failure meaning a squeeze failure basically the heart fails to squeeze blood forward so fluid fills the lungs causing pressure and this is called pulmonary hypertension which end result the right side has trouble pumping blood forward so left-sided heart failure commonly causes right-sided heart failure aka cor pulmonale or pulmonary heart disease but right-sided heart failure can also be caused by diseases of the lungs like COPD and even years of smoking or obstructive sleep apnea guys write that one down exams love to put that under the causes of right-sided heart failure now whatever the cause the heart fails to pump blood forward so now we have less cardiac output meaning less oxygen out to the body as a result the kidneys get less blood flow and falsely think the body has low blood pressure or basically low blood volume so it mistakenly increases the already high blood volume by both stimulating the sympathetic nervous system to increase the heart rate and constrict the blood vessels and also by initiating the rasz system which retains fluid by locking the kidneys and constricting the blood vessels so now we have two problems here an already weak pump with increasingly high blood volume leading to higher pressure oh snap now a little side note that will be on the NCLEX one of the main culprits in R as the renin-angiotensin-aldosterone system is mr. aldosterone we call him alpha short since he adds sodium and water to the body which increases blood pressure and he lets potassium out of the body and into the potty so we end up giving drugs that either block or cut the communication lines to aldosterone so drugs like prills Sartre ends and even act tone ending drugs without allen the mix we don't add the water to the body so we end up losing it in the potty but now we hold on to too much potassium so the big NCLEX tip here guys write this down all these drugs increase potassium leading to high potassium / 5.0 so ACE inhibitors andin prill like lisinopril guys think p for potassium sparing and also s is that spare potassium so basically sergeant like losartan and ARBs and s fort spironolactone think s for spares the potassium that's all we're mentioning right now we're gonna save the rest for the farm section now as far as diagnostic labs for the NCLEX and nursing exams the only heart failure lab that you have to know is BNP so write that down BNP also called B type or brain net ridic peptides guys we think big bulging ventricles so a hundred and less is normal over three hundred is mild and over six hundred moderate big key word here nine hundred and more is considered very severe so the ventricle starts secreting it when they're being stretched out or basically bulging out under all that heavy pressure we could also do an echocardiogram which measures both the size of the left ventricle and dejection fraction for the amount of blood being ejected from the left ventricle in one pump so 55 to 70 percent is normal but anything less than 40 percent big NCLEX key term usually indicates heart failure now lastly for severe cases hemodynamic monitoring aka the Swans ganz cath also called P AC pulmonary artery catheter these guys measure CVP central venous pressure now normally it's two to eight so just say anything over eight is not great so if you get a question about a patient on hemodynamic monitoring guys let's just say the CVP is over twenty-two now that's way over eight the patient's basically drowning in their own fluids so we give higher etics to drain that fluid from the body into the body so remember furosemide means the body is dried always an NCLEX favorite now as far as treatments our number one goal in heart failure is to drain that heavy fluid so we do that in two main ways with both drugs and lifestyle change so let's start with lifestyle change we use the acronym dr. beds so d is for diet that low sodium and low fluid big key words right there for the clicks remember sodium swells so two liters of fluid or about eight cups and two grams of salt or less per day this means no fried foods like fried chicken or even french fries and guys we're choosing grilled chicken instead always an NCLEX key term on those select all that apply questions no canned foods anything from a package is a big no-no like chips salad dressings meats cheeses and even canned vegetables or even canned beans and speaking of can we avoid all OTC or over-the-counter medications they contain lots of sodium so a big no-no see for cold and flu meds a four acetaminophen basically tylenol a for anti acids like tums and even NSAIDs like aspirin and ibuprofen or naproxen now some physicians will allow aspirin but guys on the NCLEX it contains sodium it's an over-the-counter drug so be careful now patients are turned to the hospital over and over again because they can't avoid salt and end up in worsening heart failure so guys educate the patients sodium swells avoid the sodium our four risk for Falls or orthostatic hypotension guys NCLEX key-term here slow position changes when getting out of bed B is for blood pressure and BMP guys these numbers should not be increasing so if they are please notify the doctor or HCP immediately B is for elevate the head of the bed and legs with pillows guys we're talking high fowlers to help the patient breathe here D is for daily weights now this is probably the biggest NCLEX key term here guys daily weights not weekly be careful the NCLEX will try and trick you since weight gain means water gain so anything over two to three pounds in one day huge key numbers here or five pounds in seven days guys it's very bad we have to call the doctor or HCP s is for sex and yes the NCLEX talks about sex when is it safe so the key word here guys is only after they can climb two flights of stairs without shortness of breath and lastly the last S is for stockings or Ted hoes to decrease that blood pulling so guys remember remove daily and apply before getting out of bed oh and never massage the calves and CHF patients big NCLEX tip now three common exam questions from this section and guys trust me they will try and trick you so again think H F in heart failure is H F for heavy fluid and remember sodium swells the body so we avoid salt and we avoid water so question number one a patient in heart failure who is constipated what should or would the nurse recommend so guys walking is good more fibers okay stool softeners that's good guys but no fluid no drinking extra fluid guys you want to avoid the water now the second most common question always comes from the salty foods so which food item should the heart failure patient avoid select all that apply we're looking for no packaged items so no chips but fruits and veggies are okay now grilled is good but not fries nothing that is deep-fried how about canned beans well no guys nothing that is canned or from a package not even veggies but white bread is okay one of the most common priority-based questions a client with chronic heart failure - cold medicine for flu so first off no OTC no over-the-counter drugs guys those contain sodium she presents with new productive cough with pink frothy sputum and worsening crackles what action to the nurse take first guys this patient is an extreme heart failure meaning heavy fluid so we have to give I'd any drugs to make that body dry so option number two is our best choice now if you chose option number four to clock out for lunch you bad mmm okay now for everyone's favorite topic wait for it guys doesn't that enough pharmacology always an NCLEX favorite here guys we took over ten thousand NCLEX questions and organized only the most testable stuff here for you so the content you see here is the content you need to pass okay now our main goal here is to drain that fluid and help the heart pump blood forward so pause your screen and write these names down please focus on the ending of the drugs since the NCLEX focuses on this they expect you to know what the drug does and how it can kill or harm the patient which we'll cover right after this now all these drugs drop the blood pressure and take workload off the heart except digoxin aka dig Jackson who digs for a deeper contraction it does not affect the blood pressure at all it only decreases the heart rate and he comes with toxic side effects so we call digoxin the toxin so the big NCLEX tip here is everyone here can cause orthostatic hypotension or low blood pressure and dizziness when standing everyone except died Jackson since it does not affect the blood pressure so we teach and clicks key terms here write this down slow position changes when blood pressure is low we got to go slow big on the NCLEX trust me guys they will try and trick you let's break these down one by one first up a is for ACE inhibitors and ARBs who act to lower the blood pressure only guys not the heart rate big on the NCLEX our first choice is ACE inhibitors that end in pril like lisinopril so we call it a chill pill for the heart we're talking low blood pressure not the heart rates or think prills puts the blood pressure low now our second choice is ARBs the angiotensin receptor blockers which end in Sartain like losartan so thinks are tan like relaxed man or retirement plan lowers the blood pressure not the heart rate so a question for you do we give prills and SART ins if the heart rate is grade of carnac or below 60 well guys yes ace inhibitors and ARBs act to lower the blood pressure only not the heart rate so we only hold for low blood pressure now the mechanism action is quite simple both aces and ARBs either inhibit or block the wrath system which retains fluid or in fancier terms the renin-angiotensin-aldosterone system so aldosterone is blocked from adding that sodium and water in and letting that potassium out so again the big problem here is retaining too much potassium huge side effect now speaking of side effects we just keep it simple so just think a sly can ACE inhibitor a for avoid pregnant patients these two are baby toxic a for angioedema swelling of the face and tongue resulting in a huge airway risk very deadly but guys this only happens with ACE inhibitors so just think prale's puff up the tongue and knots are tens big NCLEX tip now see us for cough but again only prills do that and E is for elevated potassium not vitamin K we're talking potassium / 5.0 so think P and prills puffs the tongue and adds potassium and S is for SART ins Sartain spare the potassium and are prescribed second after aces now we teach patients to avoid potassium rich foods like fruits and veggies specifically green leafy veggies avocados melons and oranges but even salt substitutes and liver now I didn't know the liver won until we did the NCLEX review now a quick NCLEX side note since potassium pumps the muscles early signs of high potassium we're thinking high pumps of the muscles so key word here is muscle spasms so with our ECG we have high pumps with peaked t-waves and st elevations and any potassium imbalance high or low always the first action by the nurse is cardiac monitor huge NCLEX favorite right there so again prills and Sartre ins our aces and ARBs remember the 3 a's a 4 antihypertensive we're talking low blood pressure not heart rate so slow position changes a for avoid pregnant patients not baby safe and the last day is for adds potassium aka hyperkalemia / 5.0 now a little side note before beta blockers kind of big for pharmacology exams something called first dose phenomenon if you hear first dose or newly prescribed drug or the first time taking the drug guys don't leave the patient's bedside always assess for big side effects so in this case a big blood pressure dropped okay next is B for beta blockers which puts the brakes on the heart ending at lol like atenolol so think double owls means double lows L for low heart rate and L for low blood pressure so we always check both heart rate and blood pressure before giving now pharmacology exams love to ask about the three negative tropics so guys beta blockers put the brakes on the heart so negative Chronos means less time negative I know means less force and negative drama tropic means less speed of conduction which results in less beats now these fancy words just means that we get a decrease in resistance workload and cardiac output which makes it bad for our patients in acute or that worsening heart failure so for the mechanism of action and beta blockers just think beta blockers block beta receptors in the sympathetic nervous system just fancy words for blocking beta one for a one heart and also blocking beta two for two lung and since most are non selective or aka noncardiac selective we end up blocking everything so we not only get a slow heart we also get narrowed bronchi and the lungs basically called a bronchospasm so we usually hold this drug for COPD and asthma patients so to help you remember the most dangerous side effects guys write down these four B's here bradycardia and low blood pressure we hold the drug this is always on the NCLEX so any heart rate less than sixty and any blood pressure less than 90 or a hundred sighs Delic guys we don't give the drug and since the drug affects the blood pressure we always teach the patients slow position changes to avoid passing out okay orthostatic hypotension next B is for breathing problems since beta blockers blocked beta 2 in the lungs we get these bronchospasms commonly heard is wheezing so again never give to asthma or COPD patients next be is bad for heart failure patients it can worse and heart failure patients guys and collects keywords here write these down new edema worsening crackles in the lungs rapid weight gain or even new jvd all indicate a new heavy fluid or basically worsening heart failure which is a big priority we always report these keywords always new or worsening findings to the HCP or basically to the doctor our last B is for blood sugar masking in our diabetic patients so sugars below 70 beta blockers commonly hide the signs and symptoms of low sugar that hypoglycemia hiding the cool the shaky the clammy and even hiding that high heart rate so guys we want to monitor our Sugar's closely since low blood sugar means low brain function or basically hypoglycemic alcian channel blockers which calms the hearts dropping both the BP and heart rate commonly ending in D Pines M&M mill so just think D pine declines the blood pressure not the heart rate but zoom in diltiazem it's kind of like Zen yoga relaxed blood pressure and heart rate and a mill in verapamil calm and chill low blood pressure and heart rate so again think calcium channel blockers calms the heart controlling the couple both heart rate and blood pressure yes it lowers them both together so we never give when the blood pressure is low or if the heart rate is low less than 60 now how exactly does it do this well calcium channel blockers block the movement of calcium pretty cool huh this relaxes the vascular smooth muscles which leads to decreased vascular resistance now that's just fancy words for relaxes the blood vessels and takes the strain off the heart so textbook why you got to be so fancy yes of course the you see they're stratified you suppose so just like beta-blockers we get- Cronos which means less time negative I know which means less force and they could have drom oat roping basically less speed of conduction resulting in less beats again these terms may come up on your pharmacology exams but these exact terms never came up directly on our NCLEX review now what will be on the NCLEX are these key nursing considerations so think CCB like a calcium channel blocker always before giving guys we count the heart rate and blood pressure if the BP is less than 90 or a hundred sighs dalek we hold the drug or if the heart rate is 60 or less guys we don't give the drug except for the feta pine he's the only one that declines the blood pressure see for changes positioned slowly just like any drug that affects the blood pressure we want to prevent feigning or that orthostatic hypotension and B is for bad headaches which are typically normal now a big test question when do we hold the drug so the magic numbers again here guys write these down heart rate below 60 and even blood pressure below 90 or a hundred sighs dalek which in fancier terms ma P less than 60 and we avoid big drops so always slow or stop any IV drip that's dropping that blood pressure too quickly kind of like landing a plane guys we don't want to crash we want to slow and easy to send to prevent crashing our patients so for example the NCLEX will give you a patient on an IV for a wrap a mil drip with a heart rate of 48 guys we want to stop the drip any heart rate below 60 or a patient on IV nifedipine or diltiazem with big drops in BP let's just say from 150 over 90 which drops to 120 over 70 guys that's a big drop so we want to slow that trip just like landing a plane big drops can kill the patient so LPNs and lVN's notify the RN and our ends will titrate or basically fix the drip okay our next letter is D for digoxin our cardiac glycoside this guy has nothing to do with blood pressure so we have no orthostatic hypotension and no slow position changes he is our positive inotropic drug that gives a deep contraction or increases contractility so think dig Jackson digs for a deeper contraction usually given to patients inside cell like heart failure or that squeeze heart failure to help with a more forceful contraction and also it decreases the heart rate a k- chrono trophic Cronos meaning time so negative time we get less beats per minute the guy's caution this is very toxic so think digoxin is a toxin the top-three NCLEX questions will always include our memory trick ATP a for checking the apical pulse for a full 60 seconds if the heart rate is less than 60 guys it gets a little risky we don't give the drug and here to help us out with the apical pulse location is mr. Channing Tatum okay guys focus focus the apical pulse is located left side mid clavicular in the fifth intercostal space basically between the ribs you got it okay good now go ahead and go cool off now tea is for toxicity anything over 2.0 is huge early signs include vision changes nausea and vomiting anorexia and even dizziness or lightheadedness guys we want to notify the doctor ASAP huge NCLEX key terms now another key term for vision changes include words like fuzziness or even blurred vision even color changes guys and even key word here difficulty reading now that would really surprised us in our NCLEX review I was like really like vision changes for reading what if you just have problems reading in general hmm tricky tricky not today mr. NCLEX not today no siree now a big test tip and side note about that big ol kidney behind me guys older patients with decreased kidney function are at higher risk for toxicity our dioxin toxin since the kidneys are kind of like our washing machines that wash the blood guys broken kidneys means it can't wash the drug out of the blood so remember we have two kidney labs for our two kidneys both be--when and creatinine but the number one kidney lab is guys write this down creatinine any value over one point three means no PP or basically over one point three means kidney injury huge risk for toxicity for any drugs so guys we monitor our elderly and renal failure patients very closely lastly checking potassium level any low potassium below 3.5 increases the risk for digoxin toxicity now this does not mean that digoxin can cause low potassium like diuretics guys low potassium only increases the risk for digged toxicity now the NCLEX will try and trick you so again digoxin does not waste potassium so no you don't need to eat more green leafy veggies or melons like when taking thiazide or loop diuretics that wastes potassium so guys don't get tricked now to help you a common test question here it is which patient is most at risk for digoxin toxicity guys it's always either a client on potassium wasting diuretics like those ending an IDE like furosemide or thiazide and even kidney failure clients with creatinine's over 1.3 so our next D is for dilators like vasodilators like nitroglycerin commonly given for chest pain but it also works in heart failure patients to lower the blood pressure so remember the O's here think dilators like nitro they open up the blood vessels to decrease the blood pressure by dilating the vessels and decreasing resistance in fancier terms it helps lower preload and afterload which lowers the blood pressure this results with more oxygen out to the body kind of like taking your thumb off of water hose you relieve the pressure and all that tension in the tube is suddenly decreased in the same way wider dilated blood vessels means less constriction and less pressure or low blood pressure now again our famous vasodilator is nitroglycerin so think nitro makes the blood pressure low or gives Oh to to the heart muscle or just think nitro is like a pillow for the heart rested and relaxed decreased blood pressure now the top five names on the NCLEX are nitroglycerin nitroprusside hydralazine here's a tricky one I so so bribed which is so so tricky guys write this down it ends an IDE and sounds so so familiar to furosemide the diuretic so very simply remember the O's a nice social bride means it's a vasodilator similar to nitro guys lots of O's and the last one here is minoxidil now we only saw that one time out of ten thousand NCLEX questions we took so it's not really common on the unclutch now the killer precautions the number one thing that shows up on the NCLEX and nursing tests is no viagra drugs ending in a fill like sildenafil guys it will kill we're talking extremely low blood pressure so a memory trick for a Phil is viagra it a fills a certain male anatomy or a fill will kill and speaking of low blood pressure are two key numbers here we stop nitro if the systolic blood pressure the number on top is below ninety or a hundred or if we see drops by 30 points or more and NCLEX key words like confusion agitation even cold or pale or clammy known as diaphoretic or dizzy guys these are all early signs of low blood pressure that hypotension so we always monitor that blood pressure with nitro now normal side effects are always the three H's usually always present after the very first dose so headaches are hypotension also called our orthostatic hypotension and hot flushing or facial redness now this is not an allergic reaction these are common and normal so teach patients slow position changes to avoid that dizziness and falling again called that orthostatic hypotension and always check the BP before giving this drug now for the top seven NCLEX tips on nitro we're talking patch vs. pill for angina patients guys we cover that in our angina chest pain videos you're watching that here on the membership site you can find it under angina in the mi section okay our last D is for diuretics which diurese fluid or drain the fluid from the body and into the potty this guy is the number one drug we use for acute or worsening heart failure big NCLEX tip so remember the DS diuretics decrease the blood pressure by draining the fluid or diary seing the fluid to dehydrate our heart failure patients with heavy fluid now we have potassium wasting and potassium sparing diuretics potassium wasting ends in I'd like furosemide or hydrochlorothiazide both rhyme with dried but again be careful not ice soso abide that's a nitrate guys the NCLEX will try and trick you so remember the OHS and ISO so make it a vasodilator similar to nitro now loop diuretics like furosemide and torse amide are the first drugs we use in acute or that worsening heart failure so NCLEX keywords like worsening crackles new edema in the legs and even rapid weight gain guys we give IDEs to make the body tried these guys work by blocking the reabsorption of sodium in the kidneys so with less sodium retained we have less swelling retained and our patient is saved now we only get potassium wasters if potassium is normal between 3.5 and 5.0 anything less than 3.5 is a big no-no guys we don't give the drug so we encourage our patients to eat melons bananas green leafy veggies and even liver and a big no-no here we avoid a licorice root which lowers potassium like those found in black licorice candy that's a common select all that apply question so just remember the double ELLs here licorice lowers potassium now potassium sparing diuretics s4 spironolactone just think s4 spares the potassium just like prills and Sartain this spares potassium too but instead of blocking the angiotensin this guy blocks aldosterone directly - let fluid out of the body and into the potty and it ends in tone so think it blocks aldosterone since Verona lactone spares the potassium we teach patients to avoid those potassium rich foods guys so we don't eat those green leafy veggies those Malins avocados and we avoid that salt substitute and again and again any potassium abnormality the first nursing action is to place them on a cardiac monitor always asked on the NCLEX and exams as a priority intervention lastly since potassium pumps the muscles and clicks key words like muscle spasm and even muscle cramps this indicates a potassium problem even words like weakness or paresthesias so with potassium wasters that low or potassium think low pumps in the heart we get flat t-waves and ST depression and also this little weird you wave now a little side note if you have to replace potassium via IV well guys don't kill your patient we never push potassium IV this means instant death we always give it IV bag over an hour or more guys never thirty minutes and not even 45 minutes one hour or more typically four hours and with our sprung a lactone which spares potassium we get high potassium so think high pumps with peaked T waves and even st elevation in severe hyperkalemia now for other killer nursing considerations guys these three show up a lot on NCLEX exams so guys before we give you diuretics always check the BP B for blood pressure you hold the medication for low blood pressure anything less than 100 systolic B for b un and creatinine the kidney labs we always check before giving since it can hurt the kidneys by giving too much or too quickly and again the P for potassium imbalances since P pumps the heart we always put the patients on the cardiac monitor then we watch for muscle spasms or cramps and even weakness and paresthesias big NCLEX tips now finally five general diuretic and clicks tips always on static questions number one take in the morning not at night this med drains fluid so we don't want potty breaks all the time during the night second this med makes patients dizzy so slow position changes to avoid feigning aka that orthostatic hypotension also called postural hypotension third daily weights not weekly but daily always reporting two to three pounds or more remember weight gain usually means water game so maybe we need to increase their dose for is risk for sunburns so just use sunblock and finally low sodium diet since sodium swells so guys again no chips no fried foods like deep fried chicken or even deep fried ice cream definitely no french fries and even no canned foods or packaged foods like cheese wines meats and even fast food and again avoid those over-the-counter meds like can so guys cough and flu meds anti acids like tums as Sinemet afine like tylenol and NSAIDs like ibuprofen and naproxen guys all these contain high amounts of sodium which swells the body now a little side note about furosemide our loop diuretic we already know it's the number one drug for worsening heart failure right but caution if given too fast it can be ototoxic meaning ear pain or ringing in the ears called tinnitus and even hypotension that low blood pressure but guys not not bradycardia never low heart rate and if given too much over the long term it can cause nephrotoxicity meaning kidney toxic with high B UN and high creatinine so always check the two labs to protect those two kidneys and as you know hypokalemia that low potassium below 3.5 for those long term doses not usually affected by fast administration alright guys that wraps it up now don't forget to see our eight question cardiac quiz and test your knowledge in our quiz m'q thanks guys for our full video and new quiz Bank click right up here to access your free trial and please consider subscribing to our youtube channel last but not least a big thanks to our team of experts helping us make these great videos all right guys see you next time [Music]

Channel: Simple Nursing

Views: 1,023,660

Keywords: CHF, Congestive heart failure, heart failure, HF, cardiac failure, HTN, pump failure, cardiac output, preload, afterload, NCLEX, osmosis, RN, Registered Nurse RN, ATI exit, HESI exit, Diurectics, Loop diuretics, Thiazide diuretics, Spironolactone, diltiazem, cardizem, furosemide, pharmacology, simplenursing, simple nursing

Id: uuXJNJ9LvdM

Length: 39min 37sec (2377 seconds)

Published: Sun Sep 01 2019