Heart Failure Made Easy | Picmonic Nursing Webinar

this is a heart failure webinar and I'm gonna go and get started because I am a couple minutes behind I don't like to stay behind so my name is Ken Wyatt I'm the instructional content strategist here at picnic um so you know I am I started out as a paramedic I went to nursing school and now I'm in my third year of medical school doing my rotations here in the Phoenix Valley today was actually my last day of my internal medicine rotation so quite a happy day in the med school world um I absolutely love teaching I teach lots of different things but here at pick monarch I am the instructional content strategist so what that means it's not a completely made-up title but it's what I do is I actually kind of work with our content or scholar team making sure all of our topics are medically relevant and relevant what you need to know and I go in and kind of help tweak them with knowing what all those high-yield things are and what not I mean I also kind of act as the voice of the student here and the user which are you guys and so what spec monic we use characters to show everything you need to memorize we put it all together so that you use characters dope you memorize all of those crazy drugs all the side-effects all the indications mechanisms action all that pathophysiology which interventions what assessments are with what disease and we use characters so warfarin that you need to know monitoring pt/inr will show you a little wonderful warfare II here and if you happen to need to know anything about herpes hopefully not you would be able to remember it because you would remember this herpes heart and we have tons tons and tons of thick monix and characters over 700 different topics for nursing that we cover 100% everything you need to know for a nursing school and the NCLEX so what are we going to cover today we're going to go over cardiovascular system and we're really going to talk about specifically heart failure and whatnot oh and I forgot to mention we're broadcasting live from Tempe Arizona where our pick monic offices inside of our sound booth where all of our pick monix are actually recorded so this is wonderful mood lighting here inside of our sound booth where all of our pick monix are actually recorded and you see in our learning system but what I'm going to cover today we're going to go over the concepts of the cardiovascular system I I deal with so many students and they struggle so much with really understanding the concepts of cardiovascular system and how everything compensates and we're going to go over those and you're going to be able to just put it all together and once you have those concepts then you're really going to know how to understand the blood flow understand the assessments and how they present with these different problems with heart failure in the cardiovascular system we're going to talk about the interventions for it we're going to do a a review and then a question an answer and then at the end but I'm going to give you a quick preview of our brand new feature pathways at the end so that's a that's a new thing we have released out today so the number one thing with the cardiovascular system is that you have to really understand the components for it I mean that's something you just have to memorize you have to know the components of the cardiovascular system and what does it mean well that really means you've got to understand normal blood flow you know everything I teach and everything in medicine whether you're a nurse whether you're a paramedic with your CNA or a doctor you have to know the normals you have to know what a normal patient is supposed to present is what is supposed to happen normally so then you know if something abnormal is happening you know if something is wrong then you're able to point it out with like well I know it's not normal and then it's no big deal um it's no big deal because you can say hey at least I know it's not it's normal its abnormal and then you can go from there so the other thing we're going to do is around talk about how to identify the problem area we're going to learn what's normal and then I say okay say how do we identify where the problem areas and with heart failure you've got to really understand where the blood flow backs up and understanding of the normal blood flow then you can easily walk through how and where it backs up and then you have to talk about what to do for it while the fix for it is to fix the underlying problem which we're going to talk about as we go through these topics today so I love I pick Monica here because we get to come up with a lot of really great graphics so I I teach a lot of really tough concepts and what we've done is we have evolved the human body into my educational fish tank and I always taught this is the human body of to think of it about as kind of like a fish tank and everybody he has a fish tank or a had a fish tank or knows someone that has a fish tank and you know if you think about we're going to compare the human body like enough functioning fish tank and the way this works is you think about the body itself as the tank you know it's kind of like the glass tank it's the holder of everything together if you didn't have skin right everything probably would just kind of fall out and that's what the tank does is it keeps all of this stuff together and contained but inside of a fish tank you know that there's fluid and this fluid has to move around and that moves around inside of pipes and impiety of veins and arteries veins and arteries that moves all this fluid around and to be able to move fluid around you've got to have a pump so a pump is actually moving the fluid through the pipes so that pump has to actually circulate everything and no fish tank works very well or the fish don't live and grow very well if they don't have oxygen and air right so you have an aerator in fish tanks you have little you know the little things blowing errands blowing pumping the air into the tank and that's what the lungs are in the human by they're pumping air into this tank and inside of this tank they they're aerating the fluid and the fluid is you know water in a fish tank or in the body it's just fluid or blood rather it's it's book you know blood it's fluid and blood and it's actually what gets oxygenated the air goes into the blood and it's moved by the pipes and it's pumped by the heart but sometimes everything gets a little dirty and when it gets dirty you've got to have a filter to clean it all out so which filter is in the human body well that's the kidneys and that's where they come in you've got to have these keys in every group Bape fish tank has really nice functioning filters I always loved you know you think about a great fish tank and maybe you've never had a fish tank and I'm sorry that you never did but if you didn't he probably maybe saw Finding Nemo you think about what happens when they Jam the filter it gets all gunky and gross and all of that scum builds up and that's exactly what happens in the human body and we have an entire webinar on the renal system and how all that gunk backs up and what actually happens that's how you have to think about this if you have well this buildup of all this gunk well the filters probably fail but every great system and every every great functioning ecosystem in a fish tank has to have food and every food I like to think about fish food and that's GI so if you're a human body I'm a human I hope you guys are all humans and if you are all human then you all need food and then just like a great fish gets fish food the GI system we get food and it goes in and it gets digested and turned into fuel to run things now no great pump works without a battery right no great pump works without a battery no great anything works without electrical power usually and that is actually the nervous system itself firing off all of these electrons and everything to keep everything powered and that's how we think about the nervous system kind of electrically charging everything to keep everything going because the heart does not pump without electrical impulses and that electrical impulse is part of the nervous system and that's how it all ties together now what we're going to do today is we're actually going to tie the body the veins and arteries in the heart all together we're going to show you how those work we're going to talk about where the fluid backs up we're going to run you through heart failure and what's going to happen is you're going to so easily see where it fails at the end I'm going to come back to this image and then we're going to look at it again and I'm going to point to one and you're going to be able to tell me which other ones then compensate it's going to be so great and by the end of it you're going to ow it all makes so much more sense now and then you can reason through questions because you understood the concept and that is exactly what you've got to know and here's exactly the image building and a bigger sense you've got the tank you've got your veins and arteries you've got the heart to pump it all together this pump pumping through the veins you've got this beautiful aerator bringing in oxygen and air into the system and then you have the blood inside of the tank right and you've got wonderful filters for on the sludge backs up to keep it from coming in you've got food coming into this beautiful GI system and you've got this nervous system keeping at all electrically charged and running and that is most definitely what you can think about everything together and all of these work together every single time work together and we're going to I could point to one of them and say the other ones failing how is it going to respond and where you'll be able to see so mmm types we're the types of heart failure we're going to go right back into the same thing we're gonna talk about understanding the components again and the thing we got to do is understand the normal blood flow and this is not a sexy graphic because we haven't really turned it into one yet but we talked about those pipes and you know that the pipes themselves they normal blood flow you have to know you've got a normal blood flow and what happens is you know it comes from on the left-hand side here you see this is deoxygenated blood and on the right-hand side we've got oxygenated blood what gets oxygenated in the lungs right so here are the lungs see there's the lungs and then down the bottom there are the lungs so this deoxygenated blood comes in blue your accounts all the way in and gets in and comes towards the oxygen gets pumped in and ultimately it gets pumped to the lungs and when it gets to the lungs it picks up its oxygen and says hey I got some oxygen now and then I'm going out so it comes in from the capillaries the Vino's the veins remember the veins veins are not muscular they work with body movement so if you're a mobile or you have uh you and we'll get to that in a sec but um the idea is that we works with body movement so it comes into the inferior superior vena cava comes into the right atrium the right side of the heart tricuspid valve the right ventricle the right ventricle goes in through the pulmonary semilunar valve into the UM pulmonary artery into the lungs so goes into the lungs and then it picks up its oxygen comes out comes to the left side of the heart so what I can tell you is all you have to do think about this when we're talking about this again we're gonna talk about heart failure and how it fails so if I looked here and I said what happens if the left ventricle here fails and I'd like to ask a lots of questions but if I said this left ventricle is failing blood flow through the heart should only go one way in one way only it's a one-way street mister and if it if a part of the pump the heart itself fails the fluid builds up behind the failure behind the failure so here I have left left ventricle failure so where is the fluid going to back up where do you think the fluids going to back up if it fails here where's it back up and you can type in your little question box there is as I asked lots of these questions some people find it fun to laugh and my corny jokes but that's up to you but if you if the left ventricle fails here yeah that's right guys so you can see it backs up so everywhere behind the left ventricle of its failing should have an increased pressure so the left atrium is going to have a buildup of fluid the pulmonary veins are going to have a buildup of fluid and ultimately what happens is the fluid builds up in the lungs and we're going to talk about this again so what happens is the fluid builds up and it just keeps building up it goes from the lungs then it builds up into the right side of the heart creating a more of a problem so that's definitely you've got to know how that blood flow goes so there's something you just got to sit down and and really understand how it goes through each of the how it goes through the heart if you just got to understand that concept so the next thing is with heart failure itself there are some causes of heart failure right I'm one of those things or tank failure we'll call it is actually just not having enough fluid in the tank and if you don't have enough fluid inside the tank well what's that called what are some causes of note fluid in the tank no fluid in the tank think about your fish tank happens if there's no fluid in the tank well maybe it's sprung a leak maybe there's a hemorrhage right maybe there's a hemorrhage maybe you're dehydrated that's another great cause I'm hypovolemia that's when we see hypovolemia dehydration lots of times we have our little hippo for hypo water tag hypovolemia it's a character inside of Manik that we use another thing is you can just have poor oxygenated fluid that could be a cause of this tank failure so you could be anemic so maybe the blood that's circulating just is in good blood it can't care as no hemoglobin so it can't carry oxygen or you have an infection causing sepsis and things like that as you go through another thing another section could be pipe failure so we talked about a tank failure now we talked about pipes so remember the pipes circulate everything through so if your pipes are bad what are some ways the pipes could fail what are some ways lots of lots of answers so lots of you guys are saying phase of dilation that is very true hypotension as we have our hippo BP character here hypotension phase our dilation is for sure and of course I'm kind of the same thing I mean trauma if you had a patient who cut there actually I'm cutting their wrists the correct way and since Pierce the artery that is a leaky pipe trauma to the pipe and it wouldn't you essentially have a hemorrhage because of a hole in the pipes right that is kind of the same thing as tank failure but very similar to think now what I want to talk about is now so we talked about kind of those three components we talked about tank failure we talked about pipe failure now we're going to talk about the actual pump failure or heart failure itself so all of those other two we're going to talk at the end about the compensation piece but we talk about heart failure and the actual heart muscle itself the pump failing what are some ways that the pump could fail what should be some causes classes of Oh actually I'm on the show actually said them stenosis like arterial stenosis for pipe barrier notice that is true your pipes can get all sludgy and filled up with gunk that's true it could be a possibility so I'm pumped failure pump failure you guys some might get might move my little window thing over here the other side cuz I'm having to look around the mic today hmm so uh pump failure there are lots of different causes right and so one of you know Kimberly says cardiomyopathy and that's right cardiomyopathy is way an arrhythmia again another really good one so you could have a valvular disease what the most common reason for cardiomyopathy or heart failure essentially is prolonged hypertension you know why do we treat hypertension why do we worry about keeping these patients blood pressure normal I mean you know is it bad to have high blood pressure I mean just because you're going to spring a leak and it's going to shoot out really at high pressure no it's because the pressure on the system dilates everything out it pushes against the edges and creates a dilation so it creates this especially in the heart because that's where it's pumping most of the fluid you end up with a very large heart an enlarged heart especially like left ventricular hypertrophy you see and that's because that's the biggest muscle apart that's trying to pump it all the time it's from long-standing hypertension you can have ischemia you know the actual heart muscle itself could die and because of a myocardial infarction or you could have just another type of cart you know cause of cardiomyopathy there are viruses and bacteria that could cause cardiomyopathy for sure as well so that's definitely definitely the way for sure excuse me so um the well oh here I got my little um explanation on why we actually have why hypertension as a cause for heart failure so I just want to talk through this mechanism excuse me so if I just here I just made this example here so I said okay here is our example of heart failure why does this pressure on the heart actually heart there why does it cause why is pressure in the veins arteries rather increase and cause this extra problem and what happens is if we have a normal heart here's kind of what happens in a normal heart so a normal blood pressure is 120 over 180 right if I had to pick oh sorry 120 over 80 if I had to pick this beautiful most beautiful blood pressure that's out there so 120 is a systolic that's systolic and I always think you know one in the beginning of nursing school med school or sorry to many schools when I was a paramedic first going to school in medicine I really struggled remembering systolic and diastolic and then I thought of this I said systolic think about strong and what happens when you have a strong then you have a contraction if contractions sistar like a strong contraction and it's also stroke volume it's a strong contraction which creates your stroke volume so diastolic is the rest so diastolic you know you think about diastolic and then you have a rest so you have the heart and it contracts and when it contracts it has the stroke volume so it ejects blood out contracts ejects blood out and then relax diastolic it relaxes and fills and that's the volume that stays in there and then you have ventricular or atrial filling so what happens if I have an increased blood pressure are we on the right so I said 160 over 100 well the problem is is when you have that rest so the heart contracts and then it rests but if there is already a pressure inside of there inside of that heart so the pressure is not 80 now and it's a hundred so it rests but it's not really resting it's pushing because it's not really getting to this relaxed it's actually just blowing up like a little balloon because the pressure is still there so it gets constant pressure so what happens when it gets to when it needs to contract it has to actually contract harder to overcome the the diastolic 100 so as to go overcome to eject out more out of the left ventricle and that's where you get this increased 160 blood pressure so you get an increase in what happens over time is you get this muscle just working and working working working and all that pressure creates um a dilation or cardiomyopathy of the actual heart so I hope that was a good example to help you understand what was going on so the next thing is identifying kind of the problem area so if we talk about heart failure we say okay we've got this long-standing hypertension patient one of the most reasons you have heart failure and they come in and they say hmm heart failure what is the difference as a nurse you are almost guaranteed to have to know and identify the difference.we left-sided heart failure and right-sided heart there so here's our pic monic on left side heart fair versus right side are very skewed so we actually have one right here to help you with just the types in general so there's left-sided heart failure and there's right-sided heart failure and there's high output heart failure so we're going to talk about high output at the very last but left-sided heart failure and right-sided earlier so let's look at thing about left-sided heart though you're here first and then I'm going to show you the pic monic to bring you bring the help you bring the images all together excuse me got a little indigestion today it seems like I always send up having a nutrition during webinar time so anytime of these anything anytime we think about heart failure we talked about normal blood flows the heart and what you have to know with that is you have to be able to know that the blood is going to back up behind the heart behind the fail point so if the fail point is on the left side of the heart well where is the fluid going to back up what's going to back up where anybody know right away immediately immediately what's going to happen is let's look at this blood flow left side are is the left side backs right up into the lungs and that's right guys right into those lungs and the lungs start filling up and it's really easy left side right here fills up it backs up into the lungs and here's our left-sided heart failure pick Monica I just want to so we talked about this concept you know right there's the basic concept and I want to talk through what's going to go on so I just want to talk through the actual condottiere so here is the let the characters out of our pick monic left-sided heart failure pick morning so left-sided heart failure this left dead heart here we know we have pulmonary congestion back up inside so we got these congested traffic here with the lungs help you kind of remember that left-sided backs up into the lungs so that's for sure backs up and ones you got to remember that but what do you see why do you see this well what happens is um excuse me you're going to see it back up in this exact direction and everyone always asked me when I like why are you showing me this again why do you keep beating this into my head and what happens is so many students struggle with this so here let's look here's normal blood flow through the heart just to display it in a little bit different way so I've got capillaries veins Mina cave a right side of the heart going to the lungs right then I got to go into the left heart but if the left hearts the problem here's the left heart and it's dead or failing or the problem everywhere but below behind that backs up so you it builds up in the lungs first but one thing we know about left-sided heart is left-sided heart failure will cause right-sided heart failure left-sided heart failure is the most common cause of right-sided heart failure because after it builds up in the lungs then it builds up into the right side of the heart increasing the pressure there because if the hype is high pressure in the lungs and the right heart has to pump harder to pump the blood the blood into the lungs so that's where you see left heart failure it's becoming into right heart failure but first most commonly think about left heart and building up into the lungs first so if you just remember that lungs left left heart lungs right heart body so let's just look at another the example here let me get the manage so what else do you see if we know that this fluid is building up into the lungs it's building up in the lungs what do you see these patients present with this is important this is what you need to know these are all the extra little pieces that you've got to know all these little pieces all these little pieces if you have a patient of congestion in the lungs you're going to have all of these signs and symptoms and you should be able to reason through it right you're going to be able to reason right away you're going to have this Pink's props pink frothy sputum so here's our little pink spit thumb here why do you see pink why is the sputum pink why it's pink because that's someone's favorite color pink right no you guys are right it's because it's pink tinged and it's because there's a little bit of blood in there and why is there blood because inside of the lungs I mean you have a meeting of the minds there with with the with the lungs what happens is you have the the tissue layer and then you have the vascular bed and they're right up against you got the alveoli they have a little sex and they're right up against these little tiny phenols and capillaries that are pumping the blood through right they're pumping the blood through right up against these s what happens if this increased pressure a little bit of leaks in and it causes this pink frothy sputum because a little bit of the blood then gets pushed in across back into the alveolar sac so they end up with this this pink frothy sputum and because what happens you end up having this also lymphatic lymph tissue go into the lungs and you end up with that's right have been adventitious breath sounds just like you guys said especially wheezing and especially crackers so we got our wheezing weasel here in our cracker box so I love wheezing weasel he's one of my favorite pick morning characters now as heart failure gets worse and you have more buildup in the lungs these people end up having dyspnea they have drug trouble breathing there are disc P lungs character right here now of course there's lots more things you always you know you end up being fatigued so we got a little sleepy guy down here see ya if you have a buildup you have heart failure naturally of a decreased cardiac output so you get tired so you see that in both types of heart failure but also you have this coughing how do we measure if I was a nurse and I wanted to ask my patient how would you measure this is really high-yield fact how would you measure how bad your patient's heart failure is as a nurse anybody now how would we measure how would we ask them well what we would do I can't believe I got you guys in this usually most people get this one you would ask them how many pillows they need to sleep it on at night because what happens is the fluid builds up and fluid gravity if I'm sitting up the fluid goes down and it goes in the base of the lungs and if I laid down flat what happens is that fluid then builds up all across the lungs and I start having trouble breathing I start coughing so I have this coughing coffee pot here I said coughing and eyes are waking them and that's right Darlene says how many pillows do you use that is exactly something that you can use to determine maybe how bad or how much they are having with exacerbations of our problems with their their heart failure so that's a really important fact to be able to inquire so here's all of the pigment I put together and there's an entire story to help you remember this poor left dead heart being assessed and this sputum pink sputum car-crash with our wheezing weasel here it's did one of a really great pick monic now another thing is you see you know strong bounding pulses you see tachycardia and you see an s3 and s4 heart sound so those are true but mostly because once the heart models and changes so those are all things as well so you know we already kind of went over left so let's talk about right and you should know now because we just talked I just beat in your head left side of her fear so what about right side aren't there where does the fluid back up and everybody should immediately type in the answer right away oh so while you're typing you guys a couple you made in a good point it's orthopnea orthopnea is when you have trouble breathing when you lay supine that is orthopnea orthopnea that's a that's a good point and that is true that's what how you would be measuring the pillows at night because of orthopnea so that's right everyone got it right where does the fluid back up and right-sided heart failure and it backs up into the body so left lungs so the left side over here backs up in the lungs so the right side right side all right here any kind of problems in here if you had a heart attack or Mir problems with the right side the heart what happened it backs up in the body for sure I kind of got a runny nose or something I don't feel like someone put some pepper in the sound booth today as a prank on me because I can't um my nose is running like crazy I need a tissue or something not really but I mean I feel like I do if I say that Steve's going to come bring me a tissue maybe and then I just blow my nose on the camera everyone would love that so right-sided heart failure um systemic congestion right so it backs up into the body so let me just think about this where do you see where do you see where do you see a demon where do I see this fluid back up first if you have a fluid overloaded patient that's right in the feet and the feet you see edema in the most dependent place so you have a patient and this is really important to know dependent edema dependent edema means if I took my hand here and I imagine this is my hand I laid it on something so I laid it on my other hand right so if I lay the other hand one hand on top of the other one to see if I can see myself and what happens is if I do this so then I take and I lay it off like this so that I'll lay my arm on the side and my fingers become a demitasse like this well that's a dependent edema because it's dependent it's just hanging down but so what happens is you see these patients and they sit all the time or they sleep sitting because I just sleep in my lazy chair because I can't sleep laying down because I have trouble breathing well let me tell you something grandma you got to elevate those feet you've got to elevate the feet and that is something you've got to be able to teach right away check that edema and and get rid of those cankles raise up raise up the feet put the feet elevate them to get the fluid to drain out because it's mostly it's not going to drain unusually any other way without diuretics or compression stockings bla bla bla what you know on down the road so the underlying problem of course is right side to heart though that we're talking about um excuse me so right side of affair so we're going to talk about backing up behind the problem again so if the problem is in the right side of the heart it's going to go right here you're going to have an increased pressure in the vena cava then it's going to back up into the veins and then it's going to back up right into the capillaries so you're going to back it right up and it's going to back up in what capillaries first well whichever ones are dependent and those are most usually your feet because most patients are ambulatory and they're walking around that fluid is back and up in their feet and that's just making new cankles in all these new patients and no one wants to have these cankles but here's what's important on the other side of the heart failure beyond the problem there's decreased output so there's not a good cardiac output so how do we measure cardiac output cardiac output is yeah I don't remember maybe one of you guys would help me tell me what cardiac output is hmm I Nev important to know that concept cardiac output is the amount of blood ejected by the left ventricle um how much in one minute so it's usually you know it's it's definitely something the amount of blood so it's stroke volume the amount of blood ejected out stroke volume times heart rate times heart rate in a minute so that's definitely an important thing and we're going to talk about that in compensation so if you have a decreased right side of the heart where the left hearts are not going to get any enough blood so it's going to have you're gonna have the low a decreased cardiac output most likely so here is our right-sided heart failure characters out of our pick morning um so you're going to see this peripheral edema this peripheral would edamame peripheral edamame we have here so see these edamame I actually didn't know what an edamame was until I actually used Peconic I used pic tonic for med school and I advocate for it I wished I would have had it in nursing school but one thing I didn't know what edamame was until I used Pequannock and maybe it's because I'm from West Virginia I don't know but uh the edamame is a soybean and it's kind of a like a steamed soy bean with kind of salty kind of good kind of thing good thing to try but I learned what edamame was thanks to big money and so the other thing we're always going to see this jvd see these neck jug of veins here you guys have this jugular venous jugular venous distention so the kind of these neck veins bulging and they'll be bulging with every single heart rate heart beat because where do these where the jugular veins dump into where do the jugular veins dump into if you just had to think about that well they're going to go down veins carry deoxygenated blood into the inferior vena cava right off all signs from the top half the body dump into the end or superior vena cava sorry superior vena cava and go into the right atrium and the inferior vena cava comes up from up from the bottom and drains everything below but why do I have nocturia why would I have nocturia in a patient with right-sided heart failure why would I have that anybody have any ideas the reason here is an interesting one of the reason is because you have all of this extra fluid it's building up and it's not able to circulate through because it's not able to go through and peruse through as often what happens is the fluid is not getting perused or pumped to the kidneys as well too so it backs up there and then it you end up with this fluid overloaded States you have to use the bathroom more often definitely an interesting mechanism so these types of patients we will see lots of interesting things and I like this little character I think it's fun and that is you see course fatigue again fatigues kind of a gimme OOP and you can see this ascites this some sitting ice tea guy ascites is of course this bill you know belly fluid buildup of fluid because from one of the things that drain into these inferior vena cava is the portal venous systems you could build up fluid and there just like you could build it up in your arms and feet and you see weight gain and this is why the number one most important thing that I can beat into your head today is that you must have daily weights and off your patients this is very very important because this is the only way that you can gauge whether you are giving if you're treating a patient with heart failure a fluid overloaded State what what can you give them what do you treat it with I mean if they're fluid-overloaded what do you give why yeah you give diuretics right you guys said lasix um keep in mind don't forget this lasix do not get do not use those trade names you need to be saying furosemide trade names are going to get you in trouble because trade names aren't on the NCLEX anymore you need to have chemical names furosemide actually it looks like every single person except for Victoria said lasix diuretics count so that's a good answer you guys are great on that diuretics but you're going to get furosemide probably going to give a loop diuretic first but you know you're going to give a diuretic as the point and when you give a diuretic you're getting rid of fluid and you've got to see how much fluid came out I was actually furious the other day on you know on the floor because the bed broke or something and this patients weight this patient was obviously fluid overloaded needed tons of diuretics and we were diary seing him giving him lots of lasix lots of IV lasix and what happened was you know somehow he was gaining 3 4 pounds a day you know this is impossible and no one was able to just get an actual scale and weigh the guy which is you know crazy this is really important you gotta have daily weights very in strict eyes and nose because you got to measure how much is and how much is out so you can figure out if you're actually getting rid of fluid if you are actually fixing the patient and getting rid of that fluid ah and what what is it important if I'm giving and Amanda's already kind of jumped in there if I'm giving lasix furosemide if I'm giving furosemide IV um what is one thing that I need to worry about what do I need to monitor what's the number-one three things I need to monitor we'll say you guys right away immediately said potassium and electrolytes and that's right loop diuretics dump off everything they get rid of fluid they're great at that but they lose everything else they get rid of sodium calcium all of it they get rid of everything and fluid especially potassium and what's another thing absolutely have to watch for ototoxicity and some cat got away is ototoxicity is the other one so you got a ringing of the years tinnitus if you have ringing of the years for a patient getting IV IV IV furosemide that's definitely an indication of toxicity and you should stop stop the IV for awesome.i to notify the physician that's really important so another thing is hi hi our output oh I can't talk about some high output heart failure and what happens is this is where the actual fluid on the fluid itself can't meet metabolic needs so maybe um you know you have a patient with sepsis in this patient or this patient's anemic and when they're anemic they don't have any haemoglobin right so they can't carry oxygen so they don't have enough hemoglobin to carry enough oxygen to keep the entire body oxygenated at all the tissue levels so what happens is this these hundred hemoglobins let's say for example normally in the body you have a normal human globin of thirteen mearns going to use thirteen thirteen of course I know this range is of course we're going to use one as an example so thirteen if you have thirteen and that's a quantified number thirteen hemoglobins and let's say this patient only has eight but you need thirteen to circulate around to carry enough oxygen to oxygenate the body so those red blood cells are there that cells have those seven haemoglobin they have to move around through the whole body system faster they've got to move around and round around more times so that they can oxygenate the same amount of tissue because just because you have less hemoglobin you've done a 70mm globin you're not going to be able to circulate the tissue unless it pumps more times around around around around the merry-go-round so what happens in high-output heart failure I gave in the example right here so what are you going to see as a compensation piece tying more concepts in here as we go further what are you going to see what are you going to see signs and symptoms in this patient with high output power third just think basic this right Doug tachycardia the heart if I'm talking about the fluid the fluid itself is not good enough the fluid we got some bad gasps or blad fluid we'll call it this fluids not really good doesn't have lots of haemoglobin mi7 so what's a body going to do is it's going to it's going to pump the pump is going to kick in as a compensation piece it's going to move move move that blood around more and more and more times to try to oxygenate it through the lungs grab more hemoglobin taking to the features take it back to lungs grab more hemoglobin oxygen take it to the lung it's going to going to circulate more and more it's going to circulate faster to keep it going and these patients definitely end up you know with a lot more problems so you could see other things you can see ISM if you had a really severe hyper hyper thyroidism or an AV fistula so you actually had a bypass of the heart to where arterial blood is actually just bypassing the lungs altogether and going back into the venous system and AV fistula so what happens is you know if you have this closed circuit tract but imagine that you have this square tract and then somewhere in the middle there is like a turn off to do a little shortcut and if it's doing that little shortcut then it's missing a big big chunk of everything so that's really important so last thing I want to talk about is interventions here of heart siren we're good then we're in a tie-in compensation at the very last piece so interventions for heart failure we need to increase oxygenation to the tissue right I mean that's the number one goal here is we've got to increase oxygenation of the tissue we got to you.this is you've got to do it that's you know time is tissue and if we are not oxygen or getting the hemoglobin out or whatever the problem is the tissue is going to become ischemic and it's not going to work that's definitely an important point on the other the other things you need to do the other things that could work are increasing the functionality of the pump so we can give medications to increase the pump and help the pump and we can also reduce the overall fluid so if they're just fluid overloaded we can get rid of that fluid to help increase increase efficiency we'll call will say so respirations and respiratory support what do we do for respiration I got the answers here so number one right away we know that the what system is going to kick in ethic we're right here to show you we that we have body systems we we talked about the aeration right the aerator the aerator is pumping the blood from the from the heart into the lungs and picking up the oxygen and pump it out but if the blood is not it's not getting enough blood well then we can do the number one easiest thing in the world for any patient having difficulty breathing it's just sit them up and that seems so simple but everyone always misses that question or every single time everyone misses that question just sit the patient up the other thing we can do we can apply oxygen so why do we apply oxygen why do we apply oxygen well a higher fio2 a higher percentage of oxygen first off what is the percentage of oxygen what you're breathing right now unless some of you guys are on oxygen if you're breathing normal air that's right 21% 21% oxygen in normal breathing air and what we know is we can increase that's called fio2 or fraction of inspired oxygen we can increase that by giving a patient oxygen so then how does that work what what happens is then every breath that they take every breath instead of getting 21% we can increase it to thirty forty fifty or a hundred percent we can go all the way up and give them 100% so the entire amount of air that they're getting in more likely the oxygen is getting into that membrane and in a cable the cells are able to pick up more and of course we can mechanically ventilated with like peep positive and expiratory pressure BiPAP CPAP and things like that to push to keep pressure back to keep the fluid from coming in the lungs as well if that's a problem now the next thing we can do is increase contraction we can increase contractility of the pump itself so we have this pump and the left side failed the right sides working the right sides failing and whatnot we can actually increase contractility that pump so if you got a pump you can make it work better and what are some ways we can make the pump work better what are 10 ways to be accessible with making your pump better buy a new pump no that's not a good answer you're not allowed to say that so we can increase control contractility the pump the number one way you guys some set it was you can give medications as well to increase and we can give inotropic medication we can give digoxin we can give digoxin that's a great inotropic inotropic medication or we can give dobutamine it's another inotropic type medication to increase functionality at the pump and also maybe it's an electrical problem for heart failure maybe the the actual electric the battery is just not very good for the heart right well what do we do if the battery is not very good for the art and it's not firing off this nervous system just isn't firing well we get it a external battery we get a pacemaker and we we put that pacemaker in and guess what new batteries great pace it's able to keep the electrical system going all of these systems can be supplemented with medications or electrical devices as well I mean the last thing we can do is decrease the overall workload so we have the overall workload of the heart hearts working doing great now it's failing well how could we decrease the workload of the heart how would we decrease the overall workload maybe we carry it you know something's lazy and not doing so well we carry it right now I don't think we carry it maybe we could just cut them open and squeeze it ourselves no you guys are typing in the answer and that's right and the big thing there is actually giving diuretics giving antihypertensives to fix the underlying problem problem giving diuretics to decrease the overall fluid and whatnot to actually decrease the workload but it's usually decreasing the pressure or decreasing the actual volume of what's going into the heart so it doesn't have to work as hard and there's always you know checks and balances and lots of people always say what about this and what about that and there are always a little bit of you know random scenarios but the random scenarios are not what you're going to get on on your test questions remember not to add anything to these questions think about the basic concept what do I need to do my patients in heart failure and they have edema well they're having trouble breathing the first thing I should do is sit them up you know do the easy before the heart all of the easy answers are always the best answers the easiest and the cheapest unless the patient's going to die right away without some other type of medication or whatnot that's that's where you have to think about that so here's our heart fire interventions pick monic which has all of the information here that you need to know so just an interesting point what is the diagnostic test to tell me what what my how my heart is functioning or a heart to determine the amount of heart failure what's it in that little test not ck-mb not EKGs that's not that's not the answer so this is where the beauty of pick monic comes in to help you because right here it is on our actual image right here on our image is an echocardiogram so see right here this echo echoing waves and this echo and the heart and that's an echocardiogram looks like so will you guys types it in maybe my my image here is an updating but to be able to determine the ejection fraction and the amount of fluid that's ejecting Bonnard we actually do a cardiac echo and an echo can be then done transthoracic aliy on the outside but the best way to do a cardiac echo is actually do a transesophageal echo so you go down with a scope into the esophagus and you check from there because the esophagus lies right behind the art you can kind of see exactly how it's doing and get a lot better a lot better read especially especially especially if your patient is obese which we see a lot of sometimes right so I just want to I just want to come back here and I'm going to go back to the beginning for my image and talk through this systems again compensation I should have put this at the end and I didn't today so I'm sad so here we're going to talk about each of the systems put them all here for you here all of the systems put this all together let's talk about heart failure itself let's talk about one scenario here and then we're gonna talk about a couple more here the heart fails now whether it's left-sided heart fair or right side of her it doesn't matter we're not going to talk about that the pump itself the pump fails when the actual pump fails which other pieces of the body calm say what picks up and picks up the picks up its pace and says eh I'm going to help out we're all in this together because the wonderful fishtank does not work unless all this is somes work what happens here if the pump is failing what you see is that you will increase oxygenation you will have an increased respiratory rate because it's tried an increased respiration to that smaller amount of blood that may be coming in you may see if it's hypovolemia you may see vasoconstriction you may see an increased vasoconstriction that put more fluid into the heart to put more fluid into the pump so that the pump actually has better output you're going to see those types of things and what you're going to see is you might see increased increased increased like not cheerio or or urine output because the kidneys kidneys kick into overdrive and they say hey there's way too much fluid going in here let's get some out let's filter out some filter out so let's get it out get it out get it up get it up so you see this constant urinary output because the kidneys are trying their best on their own to get rid of as much fluid as possible because the fluid here maybe is fluid overloaded or maybe the heart is failing and that's what's causing this transient fluid overload so the fluid just backs up where does it back up what backs up in the pipes and ultimately inside of the tank and that's how you have to think about it but let's look at causes of heart failure if you had a cause of heart there here's the pump what are some causes of heart failure we talked about it cardiomyopathy actual pump dilates that's true could be hypertension a constant vasoconstriction so if you have coronary artery disease and you have high blood pressure because you have this coronary artery disease well here you are you've got these sludgy pipes with all that fat in there and triglycerides and cholesterol right and what happens is it's really hard to pump blood for those so happens is the blood pressure inside the pipes goes way up so when this goes way up it dilates the heart out stretches it out to the point where that in it then fails or we could have an myocardial infarction or an arrhythmia and if we had an arrhythmia here that's where the nervous system comes in so the nervous system itself comes in nervous system comes in and it says okay in our heart you're not going to work so electrically well anymore we're just going to maybe not really conduct because the batteries aren't working so great to your electrical system in the heart so we're just not going to work so hot and we're going to fail off this piece so you see the fluid backs up in the pipes causing this fluid edema causes all these things to back up all the pressure backs up but what happens when we could paste those people give this people with pacemaker we could electrically shock them and fire those neurons back in to the actual system bring it all together this is that's exactly what we need to do and that's how you need to think about it so let me just um bring my place back to where we were I hope that was a good example of a review there no diabetes is a really good answer or a good common eina so diabetes does the exact same thing if you have diabetes um diabetes is not really a direct cause of heart failure but it definitely causes um you know hypertension usually long-standing because if diabetes diabetes is this long-standing sugary sludge that's in at all of your blood right and when it's all sugary sludge um this sludge is very hard to move it's thick and then it causes this hypertension and it causes mostly where do you see damage first where in a couple of places you see damage and diabetes because of this sludge where does it get stuck it's right picture as the kidneys the kidneys right away you see diabetic nephropathy where else do you see if wroth with the hedges gave you the word diabetic nephropathy then you see neuropathy because where do you see neuropathy think about this again we're tying all these concepts together that's right you see it in the feet and the fingers you see it down if you see the diabetic neuropathy because that sludge sledges everything up and it's not working you have this backs all this up that's why the number one thing kidney failure you see neuropathy and that's right you see retinopathy you see eye changes so what's a really high-yield fact about diabetes and their eyes is that you need to do what what do you have a patient always comes in always need to tell them we have a patient comes in and they're saying that they're having to change their glasses all the time it's such a classic question my eyeglass prescription just keeps getting worse you check their eyes you need to check their blood glucose you need to find out if they have diabetic nephropathy diet diabetic retinopathy sorry and that is also for the exact same reason why if you have a diabetic patient was it so most important thing you need to do you need to look at their feet you must look at those feet you've got to everyone loves feet they're everyone's favorite thing and with a diabetic they better be because that's always going to be probably on that list of possible questions you're going to get on your test is look at those feet and do we cut toenails and a diabetic patient no no no do not do not mess that up never cut toenails don't cut toenails bad bad choice so what you need to do is just as a review is you've got to understand the components know this normal blood flow of of the body you've got to know how to put it all together and exactly how it really works you've got to understand putting all the things you know knowing the normal blood flow of the body I mean you've got to know how it works and putting the blood flow together so if you find the fail points the left side of the heart then it's going to back up behind the left side of the heart where does it back up it backs up into the lungs and that's how you have to think about it because then you can think obviously where it backs up then you know the problem area and then you can treat it you could treat the underlying cause for sure and those interventions are really really important so um mmm of course oh and my best my best thing here on the on the review is make sure you shower me with gifts that's really really important I like lots of gifts I like chocolate and candy and cash so if you have any cash I get paid by how many times I can take show this pic monic cup on an image for advertising now if you have any questions of anything we went over today type it into the into the box there the only thing I want to show you is I want to show you the new feature we have I'm trying to enter full screen mode but we have this pathways now so what you can do with pathways is we have organized all of our pick monix and do not only the courses that you need to know whether you're in fundamentals or med surg or farm so let's say I'm doing med surg like we're doing today so you can see there we have all these pathways you're taking that search great good for you open up med surg and go exactly where you are and we can follow along all of the topics that you need to know for medical surgical nursing everything in you know so here we are in Decatur vascular we got some ECG cardiac enzymes we go down into disorders all of the disorders organized and ready for you exactly how you need to go this is great whether you're in nursing school but you think oh well I'm already graduated with nursing school I need to study and take the NCLEX well we got a treat for you if you go to our pathways what you can actually do it is we have the NCLEX right here you can click on in clicks and actually open up the entire in clicks and follow along one through a1 through 790 pick monic experience of the entire ring clicks you need to know and you go through and you learn so you open up let's say we're going to go to pharmacology basics I'm going to choose this one I'm going to go right into medication administration and I'm going to start right here at the five rights of medication six rights of medication administration and I can go in and learn that pick monic and it'll keep track of all of my progress as you go through so let me see we have four questions really quick mmm I lost my place O's in says she likes the new pathways because it's more organized then I like the new pathways too because I most definitely um love the new pathways I especially don't love how much time it took organizing all those but it was I'm glad we have it it's going to be it takes our products really pushes it to the next level um so Sierra ask how many picnics are in the NCLEX part I'm all of our pick monic for nursing big monix over 700 i think we actually have 780 in total you can go in there and they're all organized there for you 1 to 784 exactly how you need to learn ok Michael says pick really helping me feel better about ink Lex and I'm glad Michael but let us know if there's something else we can help you with or if you're struggling with a particular area oh and I forgot to mention we have other our other webinar series I'm on our pick monic free on our YouTube channel for sure oh then this is probably the most the most common question we seem to be getting is can I watch this new pathways offend them if I'm already a member and there is no extra charge if you're currently a pathways are currently epic monic subscriber pathways is a free part of pick mine so there's no extra charge you just have to be a pick monic subscriber as well so hello anna says it's actually ten rights now for medication administration and then I mean there's technically like 300 rights right but there's so many um see if we have in answer if I have a webinar on PVD or peripheral vascular disease or per for three disease no I we actually don't but we have a PICC monix which cover those and all of those really hard to remember which ones which which ones dark and brown and which ones red and pink we have pick monix to help you keep those separate and that's definitely definitely definitely important Victorious of the diabetic client should see a podiatrist to cut the toenails and the answer is emphatically yes yes yes definitely very very very important nurse nurse Chapelle 2014 first off I like you username but maybe it's a nurse Chapel I guess anyway I like learning this way it's fun and easier I agree I actually wish that I used big money for nursing in the beginning so looks like how many how many are how many are in YouTube how many videos I think here on YouTube I think we're at nine right now nine different ones working on a new one every week so okay so that's all I have I don't see too many other questions and I don't want to drag out the time but definitely if you have any other questions you can email us I'm at feedback pick Montcalm or go to pick monitor column click on contact if you have any questions if you have any questions you want to see a topic you're confused about something you just have a question you want to ask another nurse we're here for you that's what we're here for we're nurses for nurses we're students for students reach out to us send us an email go to our website write us we get back to you right away maybe we can't solve your financial issues and not so good at that I'm not really that good as a marriage counselor but if you have nursing questions great I'm here for you and we also have a new member of our team Marly who's another nurse - joy just joined us to help us out with lots of these webinars and questions so she's here as well and you'll be seeing more of her if you have any other questions reach out to us share the nursing nursing pathways code and make sure you go use it for yourself check out pathways let us know what you think click tell us feedback because we're here for you have a good night and as always good luck studying you

Channel: PicmonicVideo

Views: 68,031

Rating: 4.8284183 out of 5

Keywords: Pharmacology (Field Of Study), Heart Failure (Disease Or Medical Condition), Heart (Anatomical Structure), nursing help, nursing videos, picmonic, visual learning, audiovisual, Nursing School (Organization), Nursing (Field Of Study), nclex, ati, hesi, mnemonics, nursing student, nursing mnemonics, Heart Failure Made Easy, Picmonic Video, Picmonic

Id: 4NjmXFBvxxk

Length: 59min 31sec (3571 seconds)

Published: Fri Sep 25 2015