Left-Sided Heart Failure vs Right-Sided Heart Failure Pathophysiology Nursing NCLEX Review

hey everyone it's Sarah the registered nurse rn.com and in this video I'm going to talk about left-sided versus right-sided heart failure so let's get started to help you understand left versus right-sided heart failure you really have to visualize the anatomy of the heart in your head and think about what side is connected to what for example the left side of your heart is connected to your lungs so your pulmonary circulation while your right side of your heart is connected to the venous circulation and with heart failure what happens is that the heart becomes extremely weak and it fails the pump blood forward and instead that blood is going to back up and fluid volume overload is going to occur which is why you start seeing these certain signs and symptoms that tells you your heart is failing so let's take a more in-depth look at heart failure by looking at right-sided heart failure the right side of your heart receives deoxygenated blood from the venous system and whenever this side Fells the pump blood the blood becomes extremely congest tested on this side which will actually go into the venous circulation and this actually increases pressure in the vena cava which normally brings used blood hence deoxygenated blood back to the heart for re-oxygenation by the lungs and this built up pressure causes the hepatic veins to become very congested with blood which leads to hepatomegaly and venous congestion where you're going to see the venous congestion in the large veins of the neck like with jugular venous distention which is referred to as jvd and you're also going to see swelling in the extremities like the legs and the feet along with the abdomen which is known as ascites and right-sided heart failure is usually caused from left-sided heart failure because of the increased fluid pressure backing up from the left side to the right and this will cause the right side of the heart to become overworked so whenever you're trying to think of those signs and symptoms of a patient with right-sided heart failure remember that right-sided heart failure presents with swelling and peripheral signs and symptoms and to help you remember those signs and symptoms let's remember the word swelling so s is for swelling in the legs the feet and abdomen which again is known as ascites W is for weight gain and weight gain is one of those early signs that tells us our patient is retaining fluid so whenever a patient has heart failure you definitely want to make sure that you're doing daily weights on them at the same time every day with the same scale and that they're not gaining more than two to three pounds in a day or five pounds in a week if that is happening that is an indication that okay this patient is retaining fluid and we need to make sure that their heart failure is not becoming exacerbated e is for edema particularly pitting edema and you will see this in the lower extremities so whenever you take your finger and you press in this area and you remove your finger you will actually see an indentation from where you press and then L is for large neck pains and that is that jugular venous distention I was talking about earlier that is just where that blood is backing up and you're starting to see where it's backing up and you will see the large veins in the neck and then the other L is for lethargic these patients will be very weak and tired and it's because their heart is weak and not able to maintain proper cardiac output I is for a regular heartbeat these patients are at risk for atrial fibrillation so you definitely want to monitor their Rhythm make sure they're not entering into this n is for nausea and this happens because we have congestion of our liver and this pressure is pushing on the abdomen causing them not to really have an appetite and really to feel sick at their stomach and then G is for girth of abdomen will be increased and this is from the swelling of the liver and the fluid building up in the abdomen which can lead the patient not to be able to breathe very well now let's talk about left-sided heart failure so the left side of your heart its goal is to pump blood into arterial circulation because it has fresh oxygenated blood it just received to the lungs and it wants to get it out to your body but with left-sided heart failure what happens is that heart is too weak on this side and Blood starts to back up on this left side and where it goes is into the lung so the pulmonary circulation and it congests it and this is actually the most common type of heart failure and we can further categorize left-sided heart failure into either systolic or diastolic heart failure so with systolic this is heart failure with reduced ejection fraction so we have left ventricular systolic dysfunction and you want to remember that systolic is the contraction hence the squeezing phase of the heart remember systolic starts with an S squeezing starts with an S so this is our squeezing part of the heart and in systolic dysfunction there's an issue with the left ventricle being able to eject blood properly out of itself so the or organs can't get all this Rich oxygenated blood that it needs and you're going to see that the patient will have a low ejection fraction on their echocardiogram now what is ejection fraction well ejection fraction is a calculation used to determine the severity of heart failure a normal EF is 50 or greater meaning more than half of the blood that fills the inside of the ventricles is being pumped out and an EF of 40 or less is a diagnosis for heart failure and again the EF can be measured with an echocardiogram a heart cath or a nuclear stress test now with diastolic heart failure this is where we have heart failure with a preserved ejection fraction so we have left ventricular diastolic dysfunction and with this you want to remember that diastole is the filling or the resting phase of the harp so when diastolic dysfunction The ventricle is just too stiff to allow for normal feeling of blood and since there isn't an issue with contraction but the actual feeling of that ventricle the ejection fraction is actually going to be normal hence preserved therefore as a nurse you always want to make sure you look in the diagnostic reports to see what your patient's ejection fraction is because it'll help give you a better understanding about where your patient is in heart failure so whenever we're thinking about the signs and symptoms of left-sided heart failure you want to remember that it's going to present with mainly pulmonary signs and symptoms and these signs and symptoms are really going to come from all that fluid that's backing up in the patient's lungs causing pulmonary edema so it's really almost like they're drowning on their own fluid so to help us remember those signs and symptoms of left-sided heart failure let's remember the mnemonic drowning so D is for difficulty breathing R is for rels which is also known as crackles and this is an abnormal sound that usually indicates that your patient has pulmonary edema and here's some sample audio of what crackles may sound like oh next is O for orthopnia and this is whenever the patient lies flat in the Supine position they can't breathe they start to smother so they have to set up to breathe easier and this is really stemming back from that pulmonary edema that they're experiencing so it's more helpful for the patient to be up in high Fowler's position to breathe easier plus you want to dangle their feet at that bedside because what that's going to do is it's going to decrease venous blood return and help decrease that preload to the heart then we have W which is for weakness and again that just goes back to because the patient has a weak heart they're failing to maintain adequate cardiac output so they really can't tolerate a lot of activity instead setting in bed is more restful for them n is for nocturnal paroxysmal dysmia and this is where they have these sudden attacks while they're sleeping at night where they wake up Suddenly feeling like they can't breathe and many patients who have heart failure actually have to stack pillows together to set up at night to breathe or they have to go to a recliner to breathe at night so if your patient tells you that this is happening that is a warning sign that their heart failure is getting worse I is for increased heart rate so with this you can see sinus tachycardia because what's happening is you have the fluid volume overload and this is really taxing the heart out so as a last-ditch effort that heart is going to increase its rate in hopes of maintaining cardiac output but in the end if this heart failure is not treated with medications and other things what can happen is that this heart can completely fail and the patient can go into cardiogenic shock n is for nagging cough and this is one of those things that could be an early sign and symptom that the heart is getting weak in a patient with heart failure so you want to educate your patient to watch out for this nagging dry hacking cough that could be happening if it does they want to report it so they can get get treatment and then as a nurse what you want to monitor for with this is that that cough isn't becoming productive where they're getting a frothy foamy blood tinge cough to bat that is a very bad sign and requires immediate medical attention if you see that and then lastly G for gaining weight patients with heart failure again as I pointed out before you want to monitor their weight because weight is an early indicator to us that hey fluid volume overload is maybe presenting with the patient okay so that wraps up this video on left versus right sided heart failure if you like to watch more videos in this series you can access the link in the YouTube description below

Channel: RegisteredNurseRN

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Keywords: left sided heart failure, right sided heart failure, left side heart failure, right side heart failure, left vs right heart failure, left sided vs right sided heart failure, heart failure, congestive heart failure, nclex, heart failure nursing, heart failure nclex, heart failure next generation nclex, systolic heart failure, diastolic heart failure, ascites, heart failure causes, left sided heart failure symptoms, right sided heart failure symptoms, heart failure pathophysiology

Id: mGchzG3Ya7c

Length: 9min 44sec (584 seconds)

Published: Wed Apr 19 2023