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9.7 Cardiac Conditions (Heart Failure)

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

9.7 Cardiac Conditions (Heart Failure)

Key Takeaways Explain This Topic AI

Left-sided heart failure causes pulmonary symptoms: crackles, dyspnea, orthopnea, paroxysmal nocturnal dyspnea

Right-sided heart failure causes systemic symptoms: peripheral edema, JVD, hepatomegaly, ascites

Heart failure treatment: diuretics (reduce volume), ACE inhibitors (reduce afterload), beta-blockers (reduce workload)

Daily weights are the best indicator of fluid status; gain of 2-3 lbs in one day indicates fluid retention

  • Sodium restriction (< 2 g/day) and fluid restriction are essential lifestyle modifications
  • Last updated: January 2026

Cardiac Conditions: Heart Failure

Heart failure (HF) is a clinical syndrome in which the heart cannot pump enough blood to meet the body's metabolic demands. It is a chronic, progressive condition that is a leading cause of hospitalization and mortality.

Pathophysiology

Heart failure occurs when:

  • The heart's pumping ability (contractility) is impaired
  • The heart cannot fill properly (diastolic dysfunction)
  • Or both

Compensatory Mechanisms (Initially helpful, eventually harmful):

  • Sympathetic activation - Increases heart rate and contractility
  • Renin-angiotensin-aldosterone system (RAAS) - Retains sodium and water
  • Cardiac remodeling - Heart enlarges (ventricular hypertrophy)

These compensations initially maintain cardiac output but eventually worsen heart failure.

  • Types of Heart Failure
  • Left-Sided Heart Failure (Most Common)

The left ventricle cannot pump blood effectively to the systemic circulation. Blood backs up into the pulmonary system.

Causes:

  • Hypertension (most common)
  • Coronary artery disease
  • Myocardial infarction
  • Cardiomyopathy
  • Valvular disease (aortic stenosis, mitral regurgitation)

Clinical Manifestations:

  • Finding Description
  • Crackles (Rales) Fluid in alveoli; heard at lung bases
  • Dyspnea Shortness of breath, especially with exertion
  • Orthopnea Difficulty breathing when lying flat
  • Paroxysmal Nocturnal Dyspnea (PND) Waking suddenly at night gasping for air
  • Cough Dry, hacking; worse at night
  • Frothy, Pink Sputum Indicates pulmonary edema
  • S3 Heart Sound Ventricular gallop; "Kentucky" rhythm
  • Tachycardia Compensatory
  • Fatigue Decreased cardiac output to muscles
  • Memory Aid: " L eft = L ungs" - Left-sided failure causes LUNG symptoms
  • Right-Sided Heart Failure

The right ventricle cannot pump blood effectively to the lungs. Blood backs up into the systemic venous circulation.

Causes:

  • Usually secondary to left-sided heart failure
  • Pulmonary hypertension
  • COPD (cor pulmonale)
  • Pulmonary embolism
  • Right ventricular infarction

Clinical Manifestations:

  • Finding Description
  • Peripheral Edema Bilateral, dependent (ankles, sacrum)
  • Jugular Vein Distension (JVD) Visible with patient at 45 degrees
  • Hepatomegaly Enlarged, tender liver
  • Ascites Fluid accumulation in abdomen
  • Weight Gain Rapid, from fluid retention
  • Anorexia, Nausea GI congestion
  • Hepatojugular Reflux JVD increases with liver pressure
  • Memory Aid: " R ight = R est of body" - Right-sided failure causes SYSTEMIC symptoms
  • Heart Failure Classification
  • New York Heart Association (NYHA) Classes
  • Class Symptoms
  • I No limitation; ordinary activity does not cause symptoms
  • II Slight limitation; comfortable at rest, symptoms with ordinary activity
  • III Marked limitation; comfortable at rest, symptoms with less than ordinary activity
  • IV Severe limitation; symptoms at rest
  • Ejection Fraction Categories
  • Category EF Description
  • HFrEF < 40% Heart Failure with Reduced EF (systolic dysfunction)
  • HFmrEF 40-49% Heart Failure with Mildly Reduced EF
  • HFpEF ≥ 50% Heart Failure with Preserved EF (diastolic dysfunction)
  • Diagnostic Tests
  • Test Purpose
  • BNP/NT-proBNP Elevated in heart failure; used for diagnosis and prognosis
  • Echocardiogram Assesses ejection fraction, valve function, chamber size
  • Chest X-ray Shows cardiomegaly, pulmonary congestion
  • 12-lead ECG Identifies arrhythmias, ischemia, hypertrophy
  • Cardiac Catheterization Evaluates coronary arteries

BNP (B-type Natriuretic Peptide):

  • Released when ventricles are stretched
  • BNP > 100 pg/mL suggests heart failure
  • Higher levels indicate more severe HF
  • Treatment of Heart Failure
  • Pharmacological Management

Diuretics (Reduce Volume Overload):

  • Loop diuretics: Furosemide (Lasix), bumetanide
  • Most effective for fluid removal
  • Monitor for hypokalemia
  • Thiazides: Hydrochlorothiazide
  • Mild HF or adjunct therapy
  • Potassium-sparing: Spironolactone
  • Also blocks aldosterone (mortality benefit)

ACE Inhibitors (First-line, Reduce Afterload):

  • Examples: Lisinopril, enalapril, captopril
  • Block RAAS, reduce preload and afterload
  • Monitor for hyperkalemia, cough, angioedema
  • Hold if SBP < 90 mmHg

ARBs (Alternative if ACE-I intolerant):

  • Examples: Losartan, valsartan
  • Similar benefits without cough

Beta-Blockers (Reduce Workload):

  • Examples: Carvedilol, metoprolol succinate, bisoprolol
  • Reduce heart rate and oxygen demand
  • Start low, go slow (may initially worsen symptoms)
  • Mortality benefit in chronic HF

Digoxin (Improve Contractility):

  • Positive inotrope
  • Narrow therapeutic index (0.5-2.0 ng/mL)
  • Check apical pulse; hold if < 60 bpm
  • Monitor for toxicity: nausea, yellow/green halos, arrhythmias

SGLT2 Inhibitors (Newer agents):

  • Examples: Empagliflozin, dapagliflozin
  • Reduce hospitalizations and mortality
  • Originally diabetes drugs, now standard HF therapy
  • Non-Pharmacological Management

Sodium Restriction:

  • < 2 g (2000 mg) per day
  • Avoid processed foods, canned goods, restaurant food

Fluid Restriction:

  • Typically 1.5-2 L/day in severe HF
  • Helps prevent volume overload

Daily Weights:

  • Weigh at same time, same scale, same clothing
  • Report weight gain of 2-3 lbs in one day or 5 lbs in one week
  • 1 kg = 1 L of fluid

Activity:

  • Balance rest and activity
  • Cardiac rehabilitation when stable
  • Avoid strenuous exercise during exacerbations
  • Nursing Interventions

Monitoring:

  • Daily weights (most accurate fluid status indicator)
  • Strict I&O
  • Vital signs, especially BP before ACE-I/beta-blockers
  • Lung sounds every 4-8 hours
  • Edema assessment
  • Oxygen saturation

Positioning:

  • Semi-Fowler's or high Fowler's (reduces venous return, eases breathing)
  • Elevate legs if tolerated (but may worsen pulmonary congestion in severe cases)

Oxygenation:

  • Administer oxygen as ordered
  • Monitor for respiratory distress
  • Prepare for CPAP/BiPAP if needed

Patient Education:

  • Topic Key Points
  • Medications Take as prescribed, do not stop suddenly
  • Sodium Read labels, avoid processed foods
  • Fluid intake Measure and track
  • Daily weights Same time daily, report gains
  • Activity Pace activities, rest periods
  • Warning signs Report: weight gain, increased dyspnea, edema
  • Acute Decompensated Heart Failure

When chronic HF suddenly worsens, requiring urgent intervention.

Triggers:

  • Medication non-adherence
  • Dietary indiscretion (high sodium)
  • Infection
  • Arrhythmia
  • Myocardial ischemia

Treatment:

  • IV diuretics (furosemide)
  • Vasodilators (nitroglycerin, nitroprusside)
  • Oxygen, BiPAP
  • Inotropes (dobutamine, milrinone) for cardiogenic shock
  • Morphine (use with caution)
  • Key Points for the NCLEX
  • Left-sided HF = Lung symptoms (crackles, dyspnea, orthopnea)
  • Right-sided HF = Systemic symptoms (edema, JVD, hepatomegaly)
  • Daily weights are the BEST indicator of fluid status
  • Weight gain of 2-3 lbs in one day = report immediately
  • ACE inhibitors and beta-blockers improve mortality
  • Hold digoxin if apical pulse < 60 bpm
  • Position in high Fowler's to reduce respiratory distress
  • Sodium restriction < 2 g/day is essential