Adult Pre-simulation Paperwork

1. List the risk factors for chronic left sided heart failure related to coronary
artery disease.
Obesity
Diet - High sodium diet, high cholesterol and fat diet, high calorie intake, low
fiber diet.
Hypertension
Tachycardia
Smokers
Immobility
Diabetes
2. Explain the cause of the compensations for chronic heart failure.
In congestive heart failure, the heart is unable to pump sufficient blood to maintain
adequate circulation. This results in a backup of blood and the extra pressure may
cause accumulation of fluid into the lungs. When cardiac output is insufficient to
meet the demands of the body, compensatory mechanisms work to improve cardiac
output. (p. 745)
3. Describe the manifestations and effects of right-sided and left-sided heart
failure.
In right-sided heart failure, which is caused by restricted pulmonary blood flow from
acute or chronic pulmonary disease, cors pulmonale, and right sided infarction, the
right ventricle cannot empty completely. Increased volume and pressure develop in
the venous system and peripheral edema results. Systemic congestion occurs with
right-sided heart failure causing adverse effects such as jugular distention, enlarged
liver and spleen, anorexia and nausea, dependent edema, distended abdomen,
swollen hands and fingers, polyuria at night, weight gain, and increased blood
pressure from excess volume or decreased blood pressure from failure.
In left-sided heart failure, which is caused by CAD and HTN, left ventricular failure is
associated with decreased cardiac output and elevated pulmonary venous pressure.
Decreased cardiac output can cause adverse clinical manifestations such as fatigue,
weakness, oliguria during the day, angina, confusion, restlessness, dizziness,
tachycardia, palpitation, pallor, weak peripheral pulses, and cool extremities.
Pulmonary congestion causes effects such as hacking cough which is worse at night,
dyspnea/breathlessness, crackles or wheezes in lungs, frothy, pink-tinged sputum,
tachypnea, and S3/S4 summation gallop.
(p. 745-749)
4. List the goals in the interdisciplinary care of chronic heart failure.
Improve oxygenation
Improve CO
Decrease fatigue and weakness
Prevent pulmonary edema
(p. 750-755)

5. List the two hormones released by heart muscle in response to changes in

blood volume.
Angiotensin II
Aldosterone (p. 747)
6. Explain the nursing implications for the client receiving echocardiography
with Doppler flow studies.
Describe the procedure and purpose of the echocardiograph to the patient.
Inform the patient that the procedure is painless and takes 30-60 minutes.
Instruct the patient to lie still and quietly during the test to ensure an accurate
picture of the structures of the heart.
Elevate the head of the bed 15-20 degrees. (p. 706)
7. Define refractory heart failure.
According to the American College of Cardiology, refractory heart failure is stage D of
heart failure. Patients in this stage have manifestations of heart failure at rest despite
maximum therapy.
8. List the nursing implications and education needs for each of the following
categories of medication related to heart failure.
a. ACE Inhibitors and Angiotensin II blockers
Monitor BP
Volume-depleted patients should receive a low starting dose, or the

fluid volume should be restored before beginning the prescribed drug.

Monitor for hyperkalemia
Assess for orthostatic hypotension, acute confusion, poor peripheral
perfusion, and reduced urine output in patients with low systolic blood
pressure. Monitor serum potassium and creatinine levels to determine

renal functions.
Teach patient not to rise too quickly from lying or sitting down.
Teach patient to refrain from taking potassium supplements due to the

risk of hyperkalemia. (p.751)

b. Diuretics
Monitor fluid and electrolytes (especially potassium).
Monitor for hypokalemia.
Monitor for dehydration.
Monitor for hypovolemia.
Monitor for hypotension.
Do not give at night because they are at high risk for falls.
Educate patients to incorporate potassium into their diet by helping
them order their meals.
Teach patient how to take their own blood pressure at home.
Daily weight checks. (p.751)
c. Positive inotrope agents
Monitor heart rate- take apical pulse
Monitor for signs of digitalis toxicity. (anorexia, visual disturbances,

fatigue, etc)
Maintain a sodium-restricted diet.
Educate patient on low-sodium meal choices.

 Teach patient how to take their own pulse.

Daily weight checks. (p.751)
d. Sympathomimetic agents
Monitor BP
Monitor heart rate
Monitor ECG
Monitor for pulmonary artery wedge pressure
Hemodynamic monitoring
Monitor urine output
Explain the patient the rationale of giving the drug (to promote cardiac

output).
Advise patient to report to the nurse immediately of chest pain,

dyspnea, numbness, tingling, or burning of the extremities. (p. 843)

e. Phosphodiesterase inhibitors
Monitor ECG continuously during infusion.
Monitor intake and output.
Monitor HR and BP
Monitor for toxicity and overdose- overdose manifests hypotension.
Inform patient of the reason of the administration of the drug (to
increase cyclic adenosine monophosphate which enhances the entry of
calcium into myocardial cells to increase contractile function.
9. List the interdisciplinary interventions for each of the following nursing
diagnosis related to chronic heart failure.
a. Decreased cardiac output
Monitor and record vital signs
Auscultate heart sounds
Assess mental status
Perform a focused cardiovascular assessment
Monitor urine output
Monitor labs and diagnostic test results (BNP, echocardiogram, EKG)
Perform hemodynamic monitor as ordered
Administer cardiac medications as ordered.
b. Excessive fluid volume
Fluid restriction as ordered
Monitor I & O
Assess lung sounds
Assess for edema, pulses, JVD
Weigh patient daily
Follow low sodium diet
Assess for the need of a urinary catheter
Administer diuretics as ordered
c. Activity intolerance
Provide rest periods
Assess for fatigue and weakness
Provide bedside commode as needed
Space out procedures and ADLs.
d. Health promotion and community based care
Teach patient self-management skills

Teach patient about dietary sodium restriction.

Provide information about advance directives.
Provide information on health care resources such as home care nurse,

nutrition therapy, and medical supply companies for equipment needs.

Educate patients of the dangers of smoking related to heart failure.

10.List the signs and explain the interdisciplinary interventions for each of the
following nursing diagnosis related to pulmonary edema.
a. Impaired gas exchange
Crackles
Dyspnea at rest
Disorientation or acute confusion
Teach patient to take rest periods.
Do not leave the patient alone if confused.
Assess lung sounds.
Administer oxygen as ordered.
b. Decreased cardiac output
Tachycardia
Hypertension or hypotension
Reduced urinary output
Cough with frothy, pink-tinged sputum
Premature ventricular contractions and other dysrhythmias
Monitor HR
Montior BP
Monitor I & O
Daily weight checks
Monitor EKG
c. Anxiety
Restlessness
Lethargy
Tachycardia
Hypertension
Monitor BP
Monitor HR
Reassure patient
Teach patient calming techniques