Editing Medical-Surgical Nursing (section)

=== Heart Failure ===

Left-sided failure backs blood into the lungs and produces dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles, a persistent dry or frothy pink-tinged cough, an S3 gallop, and fatigue. Right-sided failure backs blood into the systemic venous system and produces jugular venous distention, dependent and sacral edema, hepatomegaly, ascites, and weight gain. Left-sided failure is the most common cause of right-sided failure.

B-type natriuretic peptide rises with ventricular stretch and helps distinguish cardiac dyspnea from pulmonary causes; a level above about one hundred pg/mL supports heart failure, and higher levels correlate with greater severity.

Nursing interventions: elevate the head of the bed to high Fowler position, give oxygen, administer diuretics and monitor the potassium level, restrict sodium and often fluid, weigh daily, and balance activity with rest. Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, and aldosterone antagonists improve survival and are continued even when the patient feels well.

Nursing application: teach the patient to weigh every morning after voiding and before breakfast, and to call the provider for a gain of two to three pounds in one day or five pounds in one week. That single instruction prevents more readmissions than almost any other teaching point.

Acute pulmonary edema is a medical emergency: severe dyspnea, anxiety, frothy pink sputum, crackles throughout the lung fields, and hypoxemia. Sit the patient upright with legs dependent, give high-flow oxygen, and prepare for intravenous furosemide, nitrates, and possible noninvasive positive pressure ventilation.