Congestive Heart Failure
When fluid accumulation occurs and the heart is no longer able to pump in an efficient manner, blood can back up. Most heart failure occurs when the left ventricle fails. When this occurs, the fluid backs up into the lungs, causing pulmonary edema. The signs of pulmonary edema are frothy, pink-tinged sputum; shortness of breath; and orthopnea. Distended jugular veins might also be present. When right-sided congestive heart failure occurs, the blood backs up into the periphery. The nurse might also note signs of pitting edema. Pitting can be evaluated by pressing on the extremities and noting the degree of pitting, how far up the extremity the pitting occurs, and how long it takes to return to the surface. Treatment for congestive heart failure includes use of diuretics, inotropic drugs such as milrinone (Primacor), and cardiotonics such as nesiritide (Natrecor). Morphine might also be ordered.
Diagnostic Tests for Review
The following diagnostic test should be reviewed prior to taking the NCLEX exam:
- CBC—A complete blood count tells the nurse the level of oxygenation of the blood, particularly the hemoglobin and hematocrit.
- Chest x-ray—Chest x-rays and other x-rays tell the nurse whether the heart is enlarged or aneurysms are present.
- Arteriogram—Arteriography reveals the presence of blockages and abnormalities in the vascular system.
- Cardiac catheterization —A cardiac catheterization reveals blockages, turbulent flow, and arteriosclerotic heart disease.
- ECG interpretation—Indicates abnormalities in the rate and rhythm of the conductions system of the heart.
- Central venous pressure monitoring—CVP indicates fluid volume status.
- B-type natriuretic peptide (BNP)—Used to diagnose heart failure in clients with acute dyspnea. It is used to differentiate dyspnea found in those with lung disorders from those with congestive heart failure.
- Thallium or Cardiolite (sestamibi) stress—A test used to determine ischemia. A radionuclide is injected at the peak of exercise.