Heart Failure Cheat Sheet

Heart Failure Cheat Sheet Goal: INCREASE Cardia Output (CO) INCREASE O2 to body! These drugs calm the heart: Lower BP or HR ACE Inhibitors “-pril” ↓ BP - “pril like chill, so ahhh heart is relaxing” ARBs “-sartan” ↓ BP Beta Blockers “-lol” ↓ BP & HR - “they block the beats” Calcium Channel Blockers ↓ BP & HR - “they calm the heart” - dipine as in they help BP decline - Cardizem like Zen yoga calming Dilators vasodilators - Nitroglycerin Nitrates Digoxin (cardiac glycoside) ↓HR - Deep contraction ↑ contractility ↓HR - Negative chronotropic - It does NOT affect BP !! - Check Apical pulse for 60secs/1 full min o < 60bpm HOLD! - Check K+ [3.5—5.5] risk for digoxin toxicity o K + < 3.5 HOLD! - Monitor for Digoxin toxicity >2.0 o Vision changes, N/V, fatigue “dizzy” Diuretics [ Loop or Thiazide] “ide” ↓ BP - They dehydrate the body make you pee - furosemide, hydrochlorothiazide o “the body is dried” o K+ wasting they dump K+ from the body into the potty eat green leafy veggies like spinach & fruits like melons & bananas NOTE: all of these meds can cause ORTHOSTATIC HYPOTENSION EXCEPT DIGOXIN!! - You want to do slow position changes it doesn’t affect B NOTE: Potassium pumps the muscle - High potassium > 5.0 high pump muscle spasm o ECG: Peaked T-waves and ST elevations - If K+ high or low [range: 3.5-5.0] nurse’s 1st action is to cardiac monitor! ACE inhibitors “-pril” 1st choice … “chill pril” SE: - Angioedema (puffed/swollen tongue) airway risk! deadly! - COUGH! ARBs “-sartan” Tx: AntiHTN 2nd choice ↓BP only! NOT HR AVOID: preggos, green leafy veggies (avocado, melons, oranges), salt substitutes and eating LIVER SE: hyperKalemia retain too much K+ > 5.0 Q: if pt has a HR of <60, can we still give ACE inhibitors or ARBs? A: YES! Bc they don’t affect HR Beta Blockers “-lol” ↓ BP & HR Neg. chronotropic: ↓ HR Neg. ionotropic: less force Neg dromotropic: less conduction less beats Always check BP & HR before giving BBs SE: - 1st dose phenomenon rapid drop of BP DON’T leave pt’s bedside - Mask s/s of hypoglycemia shaky, clammy & even hiding high HR… so we want to monitor glucose closely bc low sugar means low brain function” HOLD MED if: HR <60 or BP <100 systolic NOTE: “make SLOW position changes” to avoid orthostatic hypotension AVOID - COPD & asthma pts bc of bronchoconstriction - HF pts so make sure to question dr orders New edema, worsening crackles of the lungs, rapid weight gain and new JVD worsening HF Calcium Channel Blockers → ↓ BP & HR “calm the heart” “-dipine”, “-zem”, “-amil” NOTE: “-dipine” declines BP but NOT HR Never give when BP is low or if HR is <60 Digoxin → ↓ HR NOTE: No BP effect, so no orthostatic hypotension POSITIVE ionotropic → DEEP contraction → ↑ contractility ↓HR Neg. chronotropic: ↓ HR Neg dromotropic: less conduction → less beats TOXIC! Neg. chronotropic: ↓ HR - Check APICAL PULSE for a full min (60secs) o Apical → Left side mid-clavicular 5th intercostal space Neg. ionotropic: less force Neg dromotropic: less conduction → less o If <60, it can be risky, so don’t give the drug! beats - Toxicity → >2.0 o “Vision changes, nausea, dizzy” → notify HCP!! Nursing considerations ▪ Vision changes: fuzziness, blurred vision, color changes, - ALWAYS check BP and HR DIFFICULTY READING - Change positions SLOWLY o Older adults or pts w/ decreased kidney function are at higher - Bad HAs → normal risk for toxicity. ▪ Creatinine > 1.3 → bad HOLD MED if: o Potassium <3.5 (low K+) → increases risk for toxicity - HR <60 or BP <100 systolic ▪ Digoxin does NOT waste K+ → so you do NOT have to eat more green leafy veggies or melons like when taking - Big drop! … ex: 150/90 to 120/70 diuretics… don’t let NCLEX trick you!! NOTE: Give meds slow & easy ▪ Q: which pt is at most risk for digoxin toxicity? Q: pt is on IV verapamil drip w/ HR of 48 ▪ A: always a pt on K+ wasting diuretics [furosemide], or even kidney failure pts w/ creatine >1.3 A: STOP THE DRIP!! Nitrates → Dilators → ↓ BP Nitroglycerin Isosorbide [not a diuretic!] Dilate → decrease resistance → dec. BP Lowers preload + afterload → more O2 out to the body Common AE: HA, hypotension, hot flushing (facial redness) CI: Viagra “-afil” - super low hypotension → DEATH - Confusion, agitation, cold, pale, clammy, diaphoretic, dizzy → s/s of hypotension → monitor BP! STOP med if BP <100 or if drop by 30 Diuretics ↓ BP Decrease BP by draining the fluid - “They drain fluid from the body and into the potty” DOC for acute or worsening of HF [ Worsening crackles, New edema in legs, Rapid weight gain] ANY K+ abnormality NOTE: [range: 3.5-5.0] the FIRST - Decrease BP nursing action is to place pt - Drain fluid on a cardiac monitor! - Dehydrate 2 TYPES: K+ Wasting and K+ Sparing K+ wasting [Loop Diuretics]→ “-ide” … furosemide, hydrochlorothiazide - NOTE: DONT let NCLEX trick you w/ isosorbide [it’s a nitro!!] - MOA: Loop diuretics #1 drugs for worsening HF → we give ides to make the body drie! → They block the reabsorption of Na in the kidneys → less Na retained → we have less swelling - CAUTION: HypoKalemia <3.5… so DON’T give to pts w/ low K+ o Flat T waves, ST depression, weird U wave - K problems → muscle spasms, cramps, weakness, paresthesia - AVOID: licorice root → it ↓ K+, ok to give a green veggie diet! K+ sparing (aka it retains K)→ spironolactone - MOA: They block aldosterone directly to let fluid out of body - AVOID: K+ → green leafy veggies, oranges, bananas, salt - Hyperkalemia → Peaked T waves, ST elevation Always check BP first, BUN & creatine (kidneys), K+ (for imbalances) Take in AM, slow position changes, DAILY weight, sunburn, low NA diet