NR542 Capstone Simulation Questions

1. What key priority assessment findings are usually seen in left-sided heart failure? How do these findings differ from right-sided heart failure?

Left-Sided Heart Failure:

• Key Assessment Findings:
  • Dyspnea (Shortness of Breath): Often worsens with exertion or when lying flat (orthopnea). Patients may also experience paroxysmal nocturnal dyspnea, which is sudden shortness of breath during the night.
  • Pulmonary Crackles: Fine crackling sounds heard during auscultation of the lungs, indicating fluid accumulation in the alveoli.
  • Cough: Typically dry but can be productive of frothy or blood-tinged sputum in severe cases.
  • Fatigue: Due to decreased cardiac output and reduced oxygen supply to the tissues.
  • Tachycardia: The heart compensates for the decreased output by increasing the heart rate.
  • Cyanosis: Bluish discoloration of the skin, particularly in extremities, due to inadequate oxygenation.

Right-Sided Heart Failure:

• Key Assessment Findings:
  • Peripheral Edema: Swelling in the feet, ankles, and legs due to fluid buildup.
  • Jugular Venous Distension (JVD): Visible distension of the jugular veins when the patient is positioned at a 45-degree angle.
  • Hepatomegaly: Enlargement of the liver due to congestion of blood flow, often causing discomfort or pain in the right upper quadrant of the abdomen.
  • Ascites: Accumulation of fluid in the abdominal cavity, leading to abdominal distension.
  • Weight Gain: Rapid increase in weight due to fluid retention.
  • Nocturia: Increased urination at night as the body reabsorbs fluids when lying down.

Differences:

• Left-sided heart failure primarily affects the lungs, leading to respiratory symptoms and pulmonary congestion.
• Right-sided heart failure primarily affects the systemic circulation, resulting in symptoms such as peripheral edema, organ enlargement, and ascites.

2. Identify two common medication classes used to treat left-sided heart failure. What are two nursing considerations for each identified classification of medication?

1. Angiotensin-Converting Enzyme (ACE) Inhibitors

• Examples: Lisinopril, Enalapril
• Nursing Considerations:
  1. Monitor Blood Pressure: ACE inhibitors can cause hypotension, especially after the first dose. It is essential to monitor the patient’s blood pressure closely, particularly when initiating therapy.
  2. Assess for Cough: A persistent dry cough is a common side effect of ACE inhibitors. If this becomes troublesome, it may be necessary to switch to an angiotensin II receptor blocker (ARB).

2. Beta-Blockers

• Examples: Metoprolol, Carvedilol
• Nursing Considerations:
  1. Monitor Heart Rate: Beta-blockers reduce heart rate, so it’s important to regularly check the patient’s pulse. If the pulse is below 60 beats per minute, the medication may need to be held, and the healthcare provider should be notified.
  2. Monitor for Signs of Worsening Heart Failure: Although beta-blockers are beneficial for long-term management of heart failure, they can initially worsen symptoms such as fatigue or fluid retention. Continuous monitoring of the patient’s weight and respiratory status is crucial to detect any signs of deterioration.