Nursing Field Notes / CARDIO · Pharmacology
Heart Failure 🫀
NG-039
CARDIO
ADHD-friendly visual edition
HF = HEART FAILURE (failure to PUMP forward) → HF = HEAVY FLUID in the lungs & body. So every drug and every rule on this page does one of two jobs: take fluid OFF, or make the pump's job easier.
🔁 Patho, signs & causes live on NG-038 — this page is the treatment, pharmacology, monitoring & patient teaching half (with a 10-second refresher below).
📄 Simple Nursing original — opens in Drive →
💧 Furosemide is #1“Body Dried” — drain the fluid in a pulmonary edema crisis.
🧪 BNP 900+ = SEVEREB = “Broken Ventricles.”
📉 EF ≤40% = HFNormal ejection fraction is 55–70%.
⚖️ 3 lbs / dayor 5 lbs in 7 days = worsening HF.
🚨
CRISIS
STEP 1 · RESCUE THE LUNGSPulmonary edema is the emergency — the lungs are drowning while you read the chart.
🔁 10-second refresher — LEFT vs RIGHT (full detail on NG-038)
| ⬅️ L — LEFT-sided HF = LUNG fluid | ➡️ R — RIGHT-sided HF = ROCKS the BODY with fluid | |
|---|---|---|
| Signs 🔎 | “Pulmonary Edema” · Crackles “rales” that don't clear with cough (NOT rhonchii or wheeze) · Frothy pink “blood tinged” sputum · Orthopnea — dyspnea while lying flat | Peripheral Edema (pitting) · Weight Gain = Water Gain · JVD (big neck veins) · Abdominal Growth: Ascites · Hepatomegaly (big liver) · Splenomegaly (big spleen) |
| Causes 🧨 | weak heart = weak pump — MI (heart attack) · Ischemic Heart Disease (CAD, ACS) | Left sided HF can cause Right HF · Pulmonary HTN · Fibrotic Lungs “stiff lungs” |
| Risk factors ⚠️ | #1 risk factor is HTN · ECG Dysrhythmias (Atrial Fibrillation) · Valvular Malfunction (mitral valve regurgitation) · Cardiomyopathy | |
🧠 Source memory trick — Sodium Swells · Weight Gain = Water Gain Crisis! · RIGHT ROCKS the BODY · LEFT = LUNG fluid.
🗣️ KEY WORDS that scream crisis
“new · sudden · worsening · rapid”
= Pulmonary Edema CRISIS (Lung Fluid!) NCLEX TIP
Those four words in a stem are the whole question — stop reading for a diagnosis and start draining fluid.
💧 #1 action: Furosemide
Furosemide = “Body Dried”
Drain the fluid. It is the first drug in the crisis, before anything else gets added.
🧠 “Wet lungs? Body Dried.” — if the stem says new/sudden/worsening + crackles or pink frothy sputum, the answer is the loop diuretic, not the inhaler.
🆘 Priority interventions — HOPE for pulmonary edema
H
HOB 45 degrees + 🛏️
semi-Fowler's, high-Fowler's, orthopneic position — gravity pulls fluid off the lungs
semi-Fowler's, high-Fowler's, orthopneic position — gravity pulls fluid off the lungs
O
Oxygen 💨
P
Push Furosemide + Morphine, Positive inotropes 💊
E
End sodium & fluids 🧂 (Sodium Swells)
NO drinking fluids + STOP IV fluids
NO drinking fluids + STOP IV fluids
🧠 HOPE — sit them up, give them air, push the fluid out, and stop pouring more in. In that order.
💊
MEDS
STEP 2 · A B C D D DSix drug classes, four jobs: less fluid in, less pressure out, slower rate, stronger squeeze.
🗺️ The map: where each class hits the failing pump
🧠 “A B C — D D D” = ACE/ARBs · Beta blockers · Calcium channel blockers · Diuretics · Dilators · Digoxin. The A B C lower the pressure, the D D D deal with the fluid and the squeeze.
🅰️ A — ACE inhibitors & ARBs
A – ACTS on BP only (not HR)
- A–ACE “-pril” — Lisinopril “chill pril” · 1st choice
- A–ARBs “-sartan” — Losartan “relax man” · 2nd choice
Watch the four A-C-E cautions:
- A–Avoid Pregnancy
- A–Angiedema (Airway Risk) 🚨 *only ACE
- C–Cough *only ACE
- E–Elevated K+ (normal 3.5–5.0)
🧠 A-A-C-E — Avoid pregnancy · Angiedema · Cough · Elevated K+. Cough is annoying → switch to the “-sartan”; angiedema is an airway emergency.
🅱️ B — Beta blockers “-lol”
AtenoLOL — “LOL = LOW”
Blocks both BP & HR (AVOID Low HR & BP)
⚠️ Caution — HOLD IF:
- B–Bradycardia (< 60) & BP low (90/60)
- B–Breathing problems “wheezing” (Asthma, COPD)
- B–Bad for Heart Failure patients — only hold if the patient is in an acute exacerbation of CHF
- B–Blood sugar masking “hides S/S” (Diabetics)
🧠 4 B's to hold a “-lol”: Brady · Breathing · Bad-CHF-flare · Blood sugar. Say it as “LOL = LOW” — low HR, low BP, and a low blood sugar you can't feel coming.
🅲 C — Calcium channel blockers
Calms BP & HR (AVOID Low HR & BP)
- Nifedipine
- “-dipine” — “declined BP & HR”
- Amlodipine — “chill heart”
What each letter actually drops:
| Class | BP | HR |
|---|---|---|
| A — ACE / ARB | ⬇️ down | untouched |
| B — Beta blocker | ⬇️ down | ⬇️ down |
| C — CCB | ⬇️ down | ⬇️ down |
🧠 “-dipine = dipped” — the numbers dip. Same hold-your-horses thinking as the beta blocker: check HR and BP before you give it.
💥 D — Dilators (Vasodilators)
Nitroglycerin · Isosorbide
Nitroglycerin = “Nitro = Pillow for heart”
⛔ Caution: NO Viagra “-afil” — Sildenafil = DEATH!
🛑 Nitro drip — STOP for either of these: NCLEX TIP
| Side effect 😕 | Adverse effect 🚨 |
|---|---|
| HA (headache) — expected, treat it | Low BP — SLOW position changes |
🧠 “Nitro + -afil = no tomorrow.” 💀 And remember the split: headache = side effect, low BP = adverse effect.
🚽 D — Diuretics: “Drains Fluid, Diurese, Dried”
| 💦 K+ WASTING | 🛡️ K+ SPARING | |
|---|---|---|
| Drugs 💊 | Furosemide & Hydrochlorothiazide | Spironolactone — “Spares potassium” |
| Caution ⚠️ | Low K+ — potassium leaves with the water | Potassium climbs — normal 3.5–5.0 |
| Teach 🍌 | EAT melons, banana & green leafy | AVOID salt substitutes, melons & green leafy |
🧠 “Waste it → eat it. Spare it → skip it.” Furosemide wastes K+ so you eat the bananas & greens; spironolactone spares K+ so you skip them (and the salt substitute — it's potassium in disguise).
⭐ D — Digoxin (Inotropic) — “Digs for a DEEP contraction” TEST TIP
Increased contractility — the pump squeezes harder, so more blood actually leaves the heart.
🩺 Before you give it
Apical Pulse × 1 full minute — stethoscope, not the wrist, not 15 seconds
Apical Pulse × 1 full minute — stethoscope, not the wrist, not 15 seconds
☠️ Toxicity — over 2.0
Vision changes · N/V
Vision changes · N/V
🧪 Potassium 3.5 or less
= higher risk for toxicity (and K+ wasting diuretics put it there)
= higher risk for toxicity (and K+ wasting diuretics put it there)
🧠 “Dig hits the EYES and the BELLY.” 👀🤢 Vision changes + nausea/vomiting = check the level. And low K+ → high dig risk — the two D's talk to each other.
🧪
NUMBERS
STEP 3 · DIAGNOSTICS & MONITORINGFour numbers tell you how bad it is and whether your care is working.
🧪 Labs: BNP — “Broken Ventricles” NCLEX TIP
📈 Echo: Ejection Fraction & LVH
🩺 Hemodynamic Monitor — “Swan Ganz” (Pulmonary artery catheter)
🧠 “CVP over 8 = the tank is over-full.”
Pair it with the rest of your diagnostics:
🧪 BNP (Broken Ventricles) · 📈 Echo (EF & LVH) · 💓 ECG (dysrhythmias — atrial fibrillation) · ⚖️ daily weights & I's and O's.
Pair it with the rest of your diagnostics:
🧪 BNP (Broken Ventricles) · 📈 Echo (EF & LVH) · 💓 ECG (dysrhythmias — atrial fibrillation) · ⚖️ daily weights & I's and O's.
🏠
TEACH
STEP 4 · DR. BEDSNursing care & discharge teaching — six letters that cover the whole shift and the whole home.
✅ Nursing care: DR. BEDS
D
Diet: Low SCC 🍽️ — Sodium, Calories, Cholesterol
Low Sodium & Fluid — 2 L + 2 g or LESS / day
Low Sodium & Fluid — 2 L + 2 g or LESS / day
R
Risk for Falls! ⚠️ — Change positions slowly!
B
Blood Pressure & BNP 🧪 — should NOT be increasing
E
Elevate HOB & Legs 🛏️ (with pillows) — high Fowler's
D
Daily Weights and I's and O's ⚖️
Over 3 lbs/day or 5 lbs in 7 days = Worsening!
Over 3 lbs/day or 5 lbs in 7 days = Worsening!
S
Stairs 🪜 — No sex until able to climb 2 flights of stairs without dyspnea
Stockings 🧦 (TED hose) — decreases blood pooling, remove daily
Stockings 🧦 (TED hose) — decreases blood pooling, remove daily
🧠 DR. BEDS writes your care plan: Diet · Risk for falls · BP & BNP · Elevate · Daily weights · Stairs & Stockings.
🍽️ D — Diet: Low SCC
| S | Sodium 🧂 — Sodium Swells |
| C | Calories 🍟 |
| C | Cholesterol 🧈 |
Low Sodium & Fluid: 2 L fluid + 2 g sodium or LESS per day.
- NO OTC meds — Cough or Flu, Antacids or NSAIDS
- NO Canned or packaged foods — chips, sauces, meats, cheeses, wine
🧠 “Two & two, nothing from a can.” 2 L fluid, 2 g sodium — and if it came in a can, bag, jar or bottle, it's already salted for you.
❌ Never / always rules
- 🚫 NEVER massage calves (CHF patients)
- 🚫 NO Viagra “-afil” with nitrates — Sildenafil = DEATH!
- 🚫 In a crisis: NO drinking fluids + STOP IV fluids
- ✅ Change positions slowly — low BP + diuretics = fall risk
- ✅ Remove TED hose daily
🧠 “3 in a day, 5 in a week.” ⚖️ A gain of 3 lbs in a day or 5 lbs in 7 days means the fluid is winning — Weight Gain = Water Gain.
⚡
QUICK RECALL
SAY IT OUT LOUD🆘 HOPEHOB 45°+ · Oxygen · Push furosemide + morphine + positive inotropes · End sodium & fluids
💊 A B C — D D DACE/ARB · Beta blocker · CCB — Diuretics · Dilators · Digoxin
👀🤢 Dig over 2.0Vision changes + N/V · apical pulse × 1 min · K+ ≤3.5 raises risk
🚫 Never massage calves…and never nitro with an “-afil.”
🎯 Cover & check — 4 rapid-fire questions
Q1: A chronic HF client has a new, sudden worsening cough with pink frothy sputum. What is the #1 action?
Furosemide — “Body Dried.” Those key words = pulmonary edema CRISIS. Then the rest of HOPE: HOB 45°+, oxygen, morphine/positive inotropes, end sodium & fluids (stop IV fluids too).
Q2: What do you check before giving digoxin, and what says “toxic”?
Apical pulse × 1 full minute. Toxicity is a level over 2.0 — vision changes and N/V. Potassium 3.5 or less = higher risk for toxicity.
Q3: A client on spironolactone asks about salt substitute, cantaloupe and spinach.
AVOID all three — spironolactone “Spares potassium,” so K+ climbs. Those foods/substitutes are potassium. (Opposite teaching for furosemide/HCTZ: EAT melons, banana & green leafy.)
Q4: When do you STOP a nitroglycerin drip?
Systolic BP below 90, or a 30 mmHg drop. Headache = side effect; low BP = adverse effect (change positions slowly). And never with sildenafil “-afil.”
📌
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