Heart Failure Pathophysiology RN Teaching Script

Nurse: What does the word Heart Failure mean to you?

Patient: You should expect a variety of responses from the patient. The goal is to define heart failure in simple terms.

Nurse: The word heart failure does not mean that the heart has “failed” or stopped beating. Heart failure actually means that the heart muscle is not pumping as well as it should. Understanding normal heart function will help you understand what happens when you have heart failure. Let’s review normal heart function.

Normal heart function: The heart is like a pump. The function of your heart is to pump blood containing oxygen and nutrients to the rest of your body. These nutrients are needed for you to stay healthy. Blood moves to and from the heart through a system of blood vessels. First the heart receives blood from the body. It then sends the blood to the lungs to pick up oxygen. Waste products are also removed from the blood when it moves through the lungs. After it picks up oxygen rich blood, it goes back to the heart where it is pumped out to the rest of the body. Your body uses this oxygen rich blood to perform all of its functions.

Note: Use the patient’s Heart Failure Handbook or the EDOCS document About Your Heart as a teaching aid. This section provides a diagram of the heart and demonstrates the movement of blood into and out of the heart. Tracing the blood through the heart will help them understand what happens when the heart is unable to adequately pump the blood out of the heart.

The right atrium receives blood from the body. The blood is low in oxygen because it has delivered its oxygen to your body. The right atrium sends blood into the right ventricle.

The right ventricle squeezes the blood out to the lungs to pick up fresh oxygen and nutrients and to remove waste products. Oxygen-rich blood returns from the lungs to the left atrium.

The left atrium sends the blood into the left ventricle.

The left ventricle pumps the oxygen rich blood to your body.

Do you have any questions about normal heart function?

What did we say the function of the heart was?

Can you trace the flow of blood through the heart?

Patient: Based on your patient’s response you will either reinforce further teaching regarding normal heart function or move on to abnormal heart function. The patient should understand the forward flow of blood through the heart with emphasis on oxygen and nutrients being carried out to the body.

Nurse: Now let’s talk about abnormal heart function and what happens when your heart cannot pump enough blood throughout the body. Heart Failure Pathophysiology RN Teaching Script

Abnormal Heart Function: Remember we said heart failure means the heart muscle is not pumping as well as it should. This results in less blood, nutrients, and oxygen going out to your body. Blood begins to back up in the blood vessels. Because the normal amount of blood is not moving forward, the extra fluid must go somewhere. It begins to back up in the tissues. When the blood backs up in the lungs, you may feel like it is hard to breathe. Fluid backing up into other parts of the body causes swelling. When there is too much fluid in the body, it puts even more strain on the heart. We will talk about this more when we cover symptoms.

As we said before, your body needs adequate amounts of oxygen and nutrients to remain healthy. When your body gets these nutrients in less amounts, it has an effect on your body. Less oxygen and nutrients to:

1. Your brain may result in anxiety, confusion, dizziness, and/or drowsiness.

2. Your kidneys may result in less urine output and hormonal changes

3. Your muscles may result in weakness.

4. Your heart may result in chest pain/heaviness and or palpitations/racing heart.

5. Your stomach may result in nausea and lack of appetite.

6. Your lungs may result in shortness of breath.

7. Your skin may result in a cool and clammy feeling.

So, what happens when the blood begins to back up?

When less oxygen and nutrients is sent out to the body what happens? Can you name at least two things?

Patient:Expect the patient to talk about blood backing up in the lungs which produces shortness of breath and the tissues which produces swelling. Expect them to name at least two things from the list above.

Nurse: Heart Failure is not just a pump problem. It is also a hormonal problem. Your body makes hormones and other chemicals to help correct for the reduced blood flow to your body. When less oxygen and nutrients go to your kidneys, there are receptors in your kidneys that say to the body, “I’m not getting enough blood.” In response they secrete certain hormones that result in the heart pumping harder to increase the amount of blood flow throughout the body. These hormones help at first, but over time they further weaken your heart. Many of the medicines you take block the harmful effects of these hormones on your heart. We will cover these in more detail when we talk about your medication.

Remember, heart failure is a chronic disease. You will need to manage it for the rest of your life. It does not go away but can be treated successfully with your help. Heart Failure Pathophysiology RN Teaching Script

Note: utilize Pathophysiology Quiz to assess effectiveness of teaching and reinforce as needed.