Understanding Heart Failure, Simply and Easily: A Guide for Nursing Students

Have you ever felt confused about the symptoms and nursing care for Cardiac Heart Failure? After today, you won’t have to feel that way anymore! Whether you’re an advanced nursing student, or only studying the topic for the very first time, Heart Failure is an AWESOME example of how you can make your studying waaay easier and learn to think like a nurse at the same time.

(Spoiler Alert: Once you master your Step 1 of the Silver Bullet Study System for Heart Failure, you’ll be shocked at how easy the rest of it becomes…even if you’ve hade trouble understanding Left-sided Heart Failure or Right-sided Heart Failure, and maybe even got the symptoms confused in the past)

Step 1 for Understanding Heart Failure

Every nursing student who comes to me for tutoring on Heart Failure has made the same mistake: they’ve jumped straight into memorizing symptoms and “priority” nursing care, completely skipping Step 1 of the Silver Bullet Study System (FYI, if you don’t yet know about the Silver Bullet Study System–the BEST way to study for Nursing School–then click here to ask me to send you a 10-minute overview video where I explain the whole thing, start to finish!)

The problem with that, is that by definition you can’tmemorize priority nursing care. That’s because priorities change depending on the situation and the scenario. This is what makes these sorts of nursing exam questions so dang hard…not because your instructors hate you, but because you can’t evaluate and juggle priorities if you only memorized specific nursing interventions without studying to understand the different contexts you would use those interventions in.

Luckily, doing that is easier than it sounds, although a lot of nursing students don’t believe me right away that it will work, and don’t bother to try it until they’ve already gone on to fail a few more exams, unfortunately.

So in Step 1 of the Silver Bullet Study system for Heart Failure, you need to answer this question: What do I need to know about normal stuff, before I can begin to study Heart Failure?

This is a question you can start to answer no matter where you’re at in nursing school, no matter whether you have any previous healthcare experience, even if you’re a brand new nursing student who only started yesterday. Because if you know you’re studying heart failure, then you can make an educated guess that you might need to know something about the normal A&P of the heart.

My version of cardiac A&P

And you’d be absolutely right. Because the normal A&P of the heart is the secret key to understanding the symptoms of Heart Failure later on in Step 3 (and once you understand why those symptoms happen, then prioritizing the nursing actions in Step 4 will become super obvious).

How much Cardiac A&P do I need to know?

Basically, you need to know the blood flow through the heart as if you were Ms Frizzle’s substitute teacher, responsible for guiding a shrunken-down school bus full of 4th graders on a guided tour.

Any memorization that needs to get done is almost all going to be in Step 1 and 2, but that’s a good thing! Because since it’s all ‘normal’ info, you’ll get to reuse this knowledge the next time you need to study any cardiac heart disease or medication (because guess what…the ‘normal’ stuff hasn’t even changed since I was in Nursing School!!).

You will save yourself SOO MUCH study time by making the effort to memorize normal NOW…in addition to making it SOO MUCH easier to understand the symptoms and nursing care without memorization.

Don’t skip this step, or else the study process won’t work.

Step 2: Pathophysiology of Heart Failure for Nursing School

This step is usually short and sweet. You need to define, in your own words, what has ‘broken or changed’ when Heart Failure occurs.

The ‘in your own words’ is essential, because if you’re simply copying and pasting from a textbook or powerpoint slide, then that’s a passive learning strategy and you’re going to regret studying that way because you won’t understand it as well (OR retain it as well…) as if you used an active learning strategy. And an active learning strategy can be something as simple as translating the medical jargon into your own, everyday words that even a 4th grader would understand.

For Left-Sided Heart Failure, I like to reword it to say something like, “The left ventricle is no longer able to pump blood effectively.” This simple, yet accurate, definition leaves rooms for the different ways that could happen, which I usually include in my notes as ‘Step 2b’.

For example, if someone has a heart attack and some of their heart cells on the left Ventricle die…well, they won’t be able to contract anymore, which means they won’t be able pump effectively. Alternatively, another reason the ventricle might not pump effectively is because it has hypertrophied after years of working harder than it should (maybe due to hypertension), and so the larger-than-normal cardiac cells take up so much space that there’s not as much room for blood inside the ventricle anymore. That would also cause the ventricle to be able to pump out less blood.

In any case, the Step 2a should be simple, and it should directly tie to the underlying pathophysiology–not the disease symptoms. That comes in Step 3.

Step 3: How Heart Failure Affects the Body

The key to Step 3 is that now you need to start practicing how to think like a nurse during your study time. And this is the simplest way I’ve found in my 15-years of profession nursing tutoring experience to do it.

Stop thinking about your lecture. Stop thinking about your power point slide. Stop thinking about your textbook.

Only think about the info you’ve reviewed in Step 1 & 2. Now ask yourself, “Based on what I know about normal, based on what has broken or changed, what do I predict will happen next?”

Because those are the symptoms. And they’re very logical and understandable when you study this way. But the most important thing is that you need to practice predicting them first, because that’s the REAL skill you are being tested on exams…so you need to be practicing how to think during your study time, too.

Most nursing students completely skip the practice of “thinking like a nurse” simply because nobody has told them how. So I’m telling you exactly how to do it.

Symptoms of Left Sided-Heart Failure

So what do we know about normal? Well, we know the normal A&P of the heart. And what has broken or changed? the left ventricle doesn’t pump effectively. So what happens next?

We have a bloody traffic jam, that’s what!

The blood will start backing up, since it can’t get through the left ventricle at the normal speed. And where does it back up to? Just refer back to the A&P diagram from Step 1, and you’ll quickly see…

It backs up into the left atrium, then the pulmonary artery (causing elevated pulmonary pressure, a symptom of left-sided heart failure). Then the blood backs up into the lungs…and that right there explains almost all of the other symptoms of left-sided heart failure, which typically have to do with oxygenation. You can see left-sided Heart Failure symptoms like:

  • Breathing Problems (because you have fluid overload in the lungs, and some of it is leaking out into the alveoli–which, if you don’t know about the alveoli, that’s some important normal info you should go back and add to your Step 1 study notes!)
  • Coughing up pink-tinged mucous (again…excess blood is leaking fluid into the lungs!)
  • Fatigue (because if the blood is not getting oxygenated well–review the normal gas exchange process in Step 1 if you don’t already know it–then your body tissues won’t get the oxygen they need for energy, and you’ll be tired)
  • Bluish color of fingers/lips (because oxygenation is a problem, therefore perfusion will be a problem, too, with less oxygenated blood travelling around the body)
  • Possible complication: Right-Sided Heart Failure (because if you keep backing up the blood, now you’re making it harder for the right ventricle to pump effectively, and over time it can also failure…making left-sided heart failure the most common cause of right-sided heart failure–although, of course, it’s not the only possible cause.)

Symptoms of Right-Sided Heart Failure

Now if you want to predict the symptoms of right-sided Heart Failure, you simply continue remembering your normal A&P. Only this time, it’s the right ventricle that failed.

So what do you predict will happen next?

Well, the blood backs up from the right ventricle into the right atrium, then back into the vena cava blood vessel, which is the vein that returns blood from the body into the heart. This is why the primary symptoms we see in right-sided heart failure have more to do with the rest of the body, versus primarily the lungs.

(side note: don’t get me wrong, right-sided heart failure will most likely also have some symptoms of the lungs…but as you can see from the left-sided heart failure explanation, for many patients this is because the increased pulmonary pressures in the lungs caused the right-sided heart failure in the first place.)

So if the blood is now backing up into the veins, then you can predict these kinds of symptoms for right-sided heart failure:

  • Jugular vein distention (because the jugular vein feeds into the vena cava, so it’s also ‘backed up’ now)
  • Hepatomegaly & Splenomegaly (because these are some of the last organs blood passes through before returning to the heart, therefore–you guessed it!–the blood is backing up in these organs, wreaking havoc, and causing liver & spleen symptoms)
  • Peripheral Edema (because since there’s a big and growing fluid back-up in the body, it will lead to fluid volume overload, and water will be leaking out of the blood vessels into the interstitial space).

Ironically, that last point also ends up increasing hypertension, which makes it harder for the left ventricle to work, and if it’s already failing…well, you can probably see why Heart Failure is a chronic condition that doesn’t improve.

We can really only manage the symptoms, which leads us to Step 4…

Step 4: Predicting Nursing Interventions for Heart Failure

Believe it or not, I typically spend the least amount of time tutoring on Step 4, regardless of whether I’m working with a 1:1 Tutoring client or explaining a disorder to nursing students in my Group Tutoring Membership.

That’s because by now, once you’ve had a little practice, the nursing care starts to make a lot more sense. And since every nursing action you predict needs to tie to the previous 3 steps, you can think it through systematically and organize your prediction one step at a time.

Nursing Care for Symptoms of Heart Failure

Looking over the symptoms from Step 3, you can make the very educated guess that a lot of the nursing/medical care for left-sided heart failure will be related to helping the client breath better. That might include administering oxygen, encouraging them to sit or lay in a semi-upright position (aka Semi-Fowler’s position is always great!), or grouping your nursing care to allow them plenty of rest.

For right-sided heart failure, you’ll expect to have more nursing/medical care that directly effects the symptoms on the body. Monitoring lab tests for liver function, taking blood pressure, and perhaps even administering anti-hypertensives and diuretics could all be appropriate actions.

Then go through that same process to see if you can predict any nursing interventions that tie back to Step 2 or Step 1, as well. When you’re finished making predictions, be sure to check your textbook, lecture powerpoint slides, or whatever your preferred resource is so that you can check your prediction (to make sure you were correct!), and also add any additional nursing or medical care that you didn’t predict, but need to know.

Applying your Heart Failure Studying for Nursing Exams

When you start switching over to the Silver Bullet Study System from your current study methods, this can feel a little scary! After all, it’s a new skill, and you’ve got a lot at stake if you fail nursing school.

Which is why you have to learn to trust the process…and that involves actually studying this way, and doing it correctly. When you do that, you can start to see incredible results!

For example, I recently had not one, but TWO of my 1:1 tutoring students who both improved their test scores by 10% after a single tutoring session! I don’t promise that everyone will have results that quickly (because it’s like working out at the gym…the more consistently and correctly you do the exercises, the better the results over time).

But it’s obvious that if you already have a good foundation of nurse knowledge (aka, if your nursing instructor tells you, “I don’t know why you’re struggling, you seem to know everything when I talk to you in office hours!”), then you can see how quickly the Silver Bullet Study system could work for you.

And since nursing exams are REALLY testing you on “how to think like a nurse”, then once you start studying like a nurse, it’s easy to see how you can improve that quickly, too.

If you’d like help to make sure you correctly understand how to use the Silver Bullet Study System and make sure that YOU are using it correctly, the Group Tutoring Membership is a great option!

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