Heart failure means the heart cannot pump well enough to keep up with the body. Fluid backs up behind the weak side. The trick to remember: Left = Lungs. Right = the Rest of the body.
Left vs. right
| Left-sided (lungs) | Right-sided (body) |
|---|---|
| Shortness of breath, especially lying flat | Swelling in the legs and feet |
| Crackles in the lungs | Jugular vein distention (JVD) |
| Cough, sometimes pink, frothy sputum | Weight gain |
| Waking up at night short of breath | Enlarged liver, fluid in the belly |
| Fatigue, confusion | Poor appetite, nausea |
Most patients eventually have both, because left-sided failure often leads to right-sided failure.
Key labs and tests
- BNP: rises when the heart is stretched by extra fluid. A BNP over 100 pg/mL suggests heart failure.
- Ejection fraction (echo): 40% or lower is heart failure with reduced ejection fraction.
- Potassium and kidney function: diuretics and other heart failure drugs change both.
Nursing care
- Daily weight on the same scale, at the same time, in the same clothes. Report a gain of 2 to 3 lb in a day or 5 lb in a week.
- Intake and output, and a fluid restriction if ordered.
- Low-sodium diet, as ordered.
- Head of the bed up and oxygen as needed.
- Know the meds: diuretics (furosemide), ACE inhibitors, ARBs or Entresto, beta blockers, spironolactone, SGLT2 inhibitors, and sometimes digoxin.
Emergency: acute pulmonary edema
Sudden severe shortness of breath, crackles throughout, and pink frothy sputum. Sit the patient upright with legs down, give oxygen, call the provider or a rapid response, and expect IV furosemide.
Related: Digoxin nursing considerations.
Practice this in Head-to-Toe
Assess heart failure patients, hear the crackles, and treat them.
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Quick answers
What is the difference between left and right heart failure?
Left-sided heart failure backs fluid into the lungs, causing shortness of breath and crackles. Right-sided heart failure backs fluid into the body, causing leg swelling, JVD, and weight gain.
How much weight gain should a heart failure patient report?
A gain of 2 to 3 pounds in one day or 5 pounds in one week, or as their provider instructs.
Evidence & Clinical Sources
- 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
- Hinkle & Cheever, Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Wolters Kluwer
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For learning only. Lab ranges and policies vary. Always follow your nursing program, a current drug reference, and your facility's policies.