Heart Failure: Left- and Right-sided (Nursing)

00:01 Now, this is important, right sided and left sided, because you already are familiar with how the heart works, you know, the different chambers: right atrium, right ventricle, left atrial, you know the whole thing and how it works out.

00:16 But just know, whether it's right side of failure or left side of failure, not enough blood is being pumped, right.

00:23 Can't keep things moving, like we need it to in a normal and healthy heart.

00:27 So, when that happens, blood kind of stagnates, that means it hangs around, and then you end up with different signs and symptoms.

00:35 And these signs and symptoms can be grouped into the signs you're most likely to see with left sided failure, or the signs you're likely to see with right sided failure.

00:45 So, let's start with left sided failure.

00:48 Now, you know that we've gone all the way through the heart, right atrium, right ventricle, over to the lungs, back to the left atrium, left ventricle, the left ventricles job is to push blood all the way through to the rest of the body.

01:03 If that left ventricle has been damaged, like see your heart here has had an MI, it's got that dead tissue in the wall, then it can't pump blood out adequately.

01:14 So it's going to kind of what stagnate or backup. Got it.

01:18 So, right atrium, right ventricle, lungs, then left atrium, left ventricle, where's that blood going to start backing up if that left ventricle isn't strong enough to push it out to the rest of the body... to the lungs.

01:34 And you see in our picture, that left ventricle is not really functioning as well as the right side.

01:40 And what's happening in the lungs? Well, they gave you a great representation of pulmonary edema.

01:46 I mean, you're going to end up with extra fluid in the lungs.

01:49 Now, you can notice this, you'll assess this, use your stethoscope, listen to the patient's lung sounds, and you'll hear what we call crackles.

01:57 Remember, it's really important when you're a nurse and a nursing student, that you listen into the front and the back of someone's lungs, because pulmonary edema usually starts in the back and in the bases, and you don't want to miss that.

02:14 Now, what will it feel like? Like a patient? Well, it's not super comfortable.

02:18 What they'll see initially is to have this kind of cough.

02:22 They have a difficult time catching their breath, they feel kind of short of breath.

02:26 It feels like they're breathing through something that's really kind of fixed sometimes.

02:30 They may even cough up blood tinged sputum.

02:33 Think of the types of questions you should be asking your patient when you're interacting with them.

02:37 So you can get them to answer if they're having any of those symptoms without using the big medical words.

02:44 Pulmonary Hypertension. Though, you know, how the heart is all connected.

02:49 You know, right atrium, right ventricle? Yes. I'm going to go through it again.

02:53 Right atrium, right ventricle over to the lungs.

02:56 Hey, wait a minute, right atrium, right ventricle over to the lungs.

03:00 What if there is pulmonary hypertension? Now remember, pulmonary hypertension are the pressures in the lungs.

03:08 So, that's pushing against the tissues and the vessels in the lungs? If it's too high, what does that do to the workload of the right ventricle? Well, if the pressures in my lung are higher than normal, the right ventricle is going to have to work harder.

03:24 Hey, this is just like left sided when you have chronic hypertension, and coronary artery disease.

03:31 Ding, ding, ding, ding, ding, you're right.

03:33 That's what it is. So, because you took the time, as annoying as it was, to go through all the structures of the hearts, you can picture where they are, it makes perfect sense when pulmonary hypertension would cause right sided heart failure.

03:50 Okay? So, what happens is the blood not enough of it, or adequate enough makes it to the lungs, it backs up.

03:57 Now look at those arrows you see going through the heart.

04:00 Do you see where it's backing up? Yeah, that's coming back, right into that right ventricle into that right atrium and then into the vena cava.

04:10 Okay, that's going to cause a backup of fluids into the rest of the body.

04:16 That's really important. I'm going to give you a mnemonic for that.

04:18 So what are you going to see in your patient? They're going to have decreased O2. They're going to have hypoxia.

04:24 They're probably going to have low blood pressure.

04:27 They're going to have peripheral edema.

04:31 And now, why did I do this motion? Because you're thinking right side of your heart, everything's backing up here.

04:37 You're going to have peripheral edema.

04:40 Now, peripheral refers to anything that's not my trunk, right? Arms and legs.

04:44 In a patient with congestive heart failure, if they have right sided failure, you're going to see edema, particularly in their feet and in their legs.

04:52 So, watch for that, make sure you look at your patient's feet.

04:55 Oftentimes, people don't want to take their shoes off, or they don't want to show their leg.

04:59 Just be as kind and compassionate as you are but make sure that you examine those.

05:04 Now, another side of right sided failure is jugular vein distension.

05:12 Why? Because all that fluid is backing up here.

05:16 Now look at your health assessment course, watch how we assess for that. But it should make sense to you.

05:22 Pause the video for just a second and see if you can explain to a pretend study buddy, that's with you.

05:28 Why you have jugular vein distension in right sided heart failure? Now, aside these. Remember, everything is backing up.

05:37 So, jugular vein distension is all that excess fluid backing up.

05:40 Ascites is, wow, we've got stuff back in up here.

05:44 And that's what ascites is that is extra fluid in your abdomen.

05:49 So, jugular vein distension. Moving on down here we're going to have some liver issues, we've got ascites.

05:55 And that's a sign that that is not going well.

05:58 You're going to have hepatomegaly.

06:01 So that means the liver is going to be getting kind of big.

06:04 Again, there's a whole lot of blood that goes through the liver, and it needs to keep moving through the liver to go through the rest of the body.

06:11 The right side of the heart cannot pump effectively, then you've got all this blood clogging up this way, and the liver is going to get all swollen.

06:21 So what do you see, with right sided failure that's different than left sided failure? Our biggest problem and left side of failure of a worst thing that can happen is pulmonary edema.

06:33 Right sided failure, you're going to see some different things, but it's all backing up here.

06:38 Jugular vein distension, hepatomegaly, peripheral edema.

06:42 You know why all those things happen.

06:45 So, what's the mnemonic that will help you remember this? Right is our for the rest of the body.

06:52 Right sided failure has effects on the rest of the body.

06:56 Left is lungs. Remember, that's kind of helpful, but you knowing how your heart works, makes much more sense to.

07:05 That right ventricle if you can't move things over, it's going to backup to the rest of the body.

07:10 Left ventricle is going to backup into the lungs.