Walkthrough: Health Promotion and Maintenance Q7 – NCLEX-RN®

00:01 The nurse is performing discharge teaching to a client diagnosed with congestive heart failure due to persistent hypertension.

00:08 Which recommendation is given by the nurse to the client? Select all that apply.

00:14 Okay, let's break apart that stem. So I'm the nurse and I'm doing discharge teaching.

00:19 This is a pretty common topic because the reason they ask questions about discharge teaching is that you're expected to recognize all the risks of whatever diagnosis the patient has or when they go home, and how they can minimize the risk of making things worse.

00:35 So you may see a lot of questions about discharge teaching or patient teaching.

00:40 So, I'm the nurse, I'm performing discharge teaching that's appropriate to a client diagnosed with - anytime you see a diagnosis you have to start thinking, what's the worst case scenario? Congestive heart failure, okay, that means the heart is not able to adequately pump blood around to the rest of their body.

01:03 Now, it tells us what was the cause of the congestive heart failure, it was due to persistent hypertension. What? Okay, let's break that down.

01:13 How does high blood pressure cause congestive heart failure? Well, when you're thinking through the worst case scenario, remember, if the heart is pumping blood it comes in right atrium, right ventricle, over to the lungs, back to the left atrium down to the left ventricle and then out to the rest of the body.

01:32 Now, if I have hypertension, really high blood pressure for relatively long period of time, that left ventricle is going to have to work harder and harder and harder, to get that blood moving all around the body. Now, at first, it can accommodate, but then after a while, we've just so over worked it, that muscle is not as strong as it used to be, so it can't push-out blood very well or at least, adequately, like it used to.

02:03 So, what I'm talking about is the recommendations that I give to the client based on them having congestive heart failure due to persistent hypertension.

02:14 So we know we have two things - congestive heart failure and high blood pressure.

02:19 Alright, this is a select-all that apply question so let's show you the answer choices.

02:24 Remember, before we go there, write down the number 1, number 2, number 3, number 4, and number 5 on your scratch paper.

02:33 Don't write the answer choices just write those numbers.

02:36 Now as you work through this, we're going to look for what's an appropriate or safe recommendation for our client with congestive heart failure and persistent hypertension.

02:47 Okay, here come the answer choices. There they are, all five of them.

02:52 Pause the video, go ahead and ask yourself how you've reworded that question in your own words.

02:59 Ask it five separate times, so it's like you're answering a yes/no question, or a true/false question.

03:06 Ready? Alright, push the button, I'll see you in a minute.

03:15 Hi! Welcome back. Hey, I want to really encourage you, if you're pausing that button and working through those answer choices like we recommend. Good work.

03:25 It takes discipline and focus to do that.

03:28 But I promise you, that's where you get through the benefit of working through these questions with me.

03:33 You need to try it on your own, then come back, and listen to how I walk through the question.

03:38 Then you can start making some decisions, taking a look at what you are actually doing in real practice.

03:44 Often times, what we think we do on test questions is not what we're actually doing on test questions.

03:50 Because as a veteran faculty, you know what I know? You are the only expert on what's going on in your head when you answer these questions.

04:01 So you've got to be part of the team to help yourself do better.

04:04 So, I know that test taking is frustrating, don't let yourself get stuck there.

04:09 Let's learn something, let's see what we can learn about your test taking strategies as we go through this question.

04:15 Well, you see here answer choices, we've got five, right? So which one is appropriate given by the nurse to the patient who has persistent hypertension and CHF? Number 1, get as much bedrest as possible.

04:30 Now, you may have been tempted to pick that because like, hey, they're tired.

04:35 Their heart is tired, there're going to be some extra rest.

04:38 Keep in mind, on the NCLEX, you want the patient to stay as independent and active as possible, so we don't want to ask them to stay on bedrest.

04:49 Do we want them to rest occasionally, want to watch their energy, absolutely.

04:54 But something like that, get as much bedrest as possible, no, that's too extreme and not what we're looking for.

05:01 So whether you got that answer choice right or wrong, write yourself a little note about the NCLEX. On the NCLEX, and in real life, we want to keep patients as independent and active as possible.

05:15 Okay, so that's just a tip, you can use that on other questions.

05:19 Number 2. Is it appropriate for patient with congestive heart failure and high blood pressure to stay on a low sodium diet? Okay. It sounds good, let's think about that.

05:30 What does sodium do in the body? Let's see, wherever sodium goes, ahh, water follows.

05:36 So if I have a lot of sodium in my diet and I have a lot of extra fluid on board, my body's going to hang on to that fluid so a low sodium diet is a healthier choice.

05:47 Why? Remember, we talked about it, if you have extra sodium, water follows.

05:52 So if I have a high sodium level, I retain a lot more water.

05:57 When I retain more water in my intravascular space, right in my veins and arteries, my blood pressure is going to be even higher and my heart is going to have to work harder, none of that is a good idea for this client, so, yes.

06:14 If you guessed right, if you said that, yes, we want them to be in a low sodium diet because I remembered studying that somewhere.

06:21 Is there anything in my explanation that you need to add in your notebook? Could you keep in mind that anyone who has more volume intravascularly, so you write, increased volume in the IV, intravascular space, leads to increased blood pressure and more work for the heart.

06:42 That may be something you want to take away with you.

06:44 Those are the kind of nuggets that I want you to get as we're going through these questions, because, yes, we're learning how to answer this question, but most important, I'm teaching you strategies, you can apply them on questions when I'm not with you on the video, because I want you to be successful on your exams. I know, they can be frustrating.

07:04 So back in the answer choices. Number 1, we got rid of that because we want the patient to be as independent and active as possible, always.

07:12 Number 2, we explained why a low sodium diet is a good idea for somebody with CHF and persistent high blood pressure.

07:20 Number 3, continue the antihypertensive medication and monitor blood pressure.

07:25 Well, I don't know who that would be bad for, right? So you want them to stay on their high blood pressure medication and monitor blood pressure for someone who has congestive heart failure and persistent hypertension. Yes, those are good.

07:39 Number 4, report weight gain of more that 2 to 3 pounds in one day.

07:46 Ooh, okay, what would weight gain have to do with CHF? Is there any connection between CHF getting worse and weight gain? Absolutely. So this can be an early sign, no, it doesn't absolutely mean the client is going into congestive heart failure.

08:02 However, most healthcare providers will ask the client to weigh themselves everyday and let them know, give them a call, if they gain more than 2 or 3 pounds in one day.

08:13 Why? Well, weight fluctuates a lot but more than 2 or 3 pounds there might be something going on.

08:20 So the healthcare provider might adjust trial of care, the medications.

08:24 So I'm asking myself this question, is this appropriate teaching for somebody with congestive heart failure and persistent hypertension that they should report weight gain of more than 2 or 3 pounds in one day, absolutely.

08:39 That's what's recommended by the American Heart Association.

08:43 Now, a healthcare provider may change those numbers, but as a general rule, this is a good general guideline for more than 2 to 3 pounds in one day.

08:53 Now, number 5. Participate in regular exercise such as daily walking.

09:00 Well, who is that not a good idea for, right? So we're going to leave Number 5 in.

09:06 So number 1, yeah, there, 2, 3, 4, and 5 are appropriate for patient with congestive heart failure who has persistent hypertension.

09:17 Alright, pause the video, add any notes that you need to add to your notebook, and then come back and do another question with us.