Left sided heart failure! HELP!!

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Ok, so I have an NCLEX question that I need help with:

When assessing a client with suspected left sided heart failure the nurse would expect to find: (choose all that apply)

a. Edema at the anterior tibias

b. Weight gain

c. Crackles on auscultation

d. Pleural effusion

e. Hepatomegaly

I think the answer would be C and D, but I'm not sure about weight gain. I know you would typically see weight gain with peripheral edema in right-sided failure, but would you see it with pulmonary congestion as well? Thanks in advance!!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

http://www.mayoclinic.com/health/heart-failure/DS00061/DSECTION=symptoms

Chronic heart failure signs and symptoms

  • Shortness of breath (dyspnea) when you exert yourself or when you lie down
  • Fatigue and weakness
  • Swelling (edema) in your legs, ankles and feet (not ant tibias)
  • Rapid or irregular heartbeat
  • Reduced ability to exercise
  • Persistent cough or wheezing with white or pink blood-tinged phlegm
  • Sudden weight gain from fluid retention

Think of what happens with Left hearted failure......Heart failure: Causes - MayoClinic.com

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Specializes in Adult Internal Medicine.
Ok, so I have an NCLEX question that I need help with:

When assessing a client with suspected left sided heart failure the nurse would expect to find: (choose all that apply)

a. Edema at the anterior tibias

b. Weight gain

c. Crackles on auscultation

d. Pleural effusion

e. Hepatomegaly

I think the answer would be C and D, but I'm not sure about weight gain. I know you would typically see weight gain with peripheral edema in right-sided failure, but would you see it with pulmonary congestion as well? Thanks in advance!!

If the LV isn't pumping well, where does that blood back up to?

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I believe you are correct with the answers c and d...Left sided HF= Lungs ... Right sided HF = Rest of the body

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Specializes in None yet.

Thank you, kjamison! The other two answers did not address my question. The question asks about symptoms of left sided heart failure specifically.

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Specializes in Adult Internal Medicine.
Thank you kjamison! The other two answers did not address my question. The question asks about symptoms of left sided heart failure specifically.[/quote']

Thanks for the feedback. Let me return the favor.

This attitude will end up hurting you, or worse others, in the end. Both Esme and I tried to make you think about what the physiology of it is, because if you understand that you will understand the symptoms.

You learn from thinking through things. Your NCLEX will ask you about conditions you know very little about and expect you to rationalized your way through them to the correct answer. More importantly when you are out working you will need to do this.

Giving someone the answers to their homework questions teaches them nothing and is, ultimately, a disservice to them.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you, kjamison! The other two answers did not address my question. The question asks about symptoms of left sided heart failure specifically.

I am sorry you felt the information given to you as unhelpful. The goal is to make you the best nurse you can possibly be by looking up the information provided to you and to use your new and developing critical thinking skills, making a decision, and finding the answer.

Then to come back and tell us so we can discuss the answer and why that is the right answer. As per the TOS of this section.....

This is NOT the forum to ask someone to do your homework for you. When asking for assistance with an assignment, please show what you have done first.
for any thing else could be considered academic dishonesty.

Knowing your anatomy and physiology is very important to treating the whole patient for the "right answer" when dealing with real human beings the answers are not so crystal clear.

By the way....ALL CHF patients even Left heart failure are on daily weights....why would that be?

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Specializes in Pedi.
Thank you, kjamison! The other two answers did not address my question. The question asks about symptoms of left sided heart failure specifically.

Actually, yes they did. BostonFNP and Esme both addressed left sided heart failure to get YOU to think through the question and figure the answer out. You are not going to find many posters on here who will flat out answer your school questions for you without trying to get you to think and, as Boston points out, doing so is a disservice.

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Specializes in None yet.

Thanks for all the input/criticism people! I was certainly not trying to give you attitude. :yes: (Probably just frustrated because I had an exam the next day)

I understand the pathophysiology and complications of heart failure perfectly inside out. However, with this question, one of my professors said weight gain was a correct answer. I disagreed with her, and that's why I came here to get a second opinion or two on WEIGHT GAIN (specifically) being a manifestation of left-sided heart failure. Yes, Esme, a pt with left-sided failure may be at risk for gaining weight because of developing right-sided failure (hence checking weight in all HF pts), but it is not a manifestation that a nurse would expect to see in a pt with left-sided failure. I have since clarified this question with another one of my professors who is an "NCLEX question preparer" and he agreed with me saying the correct answer, in this case, would only be crackles, and pleural effusion.

Unfortunately, as I have seen many times already, the rationales and answers to NCLEX questions are not the same as what you see being carried out by nurses in hospitals, and often not the same as what text books say. This is VERY frustrating as a nursing student--being surrounded by contradiction all the time!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I was genuine very sorry you didn't find the information helpful. We really want to help everyone be the best they can be. I unfortunately that doesn't always reflect in the written word. We recognize that as students the stress is over whelming. However......I will have to disagree with the question for people with LHF will experience weight gain without the slightest sing of right heart failure.....it just ins't usually reflected in peripheral edema or ascities for that is a right heart phenomenon.

Even in pre-historic time when I went to school there we these discrepancies and yes they are frustrating.

Good Luck!!!! :)

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The weight gain is the earliest sign of left-sided failure. Your professor is correct. Remember how you should always teach a person with a tendency towards CHF about doing a daily weight check first thing in the morning, before breakfast and after emptying the bladder? Why is that?

It's because when the heart begins to fail, even before the edema and the crackles, the kidneys are sitting down there noticing decreased perfusion, and they retain fluid. You can retain liters -- LITERS-- before you get edema. That fluid retention is why the patients are instructed to call if they gain 2-3 lbs in a day. This is about four-six liters.

Weight gain is the first sign. You may or may not see the others early on.

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Anybody read this? Understand what I meant? This is partly a patient teaching question, too, you know!

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