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2 Minute EBP Challenge

Friday, March 12, 2010
Lessening Stroke Risk in Hypertension
Less variability in systolic blood pressure is associated with better outcomes in stroke risk from hypertension.  Which medication leads to less systolic variability?

Monday, March 08, 2010
Restoring Hemoglobin
One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels.  This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL.  A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.

Sunday, February 28, 2010
Renal Dysfunction
Mrs. Mersa is admitted with sepsis and hypotension.  Her labs indicate:
BUN 58 mg/dl
Serum creatinine 2.1 mg/dl
Urine sodium 70 mEq/L
Urine specific gravity 1.010, with cellular casts and RBCs in the urine.
Based on these findings you would consider:

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Home > 2 Minute EBP Challenge > Brain Naturetic Peptide is Increased in Heart Failure

Brain Naturetic Peptide is Increased in Heart Failure

Monday, June 29, 2009

Stay up-to-date the easy way!

How would you answer this question?

Ms. Leslie has a Brain-Naturetic Peptide (BNP) level of 1273 picograms/ml, as her nurse you should suspect:

a. Acute ischemic stroke
b. Acute renal failure
c. Heart failure
d. Hip fracture

The correct answer is "c" Heart Failure.

Brain Naturetic Peptide (BNP) is a hormone released from the heart when its muscle fibers are stretched.  This is a normal mechanism designed to maintain optimal hemodynamics during changes in activity.  For example, more blood comes back to the heart during exercise and that extra volume of blood stretches the heart which increases the force of cardiac contraction and thus cardiac output.  Stretching the myocardium also stimulates the release of BNP and other hormones to cause vasodilation and diuresis.  These mechanisms are designed to improve hemodynamics during excercise and maintain fluid volumes.

In heart failure, compensatory mechanisms cause the patient retain fluid in an attempt to maintain cardiac output.  Paradoxically, the patient in heart failure can not pump the fluid that it is already going to the heart and the extra fluid stretches the heart beyond its functional capacity.  The heart responds by releasing BNP and other hormones.  BNP causes vasodilation that displaces the extra fluid and stimulates diuresis from the kidney to decrease fluid overload.

With a simple lab test, nurses can assess the extent of heart failure and look for resolution evidenced by lowering levels of BNP.

A normal BNP level is <100 pg/mL.
Goal at hospital discharge <500 pg/mL
Decompensated heart failure >700 pg/mL

Hobbs, R.E. (2003).  Using BNP to diagnose, manage, and treat heart failure.  Cleveland Clinic Journal of Medicine, 70(4); 333-6.

The winner of  the drawing for an autographed copy of my 101 Tips to Improve Your Nursing Care book is Chrissy Tolson, congratulations Chrissy! 
 
This week's question comes from the PCCN Success program.

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

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