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