A patient-centered communication approach should be utilized. Before teaching the patient regarding the disease process and the complexities, the nurse must assess and evaluate the patient’s previous knowledge about their disease, on their level of understanding and cognitive functions. When patients learn about their disease, they are able to understand it better and therefore adherence is better. However, in order for this to be successful, teachings must be done repeatedly and positively reinforced.
Treatment plan
Treatment plan goals include treating the underlying cause, reducing the symptoms, preventing decompensation and improving overall quality of life. Life style changes are recommended such as healthy eating, aiming for a healthy weight, limiting physical activity and avoiding smoking. Medications in the treatment of heart failure include ACE inhibitors, beta blockers, Digoxin, diuretics, angiotensin receptor blockers. These medications must be taken regularly along with following healthy lifestyle. Oxygen therapy may be recommended in the hospital or home. A surgery or medical procedure may be needed to control symptoms as heart failure worsens such cardiac resynchronization therapy device, implantable cardioverter defibrillator, left ventricular assist or heart transplant ("How Is Heart Failure Treated? - NHLBI, NIH", n.d.).
Method for providing patient and family education
Specific strategies must be created to achieve better patient outcomes with regards to patient education. Poor knowledge and adherence to self-care recommendations are risk factors of hospitalization and readmission in patients with Heart failure (Rabelo, Aliti, Domingues, Ruschel, & Brun, 2007). The teach-back method confirmed that the patient understands the information shared by the nurse. This is done by asking the patient or the significant other to explain what has been taught and if he has difficulty in doing so, the nurse needs to repeat, clarify or modify. Reassessment of the patient’s understanding is also needed. Because there are a large amount of information involved in heart failure, multiple teach-back sessions is recommended (Xu, 2012).
Teaching plan
In patients with congestive heart failure, the objective of treatment is to stabilize the condition of the patient. There have been several studies that show the importance of systematic education in the management of these patients. As nurses, we must educate our patients in order for them to understand their condition, and to develop self- care activities. These two aspects are essential in improving adherence, preventing decompensated heart failure and in the maintenance of the patient’s stability. Teaching plan must include self-care abilities like what food to avoid, fluid restrictions, monitoring weight, medications, physical activities and monitoring signs and symptoms of worsening disease condition (Rabelo, Aliti, Domingues, Ruschel, & Brun, 2007).
Daily Weight monitoring: Mr. P should be instructed to weigh himself in the morning after first urination and before breakfast. The patient should be told to wear light clothing and to use the same scale daily. Hypervolemia signs include an increase in body weight of 1.3 kg in two days or 1.3-2.2 kg in one week.
Decompensation signs and symptoms: Teach patient how to recognize early signs and symptoms to prevent decompensation episodes.
Medication use: Review the medication regimen with patient and SO focusing on medication names, uses, dosage, schedule and side effects/adverse effects. Using a table with name and time of medications is a simple strategy. Tell patient not to change the dosage or skip unless the physician says so.
Rest and Physical Activity: In order to avoid the negative effects of inactivity, the patient should be advised to walk and to gradually increase the walking distance if possible. Rest is indicated for episodes of acute decompensation. Advise the patient to identify fatigue and shortness of breath when performing activities of daily living.
Diet: Inform patient to avoid adding salt in ready to eat food and avoid canned foods and processed foods.
Fluid Restriction: Advise to limit maximum amount of fluid to 1.5L/day.
Alcohol and tobacco use: Advise not to drink alcoholic drinks and tobacco use.
References
How Is Heart Failure Treated? - NHLBI, NIH. Nhlbi.nih.gov. Retrieved 4 January 2017, from https://www.nhlbi.nih.gov/health/health-topics/topics/hf/treatment
Rabelo, E., Aliti, G., Domingues, F., Ruschel, K., & Brun, A. (2007). What to teach to patients with heart failure and why: the role of nurses in heart failure clinics. Revista Latino-Americana De Enfermagem, 15(1), 165-170. http://dx.doi.org/10.1590/s0104-11692007000100024
Xu, P. (2012). Using teach-back for patient education and self-management. American Nurse Today, 7(3). Retrieved from https://www.americannursetoday.com/using-teach-back-for-patient-education-and-self-management/
