Introduction
Congestive heart failure is a condition whereby the heart is not able to pump enough oxygenated blood to the body (Kulick & Shiel, 2013). It is a common heart condition which is experienced all over the world. People with kidney, liver or lung problems are more predisposed to the condition than people without those problems. It can be a fatal disease if not carefully managed. Patients with congestive heart failure usually have to undergo a lot of treatment procedures to avoid fatalities. Nursing care can be administered at home for cases that are not severe. There are a variety of drugs used in treating congestive heart failure. The medications include; Beta blockers, Angiotensin Converting Enzyme (ACE) and diuretics (Kulick & Shiel, 2013).
Discussion
Angiotensin Converting Enzyme (ACE) inhibitors have been used on patients suffering from heart failure for over 20 years. They usually prevent the secretion of angiotensin II a hormone that is potentially harmful to a congestive heart failure patient as it affects the circulation of blood and thereby functioning of the heart. ACE has been shown to lower the risk of occurrence of heart attacks and heart failure. In addition, they prolong life and prevent clinical deterioration of patients suffering from CHF. They are highly recommended for patients suffering from heart failure. Patients who are allergic to ACE are usually given ARB’s in its place. Side effects of ACE’s include a dry cough, electrolyte imbalances, worsening kidney function, and low blood pressure and in rare occasions allergic reactions may occur. Some examples of ACE’s are; benazepril (Lotensin, enalapril (Vasotec), ramipril (Altace), lisinopril (Zestril, Prinivil and captopril (Capoten).
Angiotensin receptor blockers (ARBs) are given in place of ACE’s in cases where the patient may be allergic to ACE. ARB’s carry out similar actions to ACE’s but instead of preventing the secretion of angiotensin II they prevent its action at the receptor site. Some studies have indicated that ARB’s may be more efficient in treating congestive heart failure especially in the elderly but there has been no scientific confirmation of the claim. ARB’s have similar side effects to ACE’s with less occurrence of dry cough. Examples are; telmisartan (Micardis), losartan (Cozaar), valsartan (Diovan), candesartan (Atacand), olmesartan (Benicar) and irbesartan (Avapro) (Kulick & Shiel, 2013).
Beta blockers prevent the action of stimulating hormones such as norepinephrine and epinephrine on the body tissues. Hormones such as epinephrine and norepinephrine when released cause an effect on the beta receptors and stimulate the body tissues. The stimulation of the beta receptors of the heart causes a forceful contraction which can be fatal. The blockage of beta receptors has been seen to cause detrimental effects on the heart muscle in the long term such as weakening the heart muscle. However, the use of Beta blockers has been seen to increase the health of the heart when used together with ACE’s. The patient start with small dosages and the dosage is increased gradually. The side effects of Beta-receptors include; low blood pressure, fatigue and light headedness, low pulse and fluid retention. Beta blockers aren’t supposed to be used in people with certain diseases of the airways such as emphysema and asthma or in people with very low resting heart rates. The common beta blockers are carvedilol (Coreg) and metoprolol (Toprol XL).
Diuretics are another class of drugs that is commonly used in dealing with congestive heart failure. Diuretics alleviate the symptoms of fluid retention in the lungs and other body tissues. They do so by promoting the flow of liquids through the kidney. Hence, preventing the hospitalization of a patient. If a patient is admitted in hospital, diuretics are administered intravenously since oral intake may be impaired. They also relieve shortness of breath and leg swelling. However, diuretics have not been shown to impact the long term survival of a patient. Common side effects in patients with severe congestive heart failure include; low blood pressure, hearing disturbances, low potassium levels, electrolyte disturbances and dehydration. Examples of diuretics are; hydrochlorothiazide (Hydrodiuril), furosemide (Lasix), torsemide (Demadex), spironolactone (Aldactone), bumetanide (Bumex) and metolazone (Zaroxolyn). Electrolyte disturbances may cause heart rhythm disturbances.
Some side effects of these drugs are likely not to be reported. Here are some examples. Most side effects of ACE’s are known but side effects such as worsening kidney function are not reported because they lead to a lack of adherence to the drug (Shwarzer, 2008). Patients may lack to see the need of treating one problem if they know they are in some way creating another by doing that. The fluid retention side effect of beta blockers may not be reported since the patient may live in fear of developing lung problems such as pulmonary edema in addition CHF. Also when some of the patients learn of the possible severe side effects of the drugs are no longer willing to take the drugs which pose a greater danger to the patient than that of taking the drugs.
Some of the special instructions accompanying some of these drugs are:
For some of the ACE inhibitors
- Accupril (quinapril)- should be taken on an empty stomach, an hour prior or 2 hours after a meal It can also be taken with a low-fat, light meal.
- Altace (ramipril)-Swallow capsule whole.
- Capoten (captopril)-1 hour before meals.
For Beta blockers
- Coreg (carvedilol)-with food.
- Coreg CR (carvedilol, extended-release) - Taken in the morning with food. Should be swallowed whole and not crushed or chewed.
For diuretics
- (bumetanide)-If stomach upset occurs, should be taken with food or milk in case it causes stomach upset. Take before 6 p.m. to avoid nighttime urination.
- Demadex (torsemide)-taken with or without food. Take prior to 6 p.m. to avoid nighttime urination.
In additional to a registered nurse, a pharmacist can be included in the team of professionals assisting the patient (Desroches et al., 2013). A pharmacist can provide motivational informational as well as provide medication management. The pharmacist is also able to identify problems related to the medication.
Diet is an important thing to take note of when dealing with congestive heart failure. Taking the right diet can improve the health of the patient. It also reduces the symptoms of the patient. Culture provides a barrier to some dietary changes required for patients with CHF especially in regard to the meat a CHF patient should consume. The dietary changes that need to be made include; a reduction in the intake of sodium and a reduction in fluid intake (Kulick & Shiel, 2013). Sodium retains water and may lead to water retention in the body leading to conditions such as pulmonary edema which can cause fatalities for a patient of congestive heart failure. In order to reduce salt or sodium intake the patient can ensure he/she reads food labels while purchasing products and avoid added salt. In place of salt the patient may use lemon or fresh herbs (Shwarzer, 2008). Another dietary adjustment a patient may have to make is on fluid intake. The doctor will give the CHF patient an amount of fluid intake he is not supposed to exceed. The patient can then make a log to monitor his fluid intake. For foods, the patient is required to consume fresh foods as opposed to prepackaged foods. Lean meats such as chicken are advised for proteins and for daily products low fat milk, yoghurt and cheese are preferred. Diet change may be a challenge for people from strict cultures. Some cultures are against eating white meat yet chicken is advised for the CHF patients. It is especially difficult if the patient involved is elderly.
In addition to a registered nurse, a registered dietitian would be a preferred addition to the team. The dietitian will work with the nurse and family members to ensure the patient follows the diet prescribed perform Medical Nutritional Therapy (MNT) and advice on a healthy lifestyle (Desroches et al., 2013). Through the use of motivational techniques he can increase adherence to medication and a healthy lifestyle. A dietitian or nutritional professional will hence reduce hospital visits, increase the overall health of the patient, and possibly reduce prescription drug use.
Physical exercises are very important in the treatment of congestive heart failure. The role of exercise for a patient of CHF is; to improve circulation, strengthen the heart, if obese to lose weight, reduce heart disease risk factors such as obesity and high blood pressure, increase energy levels, improve heart failure symptoms and reduce tension, stress, depression and anxiety (Kulick & Shiel, 2013). The registered nurse can promote adherence to a daily physical routine by having a time table which is checked after performance of the task. The registered nurse can also work hand in hand with the family members to encourage the patient to adhere to the physical activity. Another method the nurse can use is reinforcement of good adherence to the physical activity. The nurse can keep a log where she records each daily activity that is done. The nurse could talk to the patient about the importance of the exercise and thereby motivate them to engaging in the physical activity (Shwarzer, 2008). A well informed client about the advantages and disadvantages of adhering or not adhering to the exercise may help the patient adhere.
In additional to a registered nurse, a physician assistant is required to assist in the performance of exercises (Desroches et al., 2013). Assistant physicians are good at assisting patients do their exercises. They are well versed in the exercises required for an individual suffering from congestive heart failure. A patient with CHF requires cardiovascular exercises. These exercises involves large number of muscles to strengthen the heart and lungs. A physician assistant will also be able to recognize when the client should stop the exercise in case of pain during the exercise. In general, a physician assistant is the best person to help clients with his/her exercises since they have been trained in the field and knows the dos and don’ts of exercises and which specific exercises to administer to a certain patient (Desroches et al., 2013).
Evaluating the Effectiveness of the Interdisciplinary Team
The interdisciplinary team usually consists of the physician/doctor who is usually the leader of the team and is the one who diagnoses the disease. The other people of various discipline who work together to promote the health of the patient includes, the registered nurse, the assistant physician, dietitian, nurse practitioner and the pharmacist. The dietitian approves of the diet that the patient should take, the pharmacist provides medication and identifies any effects of medication, and the registered nurse motivates the patient to adhere to the regime of medication, diet and physical activity. The interdisciplinary team needs to be evaluated in order to determine if things are being carried out at they should and also to ensure that the team is performing its duties towards improving the life of the customer. One of the ways in which the effectiveness of the disciplinary team can be evaluated is by assessing the progress of the patient. The efforts of an effective interdisciplinary team are usually reflected in the patient. The patient will show improvement. However, this method cannot be relied on as sometimes a patient’s condition cannot be improved much and, hence, the efforts of the interdisciplinary team are not reflected. Another way through which the effectiveness of the interdisciplinary team can be evaluated is through direct observations.
The evaluation team can send people to observe the client in the home setting and observe how the registered nurses relate with the patient. In this way the evaluator can manage to tell the relationship between the nurse and the patient which will determine the effectiveness of the program (Shwarzer, 2008). The last way in which the effectiveness can be evaluated is through reflective accounts. In reflective accounts a member of the team is picked and is asked to describe the activities he or she undertakes to assist the patient where financial records are available, they should be provided.
Conclusion
Congestive heart failure has led to many deaths. Some of these deaths could have been prevented if the patient had adhered to his/her medication, diet and physical activity program. The interdisciplinary team is very important to the life of a patient. Statistics show that about 125000 individuals die from CHF due to lack of adherence to medication in the U.S. with good strategies this number can be reduced to zero. Society should learn to appreciate the efforts the interdisciplinary team puts on working with patients and families of the patients should be ready to work with them and be of assistance where possible.
References
Desroches, S., et al. (2013). Interventions to enhance adherence to dietary advice for preventing
and managing chronic diseases in adults. Cochrane Database Syst Rev. 2:22-87.
Kulick, D. L., & Shiel, W. C. (2013). Congestive Heart Failure. U.K. Medicine Net.
Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the
adoption and maintenance of health behaviors. Applied Psychology, 57(1):1-29.
