What is chronic heart failure?
It is a condition where the heart is unable to sufficiently pump oxygen rich blood to the rest of the body to meet the body’s metabolic needs.
Nursing Implications and indictors of chronic Heart Failure
When a patient presents signs and symptoms of chronic heart failure, a set of assessment and diagnostic test should be conducted to ascertain the presumed diagnosis. The most imperative patient assessment should be the evaluation of patient’s medical history. A nurse is always the first person to obtain the patient’s medical history. It is important to determine the patient’s risk profile, patient’s cardiac history and what were the patient’s reaction to various therapies offered in the past were.
Indications of chronic heart failure include;
Sudden weight gain
Loss of appetite
Persistent coughing
Excessive fatigue
Protruding neck veins
Heart palpitations
Shortness of breath
Irregular pulse
Leg and angle swelling
Abdominal swelling
The nursing implications of are established through the nursing assessment of the patients physical and functional capacity. The assessment may reveal some other form of chronic heart failure precipitation. The nursing goals may include promoting the patients comfort and alleviating the patient breathing ability. It may include alleviating and preventing the signs of fluid overload on the patient. Another implication maybe preserving the patient’s peripherals perfusion, increasing the patient’s awareness on the condition and available management strategies.
Monitoring Chronic heart failure patients should start immediately after admission with. The main immediate focus should be to identify the course of the heart failure. Monitoring the patients should include making temperature observations, observing respiratory rate, observing the heart rate, blood pressure, patient oxygenation levels and the patients urinary output. More advanced patient monitoring should include placing of invasive monitoring systems such as the central venous pressure checker, or the arterial line monitor. The nursing implications should also be dependent on the patient’s clinical status.
Other nursing implications may include placing the patient on fluid restriction monitoring system. For example, a patient may have a urinary catheter placed in a patient to closely monitor the urinary output. Monitoring of these vital components is important in the management of chronic heart failure especially identifying organ perfusion. Most of the nursing implications are aimed addressing the symptoms of chronic heart failure. In cases where patients suffer self-care deficiencies such as the inability to undertake physical activities such dressing, bathing or feeding themselves. Nursing implication involve identifying such deficiencies and addressing them too. For example, when bathing such a patient particular attention should be given to the skin especially the pressure areas. A Waterlow score should be taken to identify the risk of developing pressure scores and from the results various pressure relieving interventions should be implemented. The patient may also suffer peripheral swelling of the legs which may predispose the patient’s skin to cracking. In order to prevent the skin from cracking the patient legs should be moisturized and elevated to relieve the swelling and the associated stress to the patient.
The patient may also experience anorexia especially caused by poor perfusion of the digestive system. The patient should be given appropriate nutritional guidance and advice. The patient is advised to remain in contact with a nursing led heart failure program.
What kind of nursing care can the nurse expect when caring for chronic heart failure?
A nurse may be required to conduct clinical assessment of the patient which may include evaluating the hemodynamics decomposition, clinical deterioration and congestion problems. A nurse may also be required to provide facilitation access to the patient with both the heart specialist and the primary care physician. The nurse acts as a liaison person between the health care doctors as chronic heart failure patient’s also suffer other co-morbidities. The nurses can also be expected to perform assessment of the patient’s level of perception of treatment. The nurse can evaluate the patient’s compliance to medication and the advised lifestyle changes. The nurse is also expected to educate the patient on various self-care management techniques. The nurse should ensure that the patients are able to understand their treatment plan and how to identify the signs and symptoms of their ailment or condition. The nurse may also be expected to motivate the patient and the other family members on how to be actively involved in the management of the patient.
Patient teaching regarding chronic heart failure
The most common problem in the management of Chronic Heart failure is lack of information to the patients. Patients diagnosed with chronic heart failure are found to be uninformed on the condition and most of them remain uniformed for the rest of their lives. Teaching patients with chronic heart failure is not easy especially given that most of the patients suffering the condition are elderly. The goals of the training and teaching should be help educate the patient make informed decisions. Patients should be educated on the important aspects of the heart failure condition. This includes teaching the patient the causes of heart failure and what symptoms to look for when faced with heart failure. The patient should be trained and educated on the signs and symptoms of the heart failure condition.
The patient needs to have information on the kind of exercises that can help them stimulate the heart muscles to function more effectively and efficiently. Doing physical jogging for example helps improve the heart muscle tones, it helps reduce stress, it helps improve blood circulation, helps decrease the stress levels, it helps in weight control and management. Patients should be given thorough tips and information on among other things the how to conduct actual diagnosis, signs and symptoms, when it is appropriate to involve the healthcare provide, the significance of following up, the need to avoid certain foods especially high sodium foods. Educating the patients on these issues helps ensure reduced mortality and the promotion of patient autonomy among other myriad of benefits.
References
Gulizia, M. (2003). New Advances in Heart Failure and Atrial Fibrillation: Proceedings of the Mediterranean Cardiology Meeting (Taormina, April 10-12, 2003). Milano: Springer Milan.
National Collaborating Centre for Chronic Conditions (Great Britain), & Royal College of Physicians of London. (2003). Chronic heart failure: National clinical guideline for diagnosis and management in primary and secondary care. London: Royal College of Physicians.
Pearson, M., Cowie, M. R., & Royal College of Physicians of London. (2005). Managing chronic heart failure: Learning from best practice : implementing NICE/NCC-CC guidelines on chronic conditions. London: Clinical Effectiveness & Evaluation Unit, Royal College of Physicians.
