NURS 6512 Week 7 : Heart Failure Assignment
Congestive Heart Failure is a condition in which the heart cannot pump enough blood to meet the needs of the rest of the body (Department of Health & Human Services, 2012). The failure can occur in on either side of the heart.NURS 6512 Week 7 : Heart Failure Assignment
In left-side heart failure, fluid backs up into the lungs, causing shortness of breath, due to the fact that the blood entering the left side of the heart comes from the pulmonary artery, and when the left ventricle cannot pump fluid out of the heart or when the left atrium cannot empty completely into the ventricle it backs up into the lungs.
In right-side heart failure, fluid can back up into the abdomen, legs, and feet, causing swelling. The blood being pumped into the right ventricle comes from systemic veins, and when the right atrium or ventricle can’t sufficiently empty, the fluid tends to back up into the body. There are many ways to treat this condition.
ACE inhibitors may be prescribed. These drugs are vasodilators, and help to widen blood vessels to reduce the workload on the heart, decrease blood pressure and increase blood flow (Mayo Clinic Staff, 2013). Many people with this disease are also prescribed diuretics, to increase fluid loss from the body and reduce fluid buildup and swelling. However, patients often need mineral supplements in addition to taking these drugs. When drugs are not sufficient enough, surgery may also be required.
A coronary bypass is a sort of transplant, where veins from an arm or leg are used to bypass a blocked coronary artery, allowing blood to flow freely through the heart. Beta blockers are drugs that block Beta 1 and 2 receptors on the heart, which constrict blood vessels. By doing this and keeping blood vessels dilated, these drugs reduce blood pressure and heart rate. However, Carvedilol is the only agent labeled by the FDA for use in patients with heart failure (Chavey, 2000).
The many symptoms of this condition can occur suddenly (during activity) or develop slowly over time. Common symptoms include: cough, fatigue, loss of appetite, increased need to urinate, swollen feet and/or ankles, swelling of the abdomen due to excess fluid, weight gain, shortness of breath, heart palpitations and/or irregular pulse (American Heart Association, 2011).NURS 6512 Week 7 : Heart Failure Assignment
This condition is best diagnosed after an examination for symptoms. A doctor could do several tests such as an electrocardiogram or an echocardiogram, as well as tests such as an MRI or blood tests to aid.
Some patients will be recommended for surgery such as an angioplasty, a pacemaker or even a complete heart transplant. While this condition is a chronic illness, the prognosis can be good if the symptoms are treated successfully. There are four main stages to this disease:
Stage 1: high risk for developing disease
Stage 2: patients have an enlarged/dysfunctional left ventricle but have no symptoms Stage 3: patients develop symptoms, get diagnosed
Stage 4: patient experiences symptoms even after treatment
(Heart Failure Society of America, 2002)
Depending on the specific cause of CHF, a patient could initially begin treatment at home with medications such as a diuretic and lifestyle changes (like no more drinking/smoking). Sometimes surgery to fix blockage of the coronary arteries or a congenital heart defect will be recommended. This would be done in a hospital and recovery at a rehabilitation clinic or at home. A benefit of an assisted living facility would be having preplanned meals and activities.
The CHF patient may not seek additional care until Stage 3 or 4 (Heart Failure Society of America, 2002). Also, if a patient’s symptoms are uncontrollable, hospitalization could be necessary. A downside of an assisted living facility is the spread of infection. CHF patients routinely struggle with breathing issues so a respiratory infection could be life threatening. Another example of risk in an assisted living facility is endocarditis, an infection of the inner lining of the heart chambers.
It can be caused by bacterial infections in the bloodstream, and patients with heart failure are at a much higher risk for succumbing to this infection (US Department of Health & Human Services, 2010). Contracting an infection like this can quickly kill someone already living with heart failure. It is important that a patient with CHF be monitored for signs of distress.NURS 6512 Week 7 : Heart Failure Assignment
Vital signs like high blood pressure, rapid pulse, irregular respirations and fluid intake/output should be monitored. All of these vitals will already have expected irregularities, which lead to initial diagnosis. After care is started, the vitals should be monitored for additional changes. In the event of an emergency such as inability to breathe, a nursing assistant should call an ambulance right away and begin life-supporting measures such as CPR (Carter, 2012).
Legal and ethical issues associated with caring for someone with congestive heart failure vary widely. For example, a doctor has many ethical guidelines he or she must follow with those patients in need of a heart transplant.
Depending on factors such as the patient’s age, severity of the condition and their personal wishes and beliefs, the patient may want to have a power of attorney, a will and possibly a DNR on file (Carter, 2012). Patients with congestive heart failure must be careful of the amount of physical activity they participate in.
Short spurts of low-level exercise are often safe to perform, but it is important not to make the heart work too hard for its reduced capacity. Heart failure in its early stages may not greatly reduce mobility, but as it progresses, it can eventually make a patient completely immobile.
It is important as caregivers to know the limits of a patient’s mobility, and not to push them. In order to reduce risks, the extent of a patient’s mobility should be made clear, and guidelines should be followed. It is important to communicate with the facility, care team, family and patient to make sure everyone is aware of safety procedures to reduce the chance of heart attack or complete heart failure of these patients (American Heart Association, 2011).
The diet plan for a patient diagnosed with CHF would need to be “low sodium”. Foods that are naturally low in sodium like fresh fruit and veggies, and lean meats are the best choice for this diet. A doctor may also restrict a patient’s fluid intake.
A diet high in sodium and drinking and consuming too many fluids (water, soups, etc.) can cause additional water retention, thus making the heart work harder (Mayo Clinic Staff, 2013). Patients who have been put on diuretics may be instructed to eat more foods high in potassium, like bananas, dried fruits, avocados, nuts, and whole grains, because often potassium levels drop. (Department of Health & Human Services, 2012). They may also be instructed to eat extra fiber, which helps food move along the digestive tract, and may help control blood glucose levels, as well as possibly decreasing cholesterol levels.
As CHF progresses, personal care will become more difficult. Regular tasks will require a lot of energy. Medications the patient may be taking such as diuretics could cause more frequent urination, also resulting in more energy exertion. Other simple tasks for hygiene such as brushing teeth and hair will also require energy where there is not a lot to spare. If the patient is retaining a lot of fluid, it could be difficult to move around, and even breath fully.NURS 6512 Week 7 : Heart Failure Assignment
Emotionally it will be tough for a patient to come to terms with not being physically able to do personal care and hygiene anymore, and needing someone to do it for them (US Department of Health & Human Services, 2010). Hopefully a CNA could soothe the patient and make personal care less stressful. Let the patient do as much as he/she can tolerate physically, and try to treat the patient with empathy and respect, not pity.
The condition is progressive and unfortunately terminal. At some point, the patient may need hospice care. A CNA could try to listen to what the person has to say if they feel like saying anything at all. As a nursing assistant, it is important to stay positive, and to continue encouraging the patient to be as independent as possible (Carter, 2012).
The scariest part about a progressive disease is the anticipation of death. All people will deal with this differently, but it is important to stay open-minded and do what we can to help patients and families cope and remain positive about the situation. Listening is one of the most important parts of communication, and one of the most valuable skills to have as a nursing assistant.
Diseases of the heart are the leading cause of death in America. “Nearly 5 million people in the United States have congestive heart failure. Each year, there are an estimated 400,000 new cases, and half of those diagnosed with the condition will be dead within five years”( “Two New Treatments for Congestive Heart Failure”).
Generally congestive heart failure begins with a dysfunctional ventricle in the heart; however this event usually occurs before any symptoms of the disease become apparent (Cohn). Essentially, Congestive Heart Failure is due to the heart making valiant attempts to make up for its weakened pumping abilities that is caused by this dysfunctional ventricle. It does this by enlarging and pumping faster to make up for the loss of strength. Recent studies are finding that the most indicative per-existing risk factors for developing Congestive Heart Failure is hypertension, but there are many more risk factors to be considered as well (Levy, Larson, Vasan, Kannel, & Ho). If the patient has had any previous heart attacks or coronary artery disease, an irregular heartbeat or arrhythmia, any disease of the heart muscle itself or cardiomyopathy, a disease affecting the heart valves particularly that of the mitral and aortic valves, and any kind of congenital heart disease then they are at a considerably higher risk to develop Congestive Heart Failure as well. Alcohol and drug abuse have also been linked to the development of this disease (Cohn; Congestive Heart Failure).
Symptoms of Congestive Heart Failure are often dependent upon which side of the heart has been afflicted. If the left side of the heart is the damaged side “blood and fluid back up into your lungs. You will feel short of breath, be very tired, and have a cough (especially at night). In some cases, patients may begin to cough up pinkish, blood-tinged sputum” (“Congestive Heart Failure”). If the dysfunction is in the right side of the heart then the fluid will build in the veins as opposed to the lungs. Edema of the legs, ankles, and feet will occur because of this collection of fluid. “Sometimes edema spreads to the lungs, liver, and stomach. Because of the fluid buildup, you may need to go to the bathroom more often, especially at night. Fluid buildup is also hard on your kidneys. It affects their ability to dispose of salt (sodium) and water, which can lead to kidney failure” (“Congestive Heart Failure”). In addition to these site-specific symptoms, the patient may find it difficult to breathe, feel weak or tired causing an inability to participate in physical activities, develop chest pain, loss of appetite, swollen veins in the neck, clammy skin, a fast or irregular pulse (“Two New Treatments”; “Congestive Heart Failure”). Additionally the patient may feel confused and restless, and suffer from memory lapses and difficulty in concentration.NURS 6512 Week 7 : Heart Failure Assignment
Often a diagnosis of Congestive Heart Failure can be made by a physical examination of the patient based on the development and reporting of the symptoms above. The development of fluid in the lungs can be heard through a physical examination with a stethoscope, as can an indication of arrhythmia or a hastened heartbeat. A tapping on the chest can help the doctor determine whether there has been any build up of fluid in the chest. While these diagnostic efforts are generally quite accurate, verification of diagnosis of Congestive Heart Failure can be achieved through chest x-rays which will reveal the enlarged heart and the development of fluid in the lungs. An EKG can be used to verify the arrhythmia and any other abnormalities of rhythm or pace of the heart. A sonogram-type examination of the heart called electrocardiography can take a rather detailed look at the physical structure of the heart and can evaluate valve function, motion of the heart, and can again detect an enlarged heart size. Nuclear ventriculography, a technique where a radioactive material is injected into the veins and its path through the body can be traced through special cameras, as well as angiography, a method where a catheter is fed through the femoral artery in order to take site-specific internal x-rays (“Angiography Test”), are both used to provide sure verification of the diagnosis and to determine how far alone the disease has come (“Congestive”).
There are multiple ways in which Congestive Heart Failure can be treated, many that are used together to ensure effective management of the disease. Lifestyle Changes such as smoking cessation; management of risk factors such as hypertension, diabetes and high cholesterol; a restricted low-calorie, low-fat, low-salt diet; a sensible limit set on alcohol consumption; monitoring any weight gain that could be due to continued fluid buildup; and, of course, an approved aerobic exercise program are all in the first line of defense both against Congestive Heart Failure and in the treatment of the disease once it is diagnosed. Beyond these lifestyle changes, medications are also extremely helpful in both controlling symptoms and in prolonging the life of an individual diagnosed with the disease. Medicines called inotropics (which are usually delivered directly to the heart through a catheter) work to strengthen the heart’s pumping action, while vasodilators (such as nitroglycerin) help open up narrow blood vessels. Diuretics help reduce the buildup of fluid. ACE inhibitors keep vessels open and are used to keep blood pressure in check (Cohn; “Congestive”). These as well as other medications that a doctor may feel helpful in the treatment of the disease can all be used in orchestration to both alleviate symptoms and manage the disease itself.NURS 6512 Week 7 : Heart Failure Assignment
More intrusive therapies are often used in emergency and extreme situations. Angioplasty is a technique where the arteries are “puffed up” with a small balloon. This effectively pushes any fatty buildup of plaque in the heart up against the artery wall, thus opening it up again for more healthy heart functioning. Stents, mesh-like metal inserts, are often placed at the time of angioplasty to keep the artery from collapsing (“Congestive”).
Surgery is also an option, though this is usually reserved for the most extreme cases, or for those whose other treatments are no longer effective. Correction of any congenital heart defects should be tackled first to avoid any further development of the disease and to facilitate any other kind of surgical procedures. Hear valves can be repaired or completely replaced, as can the entire heart by transplantation. Bypass surgery has been quite successful as well. Insertion of mechanical devices to help sustain the heart’s functions, such as pacemakers, is also a viable option in these extreme cases (“Congestive”).
With the help of good medical support and the various treatments available, those who suffer from Congestive Heart Failure can continue to live full, happy lives.NURS 6512 Week 7 : Heart Failure Assignment