Caring the Patients with Heart Failure and Type 2 Diabetes, Anorexia - Research Paper Example

Palliative care Part of the responsibilities of health care practitioners is to provide care in all stages of life. From childbirth, pediatric care, medical-surgical care, gerontological care, and even at the end of life, when there is no cure for disease, it is part of the responsibility of the health practitioners to ease a patient’s passing when death is imminent, and a cure is not available. This is called palliative care. Palliative care validates the perception that health care professionals take care of their patients’ right up until death (Schneider, Mitchell, & Murray, 2010). According to Vanderwerf (1998), palliative care is all about care methods that reduce pain and suffering without treating the disease. According to the World Health Organization (as cited in van der Plas et al., 2012), palliative care involves improving the patients’ and their families’ quality of life by preventing and relieving suffering through identification, assessment, and treatment of pain and other problems brought about by the disease, including the patient’s physical, emotional, and spiritual problems. Palliative care uses a support system with a team approach to meet the needs of the dying patient and his family to help them regard dying as a normal process, and easing the transition (World Health Organization, n.d.). Heart Failure According to Smeltzer & Bare (2003), heart failure is the condition wherein the heart has difficulty in distributing nutrients to the various tissues and cells. In heart failure, there is a problem with the heart’s contraction or its filling of blood. The risk for having heart failure increases with age. Class II Heart failure involves a slight limitation of the patient’s ability to perform normal tasks. The patient may experience symptoms during increased physical activity, but not at rest. Class 2 heart failure usually has a good prognosis. Class III Heart failure involves a much more significant limitation of his ability to perform, while the patient may feel comfortable at rest, slight activity can bring about symptoms. The prognosis for Class III Heart failure is fair, but not as good as Class II (Smeltzer & Bare, 2003). Diabetes (Type 2) Diabetes mellitus is a chronic metabolic disorder which is characterized by hyperglycemia (Abdulameer, Sulaiman, Hassali, Subramaniam, & Sahib, 2012). Type 2 Diabetes or non-insulin dependent diabetes is the kind of diabetes wherein the body is unable to effectively use insulin. It is the most common type of diabetes affecting 90% of everyone with diabetes in the world. It is thought to be largely a result of overweight, obesity, and lack of physical activity. This type of diabetes is difficult to detect until complications arise as it has the same symptoms of polyuria, polydipsia, polyphagia, and fatigue found in Type 1 Diabetes, but with a much lesser extent (WHO, 2012). According to Waring et al. (2011), Type 2 diabetes is a significant risk factor for heart failure. Breathlessness Breathlessness and fatigue can arise from heart failure since there is less blood flowing to the tissues; these tissues and cells receive less oxygen as well, sending a message to the brain to get more oxygen. The breathlessness and dyspnea in patients who have heart failure are especially felt during exertion. In class III heart failure, minimal exertion could lead to dyspnea (Smeltzer & Bare, 2010). According to Kamal et al. (2011), dyspnea is a common symptom experienced by patients requiring palliative care. In nursing diagnoses manuals, breathlessness can be classified as impaired breathing pattern, which means the patient’s breathing is hindering him from getting adequate air; ineffective airway clearance, which means there’s a blockage, preventing the patient from getting enough air; or impaired gas exchange, which is all about an altered delivery of oxygen to the body (Doenges, Moorhouse, & Murr, 2008). Considering the patient is under class III of heart failure, the best nursing diagnosis for his breathlessness is impaired gas exchange. One of the collaborative nursing interventions is by applying oxygen inhalation as ordered. This order has to be given by the physician (except during emergencies) since this is a collaborative nursing intervention and must be given using the lowest concentration possible dictated by pulse oximetry, Arterial blood gases, and according to the client’s condition to prevent over-oxygenation of the client (Doenges, Moorhouse, & Murr, 2008). This intervention is a key treatment in respiratory care (Krapp, 2002). Some complications to watch out for during oxygen therapy are “respiratory depression, oxygen toxicity, and absorption atelectasis.” This is why it is important to administer oxygen with equipment that would monitor the oxygenation of the patient (Doenges, Moorhouse, & Murr, 2008; Krapp, 2002). Another nursing intervention related to breathlessness is positioning. This is an independent nursing intervention that calls for the nurse to position the patient in such a way as to facilitate oxygenation. The proper position of the patient should be upright with the head of the bed elevated 30 to 45 degrees. This position helps respiration by gravity. This position is good if the client is not in distress. If the client is in distress, the client should be positioned for comfort. Some clients who are being ventilated should be put into a prone position to improve pulmonary perfusion and oxygen diffusion (Doenges, Moorhouse, & Murr, 2008; Sommers, Johnson, & Beery, 2007). Pharmacologic treatment using bronchodilators and corticosteroids is another collaborative nursing intervention requiring a physician’s order. Bronchodilators are used in the treatment of reversible airway obstruction, to promote oxygenation. For long term treatment, these bronchodilators are to be given with corticosteroids which are usually used as an antiinflammatory agent and also against reversible airway diseases, especially in its inhalable form. Contraindications for corticosteroids include heart disease, so applying this to a patient with heart failure should be done cautiously. Corticosteroids should not be given if the patient is undergoing an infection as it will also reduce the patient’s immune response (Deglin & Vallerand, 2008). Adequate rest is important for the client undergoing heart failure and breathlessness to conserve oxygen and to prevent unneeded exertion. It conserves energy and maximizes the oxygen available to the body. Patients undergoing class III heart failure experience symptoms with slight exertion, even when eating, so providing adequate rest between activities would help make sure the patient will not overexert himself. Helping him perform daily activities can also help him conserve his strength (Doenges, Moorhouse, & Murr, 2008; Sommers, Johnson, & Beery, 2007). Anorexia Anorexia is the lack of the motivation to eat, the loss of appetite, and the reduced food intake even when in the presence of an accessible food source (Watts & Boyle, 2010). This is different from anorexia nervosa which is a psychological illness wherein the patient strives to maintain a low body weight, resorting to reduced food intake and intensive exercise, sometimes to the point of lethality (Paulson-Karlsson & Nenonen, 2012; Kinzig & Hargrave, 2010). Fatigue and a reduced ability to perform normal daily tasks due to class III heart failure could reduce a patient’s appetite to the point of anorexia. Anorexia due to fatigue could be considered as an imbalanced nutrition. The definition of this nursing diagnosis is the nutritional intake is not enough to fulfill the patient’s metabolic needs. This is important to consider because a lack of nutrition paired with the decreased blood flow to the tissues brought about by the heart failure could further decrease the nutrients going to the tissues and cells, causing starvation (Doenges, Moorhouse, & Murr, 2008). One of the primary nursing interventions would be to acquire the patient’s nutritional status, intake, and output. This is the best way to monitor the patient for deficiencies in nutrition. This also helps identify poor eating habits that could be corrected or improved upon to help them achieve proper nutrition. This should be done consistently to determine patterns, strengths, and weaknesses of the client’s dietary habits (Doenges, Moorhouse, & Murr, 2008). To support the monitoring of the client’s nutritional status and eating habits, the client’s weight should also be monitored. This can be done daily at the same time everyday to determine if the client is losing weight or gaining it as an indicator of success or failure of interventions to curb his anorexia and increase his appetite. The weight of the patient could also be compared to usual weights and norms for the patient’s age and body size to identify the severity of his weight loss and malnutrition (Doenges, Moorhouse, & Murr, 2008) To directly intervene with the client’s imbalanced nutrition, the nurse could collaborate with a dietitian or a nutritional support team to determine the best way to provide the patient food rich in the vitamins and minerals he needs. This collaborative nursing intervention can also be carried over to the patient’s home care since correcting the patient’s nutrition is a long-term need (Doenges, Moorhouse, & Murr, 2008). Conclusion There are many other symptoms and complications related to heart failure and type 2 diabetes. Each of these symptoms has their own sets of interventions designed to correct them. The role of the nurse as the frontline of care is constant and dynamic, necessitating the nurse to be competent and resourceful in the field. With proper planning and implementation, the nurse should be able to achieve high level nursing care for any patient. References Abdulameer, S. A., Sulaiman, S. A., Hassali, M. A., Subramaniam, K., & Sahib, M. N. (2012). Osteoporosis and type 2 diabetes mellitus: What do we know, and what we can do? Patient Preference and Adherence, 6, 435-448. doi: 10.2147/PPA.S32745 Deglin, J., & Vallerand, A. (2008). Davis’s drug guide for nurses. Philadelphia, PA: F. A. Davis Company. Doenges, M., Moorhouse, M., & Murr, A. (2008). Nursing diagnosis manual. Philadelphia, PA: F. A. Davis Company. Kamal, A., Maguire, J., Wheeler, J., Currow, D., & Abernethy, A. (2011). Dyspnea review for the palliative care professional: Assessment, burdens, and etiologies. Journal of Palliative Medicine, 14(10), 1167-1172. doi: 10.1089/jpm.2011.0109 Kinzig, K., & Hargrave, S. (2010). Adolescent activity-based anorexia increases anxiety-like behavior in adulthood. 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