Nursing Care for Clients with Chronic Heart Failure - Case Study Example

CHRONIC HEART FAILURE Course Name Professor Name University Name Date of Submission Patient Holistic history Mr. Branson the general manager at the Starbucks Company age 67 years old lives in the old town of Middleborough, in the eastern side of the Raleigh County. As a company policy on healthcare that require each employee to take a medical policy of at least one year with a slightest of two monthly check-ups to any of the nearest hospital in the Raleigh County. Hence, Mr. Branson always took a routine medical checkup as well as to obtain her medications, which is ‘Altace’ and ‘Apresoline’. Apart from that he also suffered from high blood pressure, because of the work stress and financial constraints. However, in the past Mr. Branson was diagnosed with a gastrointestinal infection as a result of Rotavirus.in the stomach that was in the development stage hence was considered to be benign. However, the Gastrointestinal was treated years back. Mr. Branson showed evidenced by fatigue, dyspnea, swollen ankles and lastly the nocturnal paroxysmal dyspnea. Clinical manifestations, for the chronic health problem, as seen in many of patients, includes a variety of symptoms most of which are non-specific ( Jenner, Strodl, & Schweitzer, 2009). However, the most common symptoms of chronic heart failure include fatigue, dyspnea, swollen ankles or those symptoms that relate to the underlying cause. However, the accuracy of diagnosis by presenting clinical features alone, however, is often inadequate, particularly in females and obese patients. The signs and marks of chronic heart failure include; Symptoms Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Ankle swelling Nocturnal cough Signs Cachexia and Muscle Wasting Tachycardia Pulses alter nans Right ventricular heave Third heart sound Ascites Dyspnea Dyspnea that is exceptional breathlessness is frequent symptoms in the heart failure. However it is a common symptom that presents itself in the general population, particularly in patients with pulmonary disease (Jenner, Strodl, & Schweitzer, 2009). It is seen however moderately sensitive, but poorly specific, or the presence of heart failure. Orthopnea is a more specific symptom, although it has low sensitivity and, therefore, has predictive value. Paroxysmal nocturnal dyspnea results from increased left ventricular filling pressures as a result of nocturnal unsolidified restructuring, and boosted renal reabsorption and, therefore, have a greater understanding and predictive value. Fatigue and Lethargy The most common effects of fatigue resulting from chronic heart failure are manifested in the skeletal muscles resulting in abnormalities in skeletal with premature muscles lactate release. Reduced cerebral blood flow also may result in severe chronic heart failure. Edema Edema that is swelling of ankles and feet is another common presenting feature, although there are numerous non-cardiac causes of this symptom. The edema may infect an increase in weight as a result of the fluid retention. However, right heart failure may manifest too as a result of the edema. Pathophysiology of Chronic heart failure The condition in which the heart muscle is destabilized and cannot pump blood to the rest of the body is referred to as the congestive heart failure that is also known to be the chronic heart failure. Pumping problem result from the enlargement of the main pumping chambers of the heart, which is the ventricles thus cannot contract and similar relaxation. The lack of contraction and relaxation of main pumping chambers of the heart the ventricles. Result in fluid retention, more so in the lungs, abdomen and legs (Lieshout, Wensing, & Grol, 2010). There are four chambers that make the heart. The heart’s part includes the right ventricles and left ventricles, or the right and left auricles. The process of the circulation of the blood includes that of the deoxygenated blood from the veins. Entering the right superior chamber that is the right atrium or auricle, after which it moves to the right inferior chamber the right ventricle and them into the lungs. Now the blood, which has passed through the lungs are now oxygenated. The Oxygenated blood from the lungs moves into the left upper chamber that o the let atrium or auricle and then enters the let lower chamber, the left ventricle. After, which the blood is free to be pumped to the rest of the body. The process of pumping takes place as a result of the pressure exerted by the arteries that have thick muscles to pump blood at a longer distance. Diagrams of Chronic heart failure https://www.google.com/search?q=diagram+of+pathophysiology+of+chronic+heart+failure&espv=2&biw=1513&bih=374&site=webhp&source=lnms&tbm=is The left ventricle does not pump blood freely, in an individual who suffers from the chronic heart failure. Hence, such an individual experienced an increase in pressure in the superior chambers of the heart that is around the atria and nearby veins. The resulting effect leads to the backlog of blood those results in fluid retention in the lungs, abdominal organs, and legs. The overall effects result into kidneys interference hence leading to retention of salt and water, causing infections known as edema (Lieshout, Wensing, & Grol, 2010). However, in some people the chronic heart failure does not result from the failed contraction of the blood. But rather it results from failed relaxation of the inferior chambers of the heart that is the left ventricle, resulting in an effect of blood pooling as a result of the decrease in pressure. Even though the above process is the major cause of chronic heart, there are several other conditions that may cause chronic heart failure ( Jenner, Strodl, & Schweitzer, 2009). The conditions include the following; the past heart attacks from infections such as coronary heart disease as its can lead to the scarring of the heart muscle. It is the most contributing factor in the cause of the chronic heart failure. High blood pressure may result to damage heart valve that may allow the flow backward of the blood or obstruction of the blood flow hence causing the chronic heart failure. Lastly, the condition was known as the cardiomyopathy that is characterized by enlargement of the heart muscle, where the superior chamber that is the left ventricle enlargement. Types of Chronic heart failure There are two types of chronic heart failure; Left-sided heart allure and Right-sided heart failure. The Left-sided heart failure, result from the left ventricular heart chamber failure as the left ventricular appear to be having a large chamber than the other chambers. However, there are two types of left-sided heart failure. The systolic failure occurs due to the left ventricle losing its ability to contract hence the failure o the heart to pump blood to the rest of the body. Diastolic failure also known as diastolic dysfunction, the left ventricle loses its ability to relax normally. Hence, the blood cannot ill into the different parts of the chambers. The right-sided heart failure occurs due to the failure o the let-sided chambers. The effect of the left-sided by increase fluid in force is, in effect transmitted hence affecting the right side of the heart. Hence, the right side loses pumping force, thus the backlog of the blood in the body’s veins. The effects of such are the congestion of legs, ankles and swelling around the abdomen. Chronic Obstructive Pulmonary Disease The syndrome that comprise o the airway inflammation, structural changes and mucus cilia dysfunction is known as the Chronic obstructive pulmonary disease abbreviated as COPD. The chronic obstructive pulmonary disease affects the large airways, the bronchioles, and the lung parenchyma. The frequent causes result from the exposure to the noxious stimuli such as those of smoke. However, the disease-causing mechanism is not well known as they are more diverse unlike that of the chronic heart failure. The well-known mechanism is that of the increased numbers of activated polymorph nuclear leukocytes, and the macrophages release in the windpipe. It results in a huge pool of the ‘elastases’ that result in destruction of the lungs. Therefore, the ant proteases that are known, to prevent such huge amount of ‘elastases’ in the lungs are limited in numbers hence cannot have influence whatsoever. However, the cigarette smoke has been perceived to be the most common cause of the COPD. For example, the free radicals in the smoke cause the neutrophil influx, which is needed or the secretion of the emphysema. Types of Chronic Obstructive Pulmonary Disease There are two main causes of Chronic Obstructive Pulmonary Disease, chronic bronchitis, and the Emphysema. Chronic bronchitis, result from the mucous gland hyperplasia hence affecting the airway resulting to structural changes such as the ciliary abnormalities, inflammation and the thickening of the bronchial wall thickening. Hence, the destruction of the endothelium impairs the mucociliary response that kills bacteria and the mucus. The Emphysema, result from permanent enlargement of air spaces distal and that of the terminal bronchioles. The enlargement occurs due to the swift decrease in the surface area of the alveolar that is that part that air exchange takes place. The changes in the surface area of the alveolar cause a decrease in the elastic recoil that leads to airflow limitation. Besides, the narrowing of the airway as a result of the structural changes to the alveolar that limits the low on the air. Nursing Interventions in Chronic heart failure The major nursing interventions in chronic heart failure include ongoing assessment, therapeutic interventions, education or continuity care anxiety reduction and lastly the emotional support interventions. The ongoing assessment involves the use of the patient’s skin temperature and peripheral pulses, by monitoring results of laboratory and diagnostic tests. After which the documentation of the behavioral and verbal expressions of fear is done. The expected outcomes are that the chronic heart failure patient ought to demonstrate adequate understanding of the causative factors and demonstrate behaviors so has to clear the excess fluid volume. The Therapeutic interventions involve acknowledging the reason or the establishing of working relationship with the patients through continuity of care. The therapeutic intervention helps in promoting the trust and basis for communicating the fearful feelings by the patients. The expected outcomes are to ensure that patients to manifest the coping behaviors. The Education Care also known as the continuity of care helps to instruct the patient on the use of the physician prescribed anti-anxiety medications. It helps to enhance the patients’ sense of confidence and reassurance. The anxiety reduction and emotional support include helping the patients in identifying strategies used in the past to deal with fearful situations. It aids the patient focus on distress as physical and ordinary part of life that has been and can remain to be dealt with successfully. The symptom that is fatigue is the frequent symptom of chronic heart failure. The fatigue arises from the complex combination of the poorly understood physical and psychological effects of the illness that may be different in each patient. The pain results from the illness, its treatment or co-occurring illnesses. However, pain may continue to be a problem even when there is no longer any sign of chronic heart failure (Jenner, Strodl, & Schweitzer, 2009). The bodily impairments, and incapacities, as well as fatigue, and discomfort experienced by patients with the chronic heart failure. Often lead to underperforming the routine activities of daily living that most people take for granted. For the adult, these activities include such activities as bathing, using the toilet and dressing. The emotional stress and fear of recurrence, such as the distress imposed by living with the day-to-day physical problems may cause patient to have psychological problems. The patients with chronic heart failure suffer from the social isolation that is associated with the mortality of persons. Some of the cultural believes may result in the misconception that arises from the conception by the patients that chronic heart failure occurs as a result of the stress associated with the old age. Nursing Care Plan Introduction The evaluation of the chronic heart failure patients, this is done through the aspects of the therapeutic method where the examination of the individual needs to breath, eat and express feelings. The instrument of data collection incorporated includes the use of identification, methodological characteristics, and methodological interventions. Assessment Mr. Branson shows evidence of dehydration, with a decreased skin turgor and dry lips and mucous membranes. Mr. Branson height was 60cm and weight 142lbs.Mr.Branson is on bed rest as he cannot get out of bed due to the pain he experiences in the ankles. For instance, Mr. Branson says that ‘my foot hurts’ show that he is in pain. Diagnosis It provides a clinical judgment about the client’s response to actual or potential health conditions or needs. The poor nutrition, and with recurrent myocardial infarction in the abdominal area affects the patients internally. Planning Mr. Branson should maintain the intact skin. It is done through the following; Mr. Branson should change position every two hours and also he ought to avoid pressure on bony prominences. Lastly, he ought to maintain a hydrated and clean skin. Implementation The implementation ought to be under the interventions of the continuity of care of the chronic heart failure. It can be done after three days. Evaluation Mr. Branson demonstrated a well stable health after following the physician ordered anxiety medications. However, the nursing care must be constantly evaluated, and its modifications are the needed. The literature search focused on the investigation for placebo-controlled clinical trial designed in reducing major cardiovascular events and mortality. Lastly, the treatment to modify the endpoint parameters o the chronic heart failure, by using, validated search strategies; such as reference lists of the feature or key publications in lower associated with increased mortality. The best practice involved the use of the care coordination involving transitions. It improves the patient coping with the diseases (Jenner, Strodl, & Schweitzer, 2009). Hospital plans or the plans and support the provision and coordination of the client education activities. The education process o the patient can be coordinated with the different state so has to achieve educational objectives in maintaining the patient’s transition to discharge. The patient ought to be educated about pain and managing pain as part of the treatment. The educated on the nutrition must be focused so has to enable the nutrition intervention to help shape diets. The hospital should ensure that the safety and effective use of medications are given priority. Discharge interventions such as those of giving instructions to the patients must be taken into considerations. The strategies include those that focus on the management of chronic heart failure patients, symptoms monitoring and lastly the implementation of a range of self-management. The patient-centered care is respectful of and responsive to preferences, and greater care coordination is needed because fragmentation across health care and other social support systems effectively. The Multidisciplinary chronic heart failure care is distinguishable from generic chronic disease management programs, has it aid in helping the chronic heart failure special patients to have the special needs. It is vital to educate and empower individuals so has to manage the challenging condition. It can involve the use of risk management tools to monitor those patients who are at risk with those who are not at higher risk of readmission. Bibliography Chronic Heart Failure (CHF) Therapeutics - Pipeline Assessment and Market Forecasts to 2019 2012, , New York. Chronic Heart Failure (CHF) Therapeutics - Pipeline Assessment and Market Forecasts to 2019 2013, , New York. Corcoran, Katherine J,B.Sc, M.P.H., Jowsey, Tanisha,B.A.Hons, M.A. & Leeder, Stephen R, MD, PhD, FRACP,F.A.F.P.H.M., F.R.A.C.G.P. 2013, "One size does not fit all: the different experiences of those with chronic heart failure, type 2 diabetes and chronic obstructive pulmonary disease", Australian Health Review, vol. 37, no. 1, pp. 1-25. Davidson, P.M., Inglis, S.C. & Newton, P.J. 2013, "Self-care in patients with chronic heart failure", Expert Review of Pharmacoeconomics & Outcomes Research, vol. 13, no. 3, pp. 351-9. 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The TELBIL study", BMC Health Services Research, vol. 11, pp. 56 ResMed to Present New Data on Sleep-Disordered Breathing in Patients with Chronic Heart Failure at the American College of Cardiology 64th Annual Meeting 2015, , New York. Revolutionary Miniature Blood Pump from CircuLite Successfully Implanted in First Chronic Heart Failure Patient 2007, , New York. van Lieshout, J., Wensing, M. & Grol, R. 2010, "Improvement of primary care for patients with chronic heart failure: a pilot study", BMC Health Services Research, vol. 10, pp. 8. Read More