Nursing Heart Failure - Essay Example

? Nursing Heart Failure by Part provide the main symptoms associated with heart failure Heart failure is defined as the inability of the ventricleto pump blood efficiently throughout the circulatory system. Clinically, heart failure may be categorized as systolic, diastolic, congestive and decompensated. When the ventricles are weakened, the human body responds by activating the Frank-Starling mechanism and systemic vasoconstriction. However, it is the long term result of this activation that further aggravates the heart failure. A systolic heart failure is characterized by a decrease in the contractility of the myocardium resulting in decreased ejection fraction. A diastolic heart failure is characterized by the impairment of filling capacity of the ventricles and no change in the ejection fraction. Congestive heart failure is characterized by circulatory congestion and resulting transudation, particularly in the pulmonary tissue. Decompensated heart failure is an exacerbated heart failure usually due to the non compliance of the patient to pharmacotherapy or suggested behavioral modifications. Symptoms of heart failure include dyspnea, orthopnea, paroxysmal nocturnal dyspnea and history of oedema (Scottish Intercollegiate Guideline Network, 2009). The symptoms of heart failure depend upon the side of the affected ventricle. If the right ventricle is affected, symptoms will include peripheral oedema that involves thighs, sacrum and abdominal walls, ascites, anorexia, engorgement of facial veins, tricuspid regurgitation that manifests as pulsations in neck and face, epistaxis and depression. If the left ventricle is involved, the symptoms include dyspnea, impaired exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, nocturnal cough with or without pink frothy sputum, cold peripheries, cardiac asthma and muscle wasting. The lifetime risk of developing heart failure in an otherwise healthy 40-year old individual is approximately 1 in 5 in the general population (Djousse, 2009). The prevalence of this disease is rising across the world and this places an extra burden on the healthcare systems. While pharmacotherapies are very important, heart failure patients benefit greatly from the behavioral modifications that are a part of standard counseling sessions. This is where the nursing staff plays a key role in managing the patient. Part 2- consider an individual who has the diagnosis of heart failure. Discuss how the nurse can enable the patient to make alterations to his/her lifestyle to improve his/her health. Within your discussion you should examine the use of relevant models/theories that can improve the process of behavior change. Introduction Chronic heart failure has multiple risk factors and the number of patients suffering from chronic heart failure is increasing by the hour. While genetic propensity in the development of cardiovascular disease is currently under a lot of light, the elimination of risk factors has shown to prevent heart disease and delay the onset of disease in patients with a genetic tendency towards heart failure. These factors include alcohol consumption, smoking tobacco, inactive lifestyle, high intake of food rich in salts and animal fat and stress. The disease may be further aggravated by non-compliance to pharmacotherapy. None of these factors are isolated factors and one person may be exposed to more than one or all of these factors. What is even more important is the fact that these factors, as harmful as they are, are socially accepted activities and therefore, it is imperative to derive a policy and structure that not only deals with this acceptance while making people aware of the hazards that these factors pose but also to take steps that translate into optimal behavioral changes that lead to better cardiac health. Behavioral change theories have been gaining a lot of importance when it comes to planning and implementing public policies as well as designing programs that maximize the number of beneficiaries in the shortest possible time. These theories include I-Change model, the health action process approach, relapse prevention model and health belief model. These theories offer some explanation for the responses to interventions aimed at behavioral modifications of the patients. The following literature covers each of these behavioral modifications, their effectiveness and the relationship between these modifications and behavioral change theories/models. Several behavioral modifications are important in the management of heart failure patients and each of these will be looked into in a little detail in the following literature. Alcohol is one of the socially accepted risk factors of heart failure. While all forms of media have been used to create awareness among the general population regarding safe alcohol drinking habits, they have not been very effective and the link between alcohol consumption and heart failure continues to grow stronger in the light of continuing research. A study aimed at exploring the link between acute and chronic alcohol consumption and associated cardiac disorders such as alcoholic cardiomyopathy stated in its results that heavy drinking during the week prior to the ischemic event had a very clear link to the development of alcoholic cardiomyopathy (Leon et al, 2010) . This suggests that alcoholic cardiomyopathy may be an outcome of acute as well as chronic alcohol consumption. Therefore, not only does the risk assessment of chronic heart failure include chronic alcohol consumption but the management of heart failure also has to include counseling the patient to adopt restricted consumption of alcohol as a habit for life. Another study meant to assess the benefit of halting alcohol consumption in patients suffering from alcoholic cardiomyopathy and subsequent heart failure stated that patients who do not practice complete abstinence from alcohol have a 4-year mortality rate of 50%. This stands true for patients who consume more than 90g of alcohol a day for more than 5 years (Eur J Heart Fail, 2009). The role of alcohol cessation in the management of chronic heart failure cannot be overstressed. Studies claim that alcoholic cardiomyopathy, the main cause behind chronic heart failure among alcoholic patients, is reversible once alcohol consumption is abandoned all together (Maron et al, 2006). The recommended intake of alcohol is 1-2 glasses per day with 6 to 8 oz per glass (Swedberg et al, 2005) A study aimed at understanding the behavioral factors that affect the compliance of the patient to the suggested behavioral modification in cases of chronic heart failure stated that self-efficacy was the most accurate predictor of adherence behavior in comparison to depression and anxiety (Schweitzer, 2007). Current awareness programs about healthy diet seem to have a positive effect on the overall mortality due to heart diseases. In a study using the U.S IMPACT statistical model, mortality due to heart disease fell by 90% during the period 1980-2000. Ss% of this fall was attributed to behavioral modifications which include decline in blood cholesterol levels to less than 0.34mmol/L, smoking by 11.7% and physical activity by 5% among other things (Ford et al, 2007). Diet is another factor that can be modified and instilled into the patient’s mindset through facilitating by several means. Incorporation of fruits, vegetables, lentils cooked in different ways and regular weight monitoring can convince the patient into adopting these foods as his regular foods. Sodium intake has been linked to heart diseases and failures in several studies. Therefore, sodium intake has to be decreased for patients of heart failure. While this seems like a part of normal counseling of heart failure patients, one study suggests otherwise. This study stated a survey of heart failure patients indicated that 42% of the patients of heart failure reported that they hadn’t been counseled about the sodium intake in their diet while 36% of those who reported having received this advice were following it (Lainscak et al, 2007). In an observational study conducted to explore the role of diet in the management of chronic heart failure, it was stated that diets rich in amino acids and substances with anti-inflammatory properties such as megestrol acetate can improve the condition of patients considerably through alterations in the pathophysiology of this disease (Zadeh et al, 2008). The I-change model is very important in this factor as the attitude of the patient, social influences and self-efficacy; all are currently shifting towards healthy eating. Support groups on this topic are currently operational within communities and are based on the same theory. Smoking cessation is one of the most important parts of behavioral modifications required by a heart failure patient. It is also one of the most difficult parts to implement as smoking is addictive. Nurses often find it exhausting to curb the habit of smoking in their patients and days of counseling and months of rehabilitation often go to waste. Smoking cessation has been proven to decrease the incidence of complications of heart failure as well as mortality (Jay, 1999). Yet, patients with cardiovascular diseases often smoke in spite of being aware of their condition. A study suggested this to be as high as 52% of the 3778 patients interviewed (John et al, 2006). There are several ways of counseling such patients. Recently, tailored smoking cessation advice (Wells, 2003) and multiple call-back counseling (Stead, 2007) have shown more effectiveness than publicly distributed literature. Since smoking cessation has a huge psychological component to it, it is also being studied in the context of behavioral change models particularly the transtheoretical model. Initially, the psychological benefits and cost effectiveness of this model when implemented to programs of smoking cessation were considered substantial but in recent years have been under scrutiny (National Institute for Health and Clinical Excellence, 2011). Exercise is an extremely important part of the daily regimen of a heart failure patient. It has been proven to increase peak oxygen uptake in patients of different degrees of disease (McKelvie et al, 2002) and increase the ventilatory response, heart rate variability and blood flow in patients with moderate heart failure (Pina, 2003). Studies have also shown that regular exercise reduces mortality and hospitalization for all reasons (Flynn, 2009). However, studies indicate that patients do not adhere to their exercise regimen for several reasons. One such study stated that of all its interviewees, 53.2% admitted to not engaging in any exercise regimen. All of the interviewees in the study were heart failure patients (Carlson, 2001). Recommendations for exercise are a crucial part of counseling of a heart failure patient and the most recent regimen to have been suggested by HF-ACTION is an adequate warm-up that lasts for 10-15 min followed by cycling, walking, treadmill or circuit weight training, which is according to the individual patient, and a cool down period. This regimen has to be followed on 3 to 5 days a week with walking done on the remaining days (Aronow, 2006). Stress is a very important factor in the development of chronic heart failure as it induces cardiac ischemia repeatedly causing the progressive weakness of the heart. There are several aspects of the care programs that aim to alter the stress level of the patient. One such program is the home based telemanagement (HBT) program which allows the patient to be monitored by the nurses while being at home via a portable device connected to a receiving station that houses a nurse available for teleconsultation. A study aimed at comparing this to the usual care (UC) one-year program of follow up stated that the readmission rate due to heart-failure reasons was 19% in HBT patients compared to 32% in the UC patients ( Giordano et al, 2009). With patient awareness on the rise and more programs being implemented that aim at giving liberty to the patient to regulate his behavior and adopt certain measures as normal routine, self care has become a valuable tool. With the right nursing attitude and knowledge, the patient can be led to a healthy life without the perception of being under constraints. Self- care is defined as decision making process that is naturalistic in giving the patient the choice to adopt behavioral modification in order to gain physiological stability. This includes symptom monitoring, treatment compliance and response to developing symptoms (Reigel et al, 2004). Compliance with the pharmacotherapy of heart failure is very important in recovery. Study suggests that adherence to the prescribed amount of ACE inhibitors in patients of heart failure who have been discharged from the hospital fell to 80% within the first 30 days and to 60% within the following year (Butler et al, 2004). Medical adherence requires counseling of the patient as to how this is critical to his disease, how it can be incorporated into his regular life, how prescriptions have to be followed and how other engagements such as travel and illnesses not hamper the intake of medication (Reigel et al, 2009). The most effective of these theories has been Health Action Process Approach which is dependent on self-efficacy as well as volition. The patient’s liberty to decide in the knowledge of his disease has attributed greatly to the general fall in morbidity and mortality in patients of heart failure. Management plans based on this theory greatly facilitate the patient in to adopting a new lifestyle. The least effective of the behavioral theories used is the health belief theory as most patients of heart failure are in their 50s and 60s and are suffering from some degree of depression which makes it difficult to inculcate any new habits in them. Behavioral change theories have gained a lot of importance in recent times due to their potential of giving way to more effective, focused and less expensive strategies of a patient’s behavioral management. However it is important to understand that the effect of each theory will vary from patient to patient and one rule cannot be applied across the board. Conclusion The aim of linking the suggested behavioral modifications to several behavioral change theories is to allow the cardiac nurses to plan and implement strategies in accordance with human psychology so that the compliance is optimized and the quality of life is improved while minimizing the cost of public health. These strategies can be implemented within the community, at the workplace and in primary care settings with a great potential for positive results. A major change that I would want to incorporate in my practice would be increased use of motivational interviewing as this will not only allow the patient to be more open to me about his queries but will also permit me to have a closer look at the background and mental outlook of the patient. This amalgamation is unique for every patient and an understanding of this will guide me towards facilitating the patient in the maximal way. Acceptance, measured empathy, effective communication and the urge to co-operate lies at the heart of facilitating a patient of heart failure towards a healthy life. These are the factors that I would want my practice to be circled around. Bibliography Kamyar, Zadeh; Anker, Stefan; Horwich, Tamara; Fonarow, Gregg (2008), Nutritional and Anti-Inflammatory Interventions in Chronic Heart Failure, American Journal of Cardiology (2008) 101, 89-103 Giordano, A; Scalvini, S; Zanelli, E (2009), Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure, International Journal of Cardiology (2009) 131, 192-199  Leon, David; Shkolnikov, Valadimir; McKee, Martin (2010), Alcohol increases circulatory disease mortality in Russia: acute and chronic effects or misattribution of cause?, International Journal of Epidemiology (2010) 39, 1279-1290 Djousse, Luc; Driver, Jane; Gaziano, Micheal (2009), Relation Between Modifiable Lifestyle Factors and Lifetime Risk of Heart Failure, The Journal of American Medical Association (2009) 302, 392-400 Alcohol abuse and heart failure, European Journal of Heart Failure (2009) 11, 453-462 Schweitzer, Robert; Head, Kathryn; Dwyer, Jonathan (2007), Psychological Factors and Treatment Adherence Behavior in Patients With Chronic Heart Failure, Journal of Cardiovascular Nursing (2007) 22, 76-83 Ford, Earl; Ajani, Umed; Croft, Janet; Critchley, Julia (2007), Explaining the Decrease in U.S. Deaths From Coronary Disease, 1980-2000, Obstetrical & Gynecological Survey (2007) 62, 664-665 Scottish Intercollegiate Guideline Network (2009), Management of Chronic Heart Failure, Healthcare Improvement Scotland (2009), www.sign.ac.uk Maron, Barry; Towbin, Jeffery; Thiene, Gaitano (2006), Contemporary Definitions and Classification of the Cardiomyopathies, Circulation (2006) 113, 1807-1816 Reigel, B; Moser DK; Sebern, M (2004), Psychometric testing of the self-care of heart failure index, Journal of Cardiac Failure (2004) 10, 350-360 Butler, J; Arbogast, PG; Daugherty, J (2004), Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge, Journal of American College of Cardiology (2004) 43, 2036-2043 Carlson, B; Reigel, B; Moser, DK (2001), Self-care abilities of patients with heart failure, Heart Lung (2001) 30, 351-359 Reigel, B; Moser, Debra; Stefan, Anker (2009), Promoting Self-Care in Persons With Heart Failure: A Scientific Statement From the American Heart Association, Circulation (2009) 120, 1141-1163 Lainscak, M; Cleland, JG; Lenzen, MJ;Keber, I ( 2007), Nonpharmacologic measures and drug compliance in patients with heart failure: data from the EuroHeart Failure Survey, American Journal of Cardiology (2007) 99, 31D-33D Swedberg, K; Dargie, H; Cleland, J (2005), Task Force for the Diagnosis and Treatment of CHF of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure, European Heart Journal (2005) 26, 1115-1140 McKelvie, RS; Teo, KK; Roberts, R (2002), Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT), American Heart Journal (2002) 144, 23-30 Pina, IL; Apstein, CS; Balady, GJ (2003), Exercise and heart failure: a statement from the American Heart Association Committee on Exercise,  Rehabilitation, and Prevention. Circulation. (2003)107, 1210–1225. Flynn, KE; Pina, IL; Welham, DJ (2009),  Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial, Journal of American Medical Association(2009) 301, 1451-1459 Aronow, WS (2006),  ACC/AHA guideline update: treatment of heart failure with reduced left ventricular ejection fraction, Geriatrics (2006) 61, 22-29 Jay, SJ (1999), Smoking is an important component in the analysis of heart failure, American Heart Association Journal (1999) 159, 2225-2226 John, U; Meyer, C; Hanke, M (2006),  Relation between awareness of circulatory disorders and smoking in a general population health examination, BMC Public Health (2006)6 Wells, S(2003), Does screening for loss of lung function help smokers give up? British Journal of Nursing (2003) 12, 744-750 Stead, LF; Perera, R; A systematic review of interventions for smokers who contact quitlines, Tobacco Control (2007) 16 National Institute of Health and Clinical Excellence (2011), Brief Interventions and Referral for Smoking Cessation, WWW.NICE.ORG.UK (2011) . Read More