PICOT Analysis on Chronic Heart Failure
One may describe heart failure (HF) as a complicated medical condition which may arise due to functional or structural cardiac disorders capable of hindering ventricular capability of ejecting or filling blood. Chronic HF (CHF) represents a serious health issue. Its prevalence in America stands at over 5.8 million, while over 23 million individuals across the globe are affected by this problem. The mortality rate linked to HF is 40% in the initial diagnostic year, which reduces to 10% subsequently. Individuals most impacted by the condition lie in the age group of over 65 years. This age group is associated with rather high healthcare costs and high mortality and morbidity rates. HF patients get admitted to hospitals often and their re-hospitalization rates continually increase. In this paper, peer-reviewed articles will be employed for shedding light on the clinical issue, its diagnosis, patient care and the potential positive impact of nurse interventions on HF patient outcomes.
HF can surface because of LVSD (left ventricular systolic dysfunction) which largely arises on account of impairment in the left ventricle’s contraction. Diagnosed individuals possess a narrowed LVEF (left ventricular ejection fraction). HF takes another form: as PEF (preserved ejection fraction) which is characterized by impairment in left ventricle relaxation and preserved or normal LVEF. HF patients may experience dyspnea with recumbency or with exertion. Other associated signs include dependent swelling, early satiety, swift tiredness and cough. HF has been related closely to hypertension, valvular heart disease, myocardial infarction and coronary heart disease. Lastly, the condition may be a secondary element of diseases not linked typically to LVSD (for instance, infiltrative disorders (like sarcoidiosis and amyloidosis), pericardial disease, and hypertrophic cardiomyopathy).
HF-diagnosed individuals ought to be tested for LVEF, and the test ought to be repeatedly performed with modification in clinical situation when physical tests or patient history cannot easily explain it. Also, it ought to be tested six months following surgical revascularization (Nicklas et al. 2013).
Appropriate clinical evaluation will be able to identify patients that may display response to electro-physiological device implantation and pharmacologic therapy. Experts revealed that beta blockers, aldosterone inhibitors, and angiotensin-converting EIs (enzyme inhibitors) help decrease HF morbidity and mortality rates. They also indicate the potential of biventricular pacemakers and cardiac defibrillators in improving results among particular patients with reduced LVEF (Nicklas et al. 2013).
Healthcare professionals, including nurses, ought to aim at treating triggering/causal factors and decreasing cardiac workload. This may be achieved through approaches like oxygen delivery for relieving ischemia; the flow rate must depend on individual patient state and hospital policy. The maintenance of activity restrictions ought to be guided by the activity tolerance of patients. Nursing staff must constantly appraise and record electrocardiogram rhythm, mental health condition, vital signs, urine output, lung and heart sounds, and other indications of change. They are also tasked with administering small amounts of morphine intravenously for reducing venous return, anxiety, pain, preload, and myocardial oxygen usage. Diuretics may also be required for reducing blood volume and preload while digitalis may be needed for lowering heart rate and increasing contractility. Further, nurses must utilize vasopressors for supporting blood pressure and increasing contractility, besides after load-reducers for facilitating ventricular ejection and decreasing Systemic Vascular Resistance (SVR). In case of patients with installed pulmonary arterial catheter, nurses must measure and record SVR, cardiac output pulmonary arterial wedge pressure, and pulmonary artery pressure.
Nursing staff must strive towards educating patients to make sure they identify all signs that indicate a need to seek medical assistance (e.g., increased breathlessness, pulse rhythm/rate changes, weight gain, reduced activity tolerance (or complete intolerance), peripheral edema, displaced apex, and gallop rhythm fatigue). Additionally, nurses need to familiarize patients with dietary restrictions, refer them (and their families) for CPR (cardiopulmonary resuscitation) training, and educate them on emergency medical system activation in case any issue surfaces at home (Nicklas et al. 2013).
Patients must be made to realize that compliance with prescribed medicines will alleviate signs and prolong life. Their illness mustn’t trigger panic/anxiety attacks. Nursing professionals must guide them with regard to medication schedules and make them aware of potential medication side-effects.
When nurses note irregular heart rates, elevated blood pressure, sleep apnea, infection and diabetes which could aggravate HF signs, the lead doctor must be notified (Nicklas et al. 2013).
An improved grasp of HF is a sound means of avoiding complications, and improving chances of attaining overall success in treatment and follow-up.
Healthcare organizations are seeing over 1.8 million ER (emergency room) visits of late. Most US states have countless hospitals able to take care of HF patients. Health agencies report a greater number of elderly patients being admitted for HF-linked complications. Agencies also participate in studies on improving HF patient outcomes.
HF-specialized nurses are wholly committed to delivering holistic patient care to anybody diagnosed with stages A-D of HF. This may occur within all outpatient and inpatient contexts and fulfill patients’ chronic or acute requirements. HF-specialized nurses may offer personalized prevention guidelines and support systems to patients (Nicklas et al. 2013) and can discern families, population groups or communities more prone to developing HF.
To conclude, effective practice and timely HF detection can contribute to treatment success. Healthcare providers must strive to aid patients in identifying potential symptoms and signs. Another means to avert heart disease would be by emphasizing healthy living. Correct diagnosis, research and treatment can assist providers in taming the HF epidemic. Lastly, appropriate nursing practice and care can help achieve superior treatment outcomes.
Nicklas JM, Bleske BE, Van Harrison R, Hogikyan RV, Kwok Y, Chavey WE. (2013) Heart Failure: Clinical Problem and Management Issues. PubMed retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23402460
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