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NURS 287
Rick Nilson

NURSING MANAGEMENT: CHRONIC HEART FAILURE  The overall goals for the patient with HF include (1) a decrease in symptoms (e.g., shortness of breath, fatigue), (2) a decrease in peripheral edema, (3) an increase in exercise tolerance, (4) compliance with the medical regimen, and (5) no complications related to HF.  Treatment or control of underlying heart disease is key to preventing HF and episodes of ADHF. o For example, valve replacement should be planned before lung congestion develops, and early and continued treatment of CAD and hypertension is critical. o The use of antidysrhythmic agents or pacemakers is indicated for people with serious dysrhythmias or conduction disturbances.  Patients with HF should be counseled to obtain vaccinations against the flu and pneumonia.  Preventive care should focus on slowing the progression of the disease. o Patient teaching must include information on medications, diet, and exercise regimens. Exercise training (e.g., cardiac rehabilitation) does improve symptoms of chronic HF but is often underprescribed. o Home nursing care for follow-up care and to monitor the patient’s response to treatment may be required.  Successful HF management is dependent on the following principles: (1) HF is a progressive disease, and treatment plans are established with quality-of-life goals; (2) symptom management is controlled by the patient with self-management tools (e.g., daily weights, drug regimens, diet and exercise plans); (3) salt and water must be restricted; (4) energy must be conserved; and (5) support systems are essential to the success of the entire treatment plan.  Important nursing responsibilities in the care of a patient with HF include (1) teaching the patient about the physiologic changes that have occurred, (2) assisting the patient to adapt to both the physiologic and psychologic changes, and (3) integrating the patient and the patient’s family or support system in the overall care plan. o Many patients with HF are at high risk for anxiety and depression, and major depression is more prevalent in female patients and patients less than 60 years of age. o Patients with HF can live productive lives with chronic HF. o Effective home health care can prevent or limit future hospitalization. Managing HF patients out of the hospital is a priority of care. o Patients with HF will take medication for the rest of their lives. This can become difficult because a patient may be asymptomatic when HF is under control. o Patients should be taught to evaluate the action of the prescribed drugs and to recognize the manifestations of drug toxicity.  Patients should be taught how to take their pulse rate and to know under what circumstances drugs, especially digitalis and -adrenergic blockers, should be withheld and a health care provider consulted.  It may be appropriate to instruct patients in home BP monitoring, especially for those HF patients with hypertension.  Patients should be taught the symptoms of hypo- and hyperkalemia if diuretics that deplete or spare potassium are being taken. Frequently the patient who is taking thiazide or loop diuretics is given supplemental potassium. o The nurse, physical therapist, or occupational therapist should instruct the patient in energy-conserving and energy-efficient behaviors after an evaluation of daily activities has been done.  Patients may need a prescription for rest after an activity. Many hard- driving persons need the “permission” to not feel “lazy.”  Sometimes an activity that the patient enjoys may need to be eliminated. In such situations the patient should be helped to explore alternative activities that cause less physical and cardiac stress.  The physical environment may require modification in situations in which there is an increased cardiac workload demand (e.g., frequent climbing of stairs). The nurse can help the patient identify areas where outside assistance can be obtained. o Home health nursing is an essential component in the care of the HF patient and family.  Home health nurses conduct frequent physical assessments, including vital signs and weight.  Protocols enable the nurse and patient to identify problems, such as evidence of worsening HF, and institute interventions to prevent hospitalization. This may include altering medications and initiating fluid
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