An Action Plan to Treat or Prevent Congestive Heart Failure

Heart failure is one of the common diseases and the leading cause of death in all across the United States. Heart failure (HF), sometimes referred to as congestive heart failure (CHF) is a chronic progressive condition occurs when the heart muscle does not pump enough blood to the body. The most common causes of CHF are hypertension, coronary artery disease, alcohol abuse, and obesity. HF is a life-threatening clinical condition that requires prompt medical attention. Apart from the pharmacologic therapies for CHF, there is a wide variety of nonpharmacologic treatment such as weight control, ventilatory support, ultrafiltration, diet and nutrition, drug counseling, physical activities, and other lifestyle modification therapies (Shah, Pellicori, Cuthbert & Clark, 2017).

Proposed Health Services/Interventions for CHF Patients

Heart failure has become a significant public health problem with an increased incidence and prevalence. The burden of HF effects the individuals, their environment, and overall society. Pharmacological treatment only does not found to improve the morbidity and mortality rates associated with chronic HF. There is still a lot to gain from nonpharmacological therapies and appropriate health management in order to improve the quality of life and patient outcomes. Some of the interventions or services that can be provided to CHF patients are as follows:

Health Promotion and Disease Prevention

Health promotion is the process of enabling people to increase control over to improve their health. This can be achieved by a variety of interventions such as education, behavioral and lifestyle modifications, dietary counseling etc. The CHF patients in this study are advised to follow the basic principles of health promotion and illness prevention to prevent disease progression and its severity.

Education A Cost-Effective Intervention

Patient education is the foremost important intervention for the management of heart failure. In order to prevent the severity and progression of the disease, the patients should be well informed and educated about the factors that can accelerate the progression. This is the most cost-effective intervention as patients in this intervention acquire assistance in relation to decision making, behavior control, acquiring knowledge and skills(Zamanzadeh, Valizadeh, Howard & Jamshidi, 2013). The education given to the patients about the disease-illness helps them to adopt self-care behaviors which can potentially assist patients to effectively manage this chronic condition and prevent worsening of the disease. Education should be provided by considering their cultural values and practices.

Behavioral and Lifestyle Modifications

Apart from educational intervention, another cost-effective intervention includes behavioral and lifestyle modification interventions or self-management interventions. The patient needs to change their lifestyle behaviors in order to prevent disease progression and to promote health and well being. The patient may need to learn behaviors such as cease smoking and alcohol consumption, restrict their sodium, cholesterol and fluid intake, exercise regularly to prevent weight gain, and other behaviors that increase the risk of disease progression. The concept of self-management is that the patients must experience some sense of control(Toukhsati, Driscoll & Hare, 2015). Not only these patients should change their nutritional or dietary habits and maintain their body mass index, blood pressure, but they should also evaluate these implemented interventions and monitor them in order to assess the effectiveness of these interventions.

Regular Assessments/Monitoring

Despite educating the patients with appropriate and adequate knowledge about the disease and its severity, another role of population health nurse is to assess their vitals on daily basis in order to prevent the severity of the disease. Measurements include BMI, weight, blood pressure, heart rate, assess orthopnea, paroxysmal nocturnal dyspnea, examine pitting edema, observer jugular venous pressure and distension, review chest x-ray and lung exam results, ascites, Measure BNP, NT-pro BNP levels, use echocardiography and conduct the hemodynamic evaluation with cardiac catheterization. Population health nurse should assess and monitor these vital signs in order to prevent risk and disease severity. This is an important step in managing patients with CHF and is significant in the process of risk and disease, and care management.

Exercise Training in old Patients with CHF

Many kinds of research have revealed that regular aerobic training increases exercise capacity and cardiac systolic function of patients with CHF. This is strongly recommended in such patients to improve left ventricular ejection fraction and quality of life. In CHF patients, dyspnea and fatigue limit the ability to perform physical ability and aerobic exercise which leads to progressive deconditioning. Therefore, it is significant to improve exercise capacity especially in elderly with chronic HF(PI & HU, 2016).

Risk Management and Care Coordination

Apart from non-pharmacological treatment for CHF, there is a wide variety of therapeutics that are being used by the patients with CHF. They use diuretics, beta blockers, and other drugs that have adverse effects and can cause serious risks and comorbid conditions such as electrolyte imbalance. Regular monitoring and risk management is required when managing and dealing with CHF patients. Care coordination is yet another significant factor when dealing with CHF patients. The care coordinating team of the hospital can support and help provide the quality care to the patients based on their needs and demands. This is because older age is the age where great attention is required by the physicians. Also, the family and guardians of the patients may be advised to follow the care plan for them and provide emotional and physical support to the patients. This is another significant role played by the family members because they should know and understand the severity and progression of the disease and its associated desired treatment and services given to the patient.

Disease Management

Heart failure is the most common diagnosis at hospital discharge in patients over 65 years. Also, the risk of death is greater in the elderly. Hence it is important for patients to manage their disease as suggested by the healthcare professionals. According to my observation, several disease management, health promotion, and disease prevention programs can be developed and implemented in which one of the main tasks to address is the complexity of care for heart failure patients. Heart failure can be occurred due to several reasons such as age factor, multiple comorbid conditions, and side effects of the drugs. Disease management involves educating and informing patients about the disease and ways or strategies to control it effectively. Through these programs, CHF patients will understand and follow the management process and care plan for managing the disease (Moertl et al., 2017).

Conclusion

As I mentioned earlier that congestive heart failure is a prevalent disease in the elderly group. This population is unique with other multiple comorbid conditions in addition to cognitive, and functional changes. Health care professionals need to be equipped with evidence-based knowledge, facts, and tools to provide quality care and assure excellent comprehensive care not only by addressing the heart failure issues but the individual as a whole. By implementing several important interventions/services to such population, the disease will be managed not only in the individual but the whole population. By applying population health and disease management techniques, the rates of morbidity and mortalities associated with CHF with be reduced which will ultimately improve patient outcomes and their quality of life.

 References

Ariosto, D., Harper, E., Wilson, M., Hull, S., Nahm, E., & Sylvia, M. (2018). Population health: a nursing action plan. JAMIA Open, 1(1), 7-10. doi: 10.1093/jamiaopen/ooy003

Moertl, D., Altenberger, J., Bauer, N., Berent, R., Berger, R., & Boehmer, A. et al. (2017). Disease management programs in chronic heart failure. Wiener Klinische Wochenschrift, 129(23-24), 869-878. doi: 10.1007/s00508-017-1265-0

PI, H., &HU, X. (2016). Nursing care in old patients with heart failure: current status and future perspectives. Journal of Geriatric Cardiology, 13(5), 387–390. doi: 10.11909/j.issn.1671-5411.2016.05.019

Shah, P., Pellicori, P., Cuthbert, J., & Clark, A. (2017). Pharmacological and Non-pharmacological Treatment for Decompensated Heart Failure: What Is New?. Current Heart Failure Reports, 14(3), 147-157. doi: 10.1007/s11897-017-0328-x

Toukhsati, S., Driscoll, A., & Hare, D. (2015). Patient Self-Management In Chronic Heart Failure — Establishing Concordance Between Guidelines And Practice. Cardiac Failure Review, 1(2), 128. doi: 10.15420/cfr.2015.1.2.128

Zamanzadeh, V., Valizadeh, L., Howard, A., & Jamshidi, F. (2013). A Supportive-Educational Intervention for Heart Failure Patients in Iran: The Effect on Self-Care Behaviours. Nursing Research and Practice, 2013, 1-7. doi: 10.1155/2013/492729