Abstract
This paper provides a patient education plan for a hypothetical African American with congestive heart failure (CHF). The education plan includes information on diagnosis and pathophysiology of congestive heart failure, medications, and treatment of the disease, home care considerations, as well as health and wellness. Overall, the patient education plan stresses the need for physicians and nurses to undertake comprehensive education to attain good control of the disease, minimize hospital readmission, and enhance survival. Education is particularly important as the treatment of CHF requires multiple medications which may cause dangerous side effects if not taken as prescribed. The plan also underscores the importance of the patient to enroll in a home care disease management program to benefit from close follow-up, reduce hospital readmissions, lower treatment costs, and improve quality of life (QOL) indicators. Lastly, the plan stresses the importance of lifestyle and diet modifications in achieving health and wellness.
Background
The patient is a 68-year old African American male who was admitted to the health facility with a multiplicity of symptoms, including paroxysmal nocturnal dyspnea (sudden shortness of breath at night), acute pulmonary edema (pulmonary failure), fatigue, anorexia, confusion, and sleeping disorders. A careful history and physical examination coupled with routine laboratory testing and other ancillary tests (e.g., chest radiograph, electrocardiogram, and echocardiography) supported a diagnosis of congestive heart failure (CHF), which is described as a chronic disease typified by the incapacity of the patient’s heart to pump an adequate amount of blood to attain the demand of different organ systems (Baptiste, Mark, Groff-Paris, & Taylor, 2014). A diagnosis of CHF is also made when the patient’s heart is found to pump blood to different organs at increased filling pressures due to any functional or structural cardiac disorder that damages the ventricle’s capacity to fill with or eject blood (Figueroa & Peters, 2006). Further examination on the patient proved that the CHF was systolic, which means that the patient had a decrease in the capacity of the heart’s muscle to contract and pump adequate blood against the systematic vascular resistance.
In pathophysiology, it is clear that “the syndrome of CHF arises as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction” (Figueroa & Peters, 2006, 404). The major causes of CHF in the developed world, according to these authors, include ventricular dysfunction resulting mainly from myocardial infarction (systolic dysfunction) or hypertension (diastolic dysfunction), degenerative valve disease such as coronary artery disease, idiopathic cardiomyopathy, as well as alcoholic cardiomyopathy. Research is consistent that CHF often occurs in elderly patients who demonstrate multiple comorbid conditions (e.g., angina, hypertension, diabetes, chronic lung disease, renal dysfunction, anemia, depression, and cachexia) and commonly indicates not only as of the incapacity of the heart to maintain adequate oxygen delivery to the body but also as a systematic response of the heart to compensate for the inadequacy (Baptiste et al., 2014). It is of immense importance to have adequate knowledge of the determinants of cardiac output (e.g., heart rate, heart stroke, preload, and afterload) to understand the pathophysiologic ramifications of heart failure and the potential treatments. Common causes of systolic heart failure (depressed ejection fraction) include coronary artery disease (CAD), hypertension, diabetes, idiopathic cardiomyopathy, and valvular heart disease (Quaglietti, Atwood, Ackerman, & Froelicher, 2000).
Medications and Treatment
The successful treatment of CHF requires multiple medications, hence the need for physicians and nurses to undertake adequate patient education to attain good control of the condition, minimize hospital readmission, and enhance survival. First-line drugs recommended for the treatment of CHF include Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers (decrease blood pressure and enhance blood flow from the heart to the vessels), Beta Blockers (minimize the heart muscle’s requirement for oxygen and heart rate), Spironolactone and Eplerenone (prolong survival in patients with moderate to severe heart failure), and Diuretics (control symptoms of fluid retention associated with heart failure) (Figueroa & Peters, 2006).
Owing to the complexity and working interactions associated with these medications, the patient and his family need to be educated on the effects, side effects, and effective administration of the prescribed medications (Berman, Snyder, & Frandsen, 2015). Specifically, the patient should be educated on how to deal with pervasive side effects (e.g., dizziness or hypotension, cough, renal dysfunction, and worsening pulmonary function) associated with most CHF therapies and how to stop using drugs associated with serious side effects as abrupt discontinuation may prove fatal (Figueroa & Peters, 2006). Additionally, the patient and his family should be educated on medication-related dangerous side effects (e.g., renal dysfunction and worsening pulmonary function) and the immediate steps to take when he experiences such side effects. The patient and his family should also be educated on the use of nonpharmacologic methods (e.g., biventricular pacing device and implantable cardioverter defibrillators) that are often used in home settings to enhance cardiac output and reduce the risk of death (Figueroa & Peters, 2006). The value and importance of medication adherence should be underscored in the education program. Finally, the patient and his family should be educated on the symptoms to look out for before seeking immediate medical intervention for possible readmission. These symptoms include sudden weight gain, swelling of the lower extremities, inability to sleep, shortness of breath, and frequent hacking cough without sputum (Cardiac Patient and Family, 2008).
Home Care Considerations
The patient needs to enroll in a home care disease management program to benefit from close follow-up, reduce hospital readmissions, lower treatment costs, and improve quality of life (QOL) indicators (Quaglietti et al., 2000). Such programs can be accessed through community home care agencies, nurse-directed multidisciplinary home-based care, and acute care services. These programs, according to Quaglietti et al (2000), are instrumental in “slowing disease progression, maintaining or improving functional capacity, and decreasing the risk of death by using established guidelines” (p. 271). Additionally, the patient and his family need to be educated on dietary alterations such as restrictions on a high-sodium diet and fatty foods as these are known to worsen heart-related complications. In sodium restriction, the patient and his family need to be educated on how to read a food label to determine the sodium amount per serving, how to achieve and maintain a low sodium diet when eating away from home, and how to shop for different types of food items that are low on sodium.
The resources that are required by the patient and his family to effectively manage CHF in home environments include a physical training area, a home telemonitoring program or device to measure weight, blood pressure, and heart rate for ease of disease management, access to healthy diets, and ready transportation to a hospital in case of complications (Berman et al., 2015; Quaglietti et al., 2000). As already mentioned, it is important to educate the patient and his family on the use of biventricular pacing devices and implantable cardioverter defibrillators to enhance cardiac output and reduce the risk of death (Figueroa & Peters, 2006).
Health and Wellness
Available literature demonstrates that “many people with heart failure lead normal, active lives because they take care of themselves by improving their lifestyles and putting into practice some new guidelines” (Heart Failure Patient Education, n.d., p. 1). Some lifestyle modifications need to be put in place to enable patients to lead normal lives and avoid additional hospitalizations. Some of the lifestyle modifications that can be recommended for this particular patient include weighing himself daily to maintain normal body weight, taking medications exactly as directed, following a low sodium diet, avoiding drinking excess fluids, and getting regular exercises (Quaglietti et al., 2000). It is also recommended that the patient quit smoking and alcohol consumption as these variables have been found to aggravate heart failure. Additionally, it is recommended that the patient is informed about the warning signs of heart failure and the need to keep follow-up appointments or contact the primary care provider when the situation demands.
In physical exercises, it is recommended to teach the patient about the fundamental importance of maintaining regular physical activity to enhance blood circulation and vascular health (Figueroa & Peters, 2006), and also the need to increase physical activity levels steadily to exercise for at least 20 minutes four to five times per week (Berman et al., 2015). To achieve an optimal level of wellness and independence, the patient should engage in reducing weight if obese, minimizing total and saturated fats in the diet, increasing the intake of dietary fiber, avoiding over-the-counter medications as directed by the physician (e.g., ibuprofen and aspirin), and increasing his daily dietary intake of fruits and vegetables (Baptiste et al., 2014; Berman et al., 2015). The patient should also reduce his daily fluid intake to 64 ounces or 2 liters each day, avoid alcohol consumption and smoking, engage in telemonitoring or telephone follow-up after discharge, and adopt a comprehensive disease management plan.
References
Baptiste, D.L., Mark, H., Groff-Paris, L., & Taylor, L.A. (2014). A nurse-guided patient-centered heart failure education program. Journal of Nursing Education and Practice, 4(3), 49-57.
Berman, A.T., Snyder, S., & Frandsen, G. (2015). Kozier & Erb’s fundamentals of nursing: Concepts, process and practice (10th ed.). Hoboken, NJ: Pearson.
Cardiac patient and family education handbook. (2008). Web.
Figueroa, M.S., & Peters, J.I. (2006). Congestive heart failure: Diagnosis, pathophysiology, therapy, and implications. Respiratory Care, 51(4), 403-412.
Heart failure patient education. (n.d.). Web.
Quaglietti, S.E., Atwood, E., Ackerman, L., & Froelicher, V. (2000). Management of the patient with congestive heart failure using outpatient, home, and palliative care. Progress in Cardiovascular Diseases, 43(3), 259-274.
