Heart failure has become a menace in the recent past and a major killer. It is also a cause of many hospitalizations among the elderly.
In fact, it is estimated that by 2030 majority of the American population will be suffering from a debilitating form of heart failure. If this happens, then the government will be losing most of its revenue to caring for heart failure patients, a condition that otherwise properly managed would greatly cut down on this cost. Upon recognizing this, the government has put checks to ensure hospital manage heart failure patients well to enable a safe transition from hospitals to their homes and minimize the rate of hospitalization for these patients as it is the case today. This essay will discuss the management of heart failure patients to enable them live a fulfilling life and minimize the rate of re-hospitalization. The essay will be divided into four parts. The first part will focus on the medication used in Heart failure. The second and third part will focus on the dietary requirement for these patients and the role of physical exercises in the management of heart failure patients. Lastly, the essay will focus on the role of an interdisciplinary team especially a Registered Nurse in ensuring a safe transition for these patients.
Before looking at the management of heart failure, it is important to understand the pathophysiology of this condition that forms the premise for its management.
Heart failure is a chronic inability to the heart to maintain an adequate output of blood from one or both ventricles resulting manifest congestion and over distension of certain veins and organs with blood supply. It occurs when the heart fails to maintain sufficient circulation to provide adequate tissue oxygen in the presence of normal filling pressures. Because the venous pressures are increased, there is an associated pulmonary and peripheral congestion hence the condition is commonly referred to as congestive heart failure. This condition is long term therefore it is commonly referred to as chronic heart failure (Bui, Horwich, & Fonarow, 2010).
There are many causes of heart failure. Among them is a reduction in the contractile ability of the heart due to mechanical problems or any problem that limit the filling capacity of the heart chambers with blood due to any form of cardiomyopathy. Whatever the cause, the patient’s tissues are compromised because they cannot receive an adequate amount of oxygen necessary to perform optimally (Bui, Horwich, & Fonarow, 2010).
There are different classes of medications used in the treatment of heart failure. While all these classes work differently, the main goal is to reduce the blood pressure of the patient as well as ease respiration that in most cases is compromised due to pulmonary congestion. Among these medications, beta adrenergic blockers, Angiotensin converting Enzyme (ACE) inhibitors, and diuretics are the most common.
The beta blockers target beta receptors that are usually found in the cardiac muscles, smooth muscles, arteries, kidneys, airways and other tissues that are supplied by the sympathetic nervous system. Beta blockers are used in the management of heart failure as they antagonizing the sympathetic activity of the heart causing a reduction in heart rate that in turn increases the ejection fraction. In addition, they reduce oxygen consumption of heart muscles reducing fatigue by minimizing the secretion of renin. Beta adrenergic blockers include atenolol and carvedilol which also is unselective and also has alpha adrenergic activity and indicated for heart failure.
The ACE inhibitors are the drugs of choice in the management of heart failure and blood pressure and are, therefore, indicated for most patients. As their name suggest, these medications reduce renin production lowering the amount of angiotensin produced. Since angiotensin is known to increase blood pressure through by increasing peripheral resistance and increasing fluid retention, ACE inhibits this effect leading to reduced blood pressure, and vascular congestion Examples of these medications include captopril and enalapril. Diuretics on the other side increase diuresis reducing fluid overload in the body consequently lowering blood pressure and congestion. Frusemide is the common drug used in this class.
All these medication like any other drug have side effects. Beta blockers are associated with nausea, vomiting and diarrhea. When they are acutely stopped, they can worsen the illnesses and therefore the patient should be educated on the use of these medications and their effects. This effect may not be reported by the patient for lack of knowhow.
Diuretics, on the other hand, are associated with hypokalemia that cause dysrhythmia. It is, therefore, advisable to combine diuretics like Lasix with potassium sparing medications like spironolactone to prevent the excessive loss of potassium ions through the glomerular tubules.
Beta blockers interact with drugs that enhance their hypotensive effects e. g alcohol, anti-hypertensive, anxiolytics, hypnotics and diuretics those that decrease their hypotensive effect include NSAIDS, rifampicin and corticosteroids.
ACE inhibitors interact with antacids, tetracycline, digoxin, potassium sparing preparations and indomethacin class doesn’t significantly affect cardiac output and heart rate but are extremely useful in stabilizing renal failure.
The nurse should work together with the pharmacist; family members and a family health care provider to ensure the client takes the drugs appropriately. The family health care provider should participate in the development of the patient care plan including the counseling about drug adherence to enable appropriate transition from the hospital to home.
Reducing salt in the diet decreases water retention in the body, In addition, minimizing fluid intake helps maintain a blood volume that won’t overwork the heart. Simple adjustments like eating fresh fruits and vegetables and choosing foods with less salt e.g., fresh beef and poultry, milk and yogurt,season food with herbs, fresh juice and vinegar may help control the amount of salt and fluid intake.
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