Care Plan Case Study: Systolic heart failure myocardial infarction
Heart failure is costly for our healthcare systems and one of the leading causes for hospitalization. Many patients are not able to manage their heart failure after discharge and are readmitted back to the hospital within 30 days of being discharged. Another issue among these heart failure patients is their quality of life. These patients tend to have a poor quality of life if they don’t know how to manage their disease. In this case study, I will be able to discuss the nursing care plan for the patient with heart failure. The case I will be discussing involves a 71-year-old Alicia Spinnett whose husband recently dies and have a son and three grandchildren who lived in the next village. She is retired and per history has been involved in an active social life. She enjoys walking with her dog and participate in local social events which has not been attending of recent. Her health status is that in the few months she has been feeling dizzy and tired. Some of the characteristics is that she has episodes of severe sweating, breathing difficult and irregular heartbeat. This is also accompanied by severe bouts of chest which she put down to indigestion. The systolic heart failure following a myocardial infarction is addressed in this case study
Systolic heart failure following a myocardial infarction
One of two major types of heart failure are systolic heart failure. It's an issue with how quickly the heart pushes blood to the nervous system or how it fills with blood inappropriately. Heart failure could be caused by excessive illnesses and heart conditions. Those mechanisms are triggered due to high respiratory activity, activation of the receptor, respiratory parenchyma, and activation of the chemoreceptor. The stimulation of these receptors sends a message to the CNS through the respiratory muscles and, as a result, enhances the concentration of liquid within the lungs. High blood pressure and breathlessness or severe dyspnea result in fluid accumulation. Lung exultation is the reduction of air motions and the individual induces wheezing. Auscultation in the lungs may result in inflammation and edemas forming in the capillaries contributing to heart failure.
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To order to manage systolic heart failure, early diagnosis is important. They employ advanced technology to accurately detect, advice patients, and carefully monitor the disease, and decide if someone has systolic heart failure. Procedures for diagnosis may include Blood tests: Blood tests assess the activity of the kidney, liver, and thyroid and search for signs of other heart-related diseases. A unique examination (NT-proBNP) aims to explain the existence ofheart failure. Chest X-ray: A popular cardiac screening procedure that may indicate heart enlargement and fluid build-up in the lungs. Coronary angiography: coronary catheterization is the treatment. During the operation, the heart passages and coronary arteries release blood that can be seen on an X-ray. To find certain blockages, the dye helps a surgeon to examine blood flow through the heart and blood vessels. Echocardiogram: an imaging test uses soundwaves to capture moving images of the regions of the heart.
Stress testing: during training, this experiment is done. If a patient is unable to exercise, heart rate decreases with treatment. The check can be used in combination with an EKG to show changes in heart rate, rhythm, and electrical activity as well as blood pressure. Exercise makes the heart work hard and pumps rapidly when performing cardiac checks.
Nursing model
Heart failure is a concern for many hospitals, nurses, and families. As a cardiac nurse, I see many patients suffering from congestive heart failure. These patients try to manage their condition, but sometimes fall victim to this terrible disease. This is important among the healthcare arena, as along with heart failure other health issues arise. These patients have to live with this disease and manage it every day. It is costly for our healthcare systems and also these patients. In the hospital, we try to teach them as we are doing interventions to help them learn how to manage it. We give their medications such as Lasix, monitor their diet, fluids, weight, and output. As for their medications, it takes some balancing. The patient cannot have too much Lasix or this may dry them out too much, resulting in lower blood pressure. Therefore, it is important to get the right amount of Lasix to ensure that the fluid doesn’t build up in their body. As nurses working with these patients, we are continuously monitoring their blood pressure and edema. The goal is to get the patient to a good level with their fluids and education before leaving the hospital. Managing this disease can be challenging and costly to the healthcare arena. We are hopeful that the patient has learned enough while in the hospital so that they can go home and manage this on their own.
Patient/client assessment
I see patients suffer from this on a weekly basis, and Mrs. Alicia Spinnett also struggles with heart failure. It is important for patients to manage their symptoms daily. Patients try to manage this by taking their medications, keeping their fluid levels down, and making diet modifications, such as reducing sodium. A lot of times, patients also suffer from fatigue from the heart failure and the Lasix. I have seen patients, along with Mrs. Alicia Spinnett stop taking their medications. They complain that it makes them tired, or that it makes them have to go to the bathroom too much. Or they will not be aware of their diet and will eat too much sodium, resulting in edema. Any time they have fluid buildup, it takes some work to figure out how much medication they need to start talking again. The goal is to get that edema down without lowering their blood pressure too much. It is important to help these patients understand why they must remain compliant with managing this disease every day. I enjoy educating these patients at the hospital, and my hope is that they will learn some of this information so that they can better manage their condition at home.
The information evaluated for this literature review provides evidence that nursing interventions have a positive outcome for reducing readmission rates among congestive heart failure patients. Being able to use analytics and predict when a patient may be a high risk for readmission can also help reduce patient readmissions. Telehealth is another tool that proved to be helpful among this population. Telehealth can help healthcare workers stay connected with these patients each week and help them manage their disease at home. Patients saw a better quality of life by managing their disease and symptoms at home. Exercise programs also showed a better quality of life which resulted in better management of their disease. Nursing care and check-in visits at the patients’ homes also helped patients manage their disease resulting in lower hospital readmissions.
Telehealth tools can make positive impacts on heart failure patients resulting in lower readmission rates. Overall, telehealth can make a patient feel like they are right there with the healthcare provider as they are doing these meetings through a face-to-face type program or just over the phone. Either way, the healthcare provider can give the patient information and education, while motivating them until the next time they talk.
A couple of articles that studied telehealth agree that heart failure is the leading cause for hospital readmissions. These studies found that telehealth tools can assist the heart failure patient at home and allow for check-in meetings periodically. This helps the patient remain on track after leaving the hospital. By checking in, the healthcare professional is able to determine what the patient needs are and be proactive instead of the patient not being able to manage their symptoms at home and end up readmitted into the hospital.
One study found that patients had a better quality of life from exercising and using the telehealth check-in visits. Another study looked at patients’ adherence to their check-in telehealth meeting itself to see how the patient was doing overall. This study found that adherence to the check-in visits was excellent. Another article studied telemonitoring and health coaching through the phone. This study did not find these interventions to help the readmission rates but did find that it helped the patients’ quality of life.
Care Plan for the patient
It is important for heart failure patients to receive education and information on how to manage their heart failure before leaving the hospital. The goal is for these patients to manage this when they get home to reduce hospital visits. Education may be directly from the hospital staff or brochures to read while in the hospital. Some studies proved that patients that received education before discharge, along with follow-up after leaving the hospital, saw positive outcomes with such areas like quality of life and reduced readmission rates
Healthcare professionals perform the function of ensuring patients stay healthy all the time. In the circumstances that individuals become sick, healthcare practitioners must make them feel well again and enable them to continue with their healthy lives. Among illnesses that have high rates of readmission, heart failure, and other related health problems are more common. Heart failure is a critical condition that demands timely and precise medical attention to prevent severe consequences. According to medical research, the problem is among the significant health challenges that have contributed to high mortality globally. It is therefore essential that an evidence-based education plan is designed that will give patients the knowledge to take part in their recovery process and wellbeing.
Nursing education on heart failure self-management and follow-up meetings are key to ensure the patient doesn’t have to return to the hospital. These education sessions may start in the hospital, but it was evident that they must continue beyond the hospital. Self-management interventions may consist of weighting yourself daily, eating a sodium-restricted diet, taking medications, and keeping follow-up appointments. Studies also found that patients saw improvements in their quality of life from some of these interventions. Exercising programs after leaving the hospital were also beneficial and helped these patients manage their disease and reduce readmissions. Another area looked at by a couple of studies is adherence to the self-management protocols or interventions while at home. Education and information are needed; however, adhering to these interventions is most important. The check-in visits from healthcare workers were conducted in various ways. Some were standard phone calls, some face-to-face telehealth calls or some in person meetings. Either way, having these periodic checks in meetings really helped keep the patient on track. The healthcare worker is able to see how the patient is doing and praise them for the good work and give them information on how to continue management of their disease during each meeting.
Implementation of care plan
Patients will only gain interest in the education program if it possesses information related to their medical history. According to professional and legal standards, there is a need to establish possible causes and environmental conditions that may contribute to the disease. The healthcare provision team also needs first to inquire if the target patient is suffering from any other illness with similar characteristics to heart disease. Proper research should also be performed to establish if any family members suffer from related illness given that the health condition is hereditary. Acquisition of information about the habits of an individual in their daily life can also play an essential role in determining factors that can lead to the disease.
After the information collection process, the educators have to explain to the patient about the data they have been able to collect and start assisting them through the recovery process. The patient at this point as the legal right to decide on whether advance with the treatment plan or not depending on the presented information. Assistance in the recovery program includes the provision of supplement medications and doing a follow-up to ensure they take them as diagnosed. Apart from medication provision, the plan should also promote improvement in the environmental conditions to enhance the well-being of individuals. Treatment of heart disease does not only depend on pharmacology treatment but also changes in living styles and performing more body exercises. Provision of the discussed information is essential to minimize the possibilities of the health problem in the future and promote faster recovery after going through medication.
Heart disease is a condition that can be inherited and sometimes is related to the eating habits of individuals. It is essential first to identify the primary source of the disease to create measures that can help in recovery and prevent future reoccurrence. For patients who acquire the infection because of poor eating habits, the best technique of treatment is by educating them on how to become more responsible with their diet. They should avoid taking in food that has high-fat content and consumes what is needed for them to promote their wellbeing. Obesity leads to the emergence of many diseases including heart illness. Therefore, measures need to be created to make sure there are limited opportunities for the occurrence of obesity. Obesity can only be controlled by improving the diet and engaging in more physical exercises to burn off extra fat in the body. Lastly, the patients can be advised to be keen in identifying signs and symptoms of possible heart diseases to report in time and start timely treatment to avoid severity and high costs.
Evaluation of the plan’s success
The decrease in the levels of readmission is the main sign of a successful education program since it indicates that the patients understood the knowledge correctly and had put it into the application. Another sign of success to the educators is when the patients gain maximum interest in the program and keep their appointments to receive medical attention from the doctor at scheduled periods. Taking medicines as prescribed by healthcare professionals to aid in the recovery process can also be identified as another indicator of success for the education program. Lastly, increased inquiry about the issue of heart diseases can also indicate success since it shows that the learning process has increased their curiosity to learn more about the health problem.
Nursing research is affected by various variables that complicated the process of coming up with striking findings. However, there are certain factors that a researcher can use to resolve the factors affecting nursing research. For instance, understanding the topic under research by considering the cause of the problem, the elements and stakeholders involved, and so on. The likelihood of a researcher to solve factors affecting medical research is enhanced by the possession of cognitive skills, communication skills, and team skills. The researcher's technical skills also affect the process of nursing research. Therefore, it is advisable that individuals with skills and technical know-how in medical practice should be enlisted to lead the process of nursing research. The resources available to the team conducting nursing research prove to be influential; therefore to research ease then the team involved should have access to adequate resources.
Conclusion
Like I have discussed, it is important for these patients to monitor their symptoms at home and manage their disease every day. This includes multiple areas such as monitoring fluid input and output, checking daily weights, and modifying their diet. All different types of education and delivery methods are needed to meet each individual where they are. It is important to understand what the patient already knows about heart failure, and how they currently monitor and manage their condition. The healthcare professionals are then able to individualize a plan for each patient. There are many different nursing interventions and daily activities that can help these patients manage their heart failure. Not only has this research proved that nursing interventions can reduce hospitalizations among these heart failure patients, but it can also improve their quality of life. Following the above intervention, am sure Mrs. Alicia Spinnett will be able to handle heart failure problem. The intervention given by the doctor in how to manage heart disease is basic solution in the management. It is known that heart disease especially to the adults are one of the major concern. Different cases have been reported following the systolic heart failure which most is contributed myocardial infarction.
References
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- Chen, Y., Wang, C., Lai, Y., …Wu, T. (2018). Home-based cardiac rehabilitation improves quality of life, aerobic capacity, and readmission rates in patients with chronic heart failure. Wolters Kulwer Health, 1-5.
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- Leavitt, M., Hain, D., Keller, K. & Newman, D. (2020). Testing the effect of a home health heart failure intervention on hospital readmissions, heart failure knowledge, self-care, and quality of life. Journal of Gerontological Nursing 46 (2), 32-40.
- Ong, M., Romano, P., Edgington, S.,…Fonarow, G. (2016). Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure the better effectiveness after transition-heart failure randomized clinical trial. Health Care Reform, 173(3), 310-318
- Peng, X., Su, Y., Hu, Z.,…Hu, X. (2018). Home-based telehealth exercise training program in Chinese patients with heart failure a randomized controlled trial. Medicine, 97(35), 1-9.
- Rosen, D., McCall, J., & Primack, B. (2017). Telehealth protocol to prevent readmission among high-risk patients with congestive heart failure. The American Journal of Medicine, (130):1326-1330.
- Sezgin, D., Mert, H., Ozpelit, E. & Akdeniz, B. (2017). The effect on patient outcomes of a nursing care and follow up program for patients with heart failure: A randomized controlled trial. International Journal of Nursing Studies (70), 17-26.
- Xiaoning C., Xiaozhi, Z., Long-le, M., Tong-Wen, S.,…Wang, L (2019). A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China. Rural and Remote Health, 19 (2).
- Young, L., Hertzog, M., & Barnason, S. (2016). Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients: The patch randomized controlled trial. BMC Cardiovascular Disorders, 16(176), 11.
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