Discuss the physiology of the heart, the causes and pathophysiology of heart failure, and treatment and management options.

Congestive Heart Failure
Foluke Aremu
Indiana State University

Congestive Heart Failure
Heart disease is one of the leading causes of death in the United State and it can affect anyone regardless of gender or racial background. Congestive heart failure (CHF) is one of the common problems encountered by Veteran population. The teaching/learning project will be directed to what the patient needs to do to better manage the disease and be healthy. Since the beginning of my clinical rotation on intensive care unit (ICU), I have come across patient with heart failure problem with repeated hospitalizations because of their non-compliance with treatment regimen. Many of these patients lack knowledge about the benefits medication adherence and following diets that will help to prevent exacerbation of this disease. Patient education regarding self-management care is one of the tools that have been identified to be effective in decreasing patient readmission for CHF.
Congestive heart failure is the inability of the heart to supply sufficient blood flow to the entire body. This usually takes place when the body is congested with fluid or when the body needs more oxygen and nutrients than the heart can provide. It can affect left or right side of the heart. According to Angelidou (2010), CHF is a syndrome that occurs when the heart is unable to pump enough blood and nutrients that meets the body’s oxygen demand. Butler (2012) defines it as cardiac disorder that impairs pumping ability of the heart. The pumping impairment weakens the heart which results in blood backup in the heart and makes breathing difficult or result shortness of breath.
CHF is a progressive disease that reduces the quality of patient’s life. A few signs or symptoms of the disease are shortness of breath (dyspnea), cough, crackles, and low oxygen saturation level, swelling of legs (edema), abdominal pain, weight gain, ascites, fatigue, weakness, anorexia, and liver enlargement (Angelidou, 2010). Unfortunately, the disease cannot be cured but can be treated successfully. Many people have been able to treat CHF through medication and living a healthy lifestyle. Simple changes like not smoking or using drugs; medication compliances, and changes in diet all contribute to improvement of CHF. Other people suffer from the disease to the point that medications are taken regularly and surgeries to place pacemakers have to be done.
Identifying the Teaching/Learning Need
After reviewing admission assessment for some veterans that came to the ICU for treatment, I saw many veterans coming back to the unit with the same complain from complications of the disease. I noticed that the medical management or intervention of veterans at this hospital did not reduce the rate of readmission. I also noticed that some of these patients have not been taking their medications regularly nor make positive changes to their lifestyles. One of the patients reported that he has not been able to fill his prescription for a month. It is obvious that they lack adequate knowledge to adhere to self-care recommendations to treat the disease.
The Scope and Breadth of Teaching/Learning Need
Most patients cannot live successfully without long-term lifestyle adjustment. Most of the causes of readmission can be prevented if there is adequate education and discharge planning for the patient and family. The teaching/learning needs were assessed by interviewing the patient. The breath of information of CHF was emphasized. Patients were asked questions regarding their medication, diet, and physical activity. Information was provided based on the answer to these questions.
Teaching/Learning Tool Development and the Rationale
Treatment of CHF involves a multifaceted process and the goal is not on how to recover but how to reduce rates of readmission, and improve the quality of life of affected patient. I decided to create a mini literature that is evidence based for veterans on how to manage CHF. The tool is not meant to be the final authority on CHF but an extra resource for veterans while being treated for the disease. It will educate veterans with CHF about healthy lifestyles and self-care management strategies so that they can successfully monitor symptoms and seek help when necessary. The learning tool would be a helpful guide that can influence veteran’s knowledge behavior, and attitude about CHF management.
Scientific Literature to Support Development Decision
Assari, 2014 conducted a research on risk of heart disease in the United States among veterans: a cohort with 20 years of follow up. The aim of the study was to investigate if veterans are at a higher risk of new onset heart disease over 20 years in the United States (U.S.) and to test if the above association is independent of socio economics, physical health, mental health, and health compromising behaviors. The research was a comparative and descriptive that utilized Health and Retirement Study data from 1990 through 2012 to study the development of heart disease among veterans in the U.S. (p. 704). The study used 8,375 individuals who have never had heart disease as the baseline for the duration of the research with a 95% confidence interval rate (p. 703).
In the study, the author stated that “veterans should be considered as a high‑risk population for CVD and should receive targeted interventions to reduce their risk of heart disease” (p. 707). Based on results from the study data, evidence shows that there is a higher link to development of CHF among veterans because they have higher rate of mental illness such as depression, and post traumatic depression (PTSD) (p. 706). The conclusion of this study helped in knowing that veterans have greater risk of having CHF and this risk is independent of health behavior, body mass index, socio-economic characteristics and chronic medical conditions.
Will, Valderrama, and Yoon (2012) conducted a study on preventable hospitalizations for congestive heart failure: establishing a baseline to monitor trends and disparities. The study reported on baseline rates of CHF hospitalizations and describes trends by race over 15 years. The method of the study was a random sampling from National Hospital Discharge Survey data from 1995 through 2009, this data represent approximately 1% of hospitalizations in the United States each year. The authors used SUDAAN (Research Triangle Institute, Research Triangle Park, North Carolina) to calculate 95% confidence intervals around the estimates of the number of hospitalizations for CHF (p. 3). The study provided unique information regarding clinical guidelines for the management of CHF and other ways to reduce the rate of readmission through symptom monitoring, weight monitoring, and medication dosage adjustment (p. 1). The majority of the references in this study appear to be primary sources and they provided the rationale for CHF intervention.
Angelidou, 2010 conducted a study on roles and interventions of nurses in the treatment of heart failure. The aim of study is identify ways to prevent readmission, increase functional ability and improving quality of life for patients with CHF. The author stated that there are three basic management strategies of treating heart failure namely, pharmacologic management, devices and surgical management, and lifestyle management (p. 2). In this study, lifestyle management is championed as the most important strategy that nurses are responsible for when caring for CHF patients.
The lifestyle management includes restricting sodium intake, smoking cessation, appropriate levels of exercise, self-monitoring for symptoms and signs of congestion. Management of care provided by nurses to CHF patients have shown to help in reducing readmission and mortality rate. The author also provided some information on how nurses can use patient education in self-care management for patients with CHF. This type of education will help patients to understand and compare their treatment regimen; and ways to recognize and manage symptoms and signs of CHF. The interventions listed in this study are evidence based and it contributes to a clearer delivery and components that can help future researchers.
Alspach, 2014 also conducted a study on how to slow the revolving door of hospitalization for acute heart failure. One of the objectives of the study involves how critical care nurses can contribute in reducing the readmission of heart failure. According to the Alspach 2014, “critical care nurses have numerous opportunities to collaborate with other members of the health care team and successfully manage acute episodes and to intervene in meaningful and effective ways to better prepare patients and families for discharge in a manner that diminishes the need or at least extends the timeframe for the next readmission” (p. 10). The study points to how nurses can teach individuals to recognize heart failure symptoms which can help to improve patient self-care management.
Butler (2012) conducted an overview study on CHF management. The article reviews the causes, signs and symptoms, diagnosis and management options for CHF. The study also discusses the physiology of the heart, the causes and pathophysiology of heart failure, and treatment and management options. According to the author, management of CHF consists of two interventions namely pharmacological and non-pharmacological. The pharmacological in the study discussed about different types of treatment based on heart failure due to left ventricular systolic dysfunction. The study reveals how the non-pharmacological intervention helps improve management of CHF. The author also discussed how education and lifestyle information should be part of medication and management plan for a patient with CHF. This study is a well-documented research that provides a level II evidence since it supports most of the basic nursing intervention for CHF patients.
Project Suitability for Future use and/or Revision
Many of the patients with CHF that were seen during the clinical experience did not understand the magnitude of the disease. Many of them reported not knowing what to do to in managing the disease. Many of them did fail to adhere to medication regimen. Patient education and effective communication is a very important part of nursing care. The teaching/learning goal focused on improving patient quality of life, decrease symptoms and reduce hospital readmission for CHF. Patient verbalized understanding of these goals after teaching. The teaching intervention described and explained why patients were at risk and educated them about ways to prevent or manage CHF. The tailored component of the education focused on unique concerns identified by each patient. The entire patients that I had the opportunity to teach were interested in knowing different aspect of the disease and the best way to manage it. There is a need to create for more educational intervention that will be efficient and effective to patient learning needs in the future.
Reflection on the Teaching/Learning Process from Inception to Delivery of Content
Collaboration from all health care team members on ICU was very useful in delivering the content of teaching to the patients and their family. The result of collaborations among all health care staff helps to build safer and better patients care. During the development and management of CHF, many patients have at one time or the other been admitted, discharged and readmitted; through these periods of hospitalization, nurses have opportunities to collaborate with other health care team members and successfully manage the patient. A meaningful and effective intervention will better prepare the patient and families for discharge in such a way that reduces the need for readmission. Patient understanding was assessed to ensure that the context of the information was received.
Critical thinking element was also important in order to deliver effective patient teaching. It was found useful in making clinical decision after gathering data from the clients on why they are non-compliance with treatment regimen for CHF. The cause of CHF and its treatment was critically analyzed before delivering patient’s teaching. Conceptualization plays a huge part in planning and evaluation of the patient understanding of the teaching process of CHF. There is a need to develop conceptualization methods that will help all health care team to collaborate in reducing or preventing readmission of veterans with CHF.
Take Away/Conclusion
The goal of teaching is to help people and their families to understand what the condition is and to know that there are treatment available that can improve lives. Although, there are treatments that can help people deal with the symptoms of CHF, too few people reach out for the support. Greater understanding and awareness of CHF will assist veterans and other people who are suffering to recognize the symptoms and seek the care they need. To successfully manage CHF, veterans need to be adherent with daily self-management behaviors, including medication use, monitoring of disease signs and symptoms, diet awareness related to sodium and fat intake, and exercise. My take away from this experience is that as a nurse, we have a role to play in helping to reduce hospital readmission of CHF patients. We have the ability to help patients improve their quality of life by providing learning tools and educational needs that will aid in self-management and promote quality life.

Alspach, J. (2014). Slowing the revolving door of hospitalization for acute heart failure. Critical Care Nurse, 34(1), 8-12.
Angelidou, D. (2010). Caring for the heart failure patient: Contemporary nursing interventions. Hospital Chronicles, 1-8.
Assari, S. (2014). Veterans and risk of heart disease in the United States: A cohort with 20 years of follow up. International Journal of Preventive Medicine, 5(6), 703-709.
Butler, J. (2012). An overview of chronic heart failure management. Nursing Times, 108(14), 16-20.
Will, J., Valderrama, A., &Yoon, P. (2012). Preventable hospitalizations for congestive heart failure: Establishing a baseline to monitor trends and disparities. CDC – Preventing Chronic Disease, 9, 1-9. doi: http://dx.doi.org/10.5888/pcd9.110260
American Heart Association, http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp

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