Care Management Of Patients With Heart Failure

In this assignment the author will consider the chronic condition Heart Failure. The author will analyse the effectiveness of care management given to a patient with heart failure and depression. The Patient identity, in accordance with the NMC (2008) Code of professional conduct, will remain confidential. For the Purpose of this assignment the patient will be called Mr. Singh.

The role of some health care professionals will be discussed to show the importance of, and how working collaboratively can help promote autonomy and independence. Issues concerning therapeutic and complimentary therapies will be looked at in relation to depression. Professional, statutory, and government frameworks will be analysed to find out how they affect nursing and clients with chronic health problems. Health education and health promotion will be analysed in relation to the nurse.

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The patient Mr. Singh Is a 68 year old Asian male with chronic heart failure. The Patient has Vitamin B12 deficiency, severe depression, anemia and dependent oedema. Mr. Singh has right-sided Heart failure and has experienced Swelling of feet and ankles, Fatigue, and heart palpitations. Mr. Singh’s wife is fit and well and they have 4 daughters and several grandchildren who visit regularly.

Heart failure is progressive disorder; damage to the heart causes a weakening of the cardiovascular system. Heart failure appears through fluid congestion or inadequate blood flow to tissues (Romeo et al, 2006) Heart failure can be caused by a heart injury or an inappropriate response to heart impairment (Romeo et al, 2003 and Bupa, 2009). According to European Society of Cardiology (2008) coronary artery disease is the leading cause of heart failure by 70%.

Heart failure can affect different sides of the heart, ‘right heart failure’ reflect congestion of the systemic veins with symptoms of dependent oedema, the liver is enlarged, and the jugular veins are distended. ‘left sided heart failure’ affects the pulmonary veins. With left heart failure, there are features of pulmonary oedema and symptoms of breathlessness chest x-rays will show signs of excess fluid in the lungs (NHS, 2006). Heart failure is more common in men and affects those over 65, People of South Asian descent are at high risk for heart disease according to AHA (2004).

Heart Failure can impact on a patient psychologically and socially. This is important as well. Up to a third of people with heart failure develop severe depression (DH, 2000; Thombs et al, 2008). Depression is a mental disorder that is fairly common, it presents with depressed mood, loss of interest, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.

People who have Depression is estimated to be 100 cases per 1000 persons in the population more than 65 years old (Mcmurray et al 2000) Evidence suggests that there is a link between depression and an increase in morbidity and mortality in patients with heart failure and that men with heart failure are more likely to become depressed

than the general population (Thomas et al 1997) . Studies around heart failure and depression have shown that the manifestations and prognosis of depression is also recognised as a risk factor for heart failure. Some preliminary studies have suggested that , with concurrent depression may result in adverse clinical outcomes in people with heart failure, including higher mortality rates (Mcmurray et al 2000).

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Complimentary therapies are used for healing practice “that does not fall within the realm of conventional medicine”, (Bratman and steven 1997) complimentary therapies are often different to evidence based medicine and include therapies with an historical or cultural basis, rather than a scientific basis. Studies have suggested potential effectiveness for certain complementary and alternative medicine interventions for depression and anxiety in older adults, these theories however need more vigorous research is required (Meeks 2007)

Ernst & White,2000 and Thomas et al,2001 suggest that Complementary therapies are gaining in popularity finding they have more importance in health care (Peters et al,2002). Health care professionals have created more of an interest in complementary therapies and they are more widely integrated into nursing and midwifery (Ong & Banks, 2003). The Midwifery Council (NMC,2008) Code of Professional Conduct requires that nurses and midwives must be convinced of the safety and relevance of any therapy that are used, and should be able to justify its use when introducing complementary therapies. It is important that any therapies used are of interest of the client and should be within the best interests and safety of clients. Although studies have shown that complimentary therapies need more research, this could help give some improvement to Mr Singh’s depression, if improvements are made, this could reduce the risk of more heart problems.

Health Promotion is an important part in a nurses role of care to a patient/client (NMC 2008). Even before looking at how patients receive health promotion advice, a consideration should be given for their approachability and willingness to receive that advice. Prochaska and DiClemente’s model of readiness to change is a good example of this (Budd et al 1996). In resent years of health promotion the locus of control is a concept that has changed in both emphasis and definition. It is probably fair to comment that in the mid part of the last century, the emphasis of control was with an instructive approach from the healthcare professionals. The patients were given instructions and were expected to obey (Martyn 1999). Practice today prefers an understanding and an agreement, which is reached after a discussion that involves the patient as much as it involves the healthcare professional (Richards 1999). As discussed previously the theory of patient empowerment and education is seen to be an important part of increasing patient compliance. In due course, the locus of control stays with the patient, as they will decide on how, when and how much they will comply with the treatment plan, they will decide whether or not to be empowered to change their life (Bandura, 2007). Healthcare professionals are seen as a resource of knowledge, this allows for the process of concordance to take place (RPSGB, 1997).

Diet is also an important factor in changing Mr. Singh’s lifestyle, and trying to improve his heart function; a dietitian would give examples and give health education on how to change his diet. Loosing weight will help to reduce the hearts effort. Salt can cause water retention; Mr. Singh should reduce the amount of salt in his diet (FSA 2010). The dietitian would teach Mr. Singh and his family where to look for hidden salts in food. Diet Plans can be written up and the best food chosen to ensure salt is reduced from Mr. Singh’s diet. Mr. Singh should be advised not to replace salt with salt substitutes; many of these are high in potassium, because they may enhance the “potassium-sparing effect of angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, and aldosterone antagonists.” (FSA 2010).