Discuss about the Treatment to achieve fluid balance in heart failure.
CHF is a common disease which has a very poor prognosis. It brings forth several devitalizing symptoms to the patient. For the sufferers to garner maximum benefits from their daily therapy, both them and their carers need to have a background understanding of the nature of this condition, cause and its management. Woodruffe et al. (2015) agree that guidance on diet, fluid and salt restriction, the purpose and nature of given medication, exercise programs and lifestyle changes can facilitate compliance and reduce the risk of developing decompensation episodes. Piepoli et al. (2016) suggest that non-pharmacologic management of chronic heart failure should include lifestyle modification, dietary advice and fluid control.
This paper is based on the scenario of Mr M. W; he is 66 years old and living in a nursing care home where the writer works as a registered nurse. Mr M. W is a heart failure patient, and the multidisciplinary team has prepared his care plan in conjunction with him and his relatives, in deciding the course of his medical program. This paper seeks to address the main nursing strategies and interventions used in the long-term treatment and management of Mr M. W’s condition as regards lifestyle, nutrition and fluid management, with a particular focus on ensuring M. W’s independence and wellbeing.
How does lifestyle influence chronic heart failure? Woodruffe et al. (2015) report that the benefits of lifestyle modification in the management of heart failure include lowering morbidity and mortality and improving the quality of the patient's life. Milligan (2013) asserts that weight management and moderate physical activity pertain lifestyle modification. Both are fundamental in the care and control of chronic heart failure; the quality of life and the autonomic balance are both intensified; both the inflammatory response and the neurohumoral activation are reduced and, the capacity of moderate physical activity is heightened (Milligan, 2013).
Nursing intervention: Due to Mr M. W’s condition, his attending nurse(s) must lay great emphasis on psychological support and lifestyle changes. The advantages of weight loss and moderate exercise to Mr M. W. as a patient with chronic heart failure have been proven by significant evidence derived from experiments and several observations rather than theory. An investigation of the clinical benefits exhibits the regression of the remodelling of the left ventricle which occurs as a result of aerobic exercises (Milligan, 2013). The nurse(s) should advise Mr M. W to have a personal scale to weigh himself, wearing the same attire every morning after he urinates, as part of his weight management plan. Additionally, Mr M. should be encouraged to participate in mild to moderate physical activity and, to regularly inform the attending nurse(s) on any weight loss or weight gain. This lifestyle modification would promote Mr M. W’s independence and wellbeing.
How does nutrition impact on chronic heart failure? The sustenance of the nutritional requirements of patients suffering from heart failure has many challenges, and this can have a substantial consequence on the disease progression (Wingham, Harding, Britten & Dalal, 2014). Failure to correct the situation results in early deaths occur. The nurses managing this condition need to be abreast with information about the dietary intake that might affect the nutritional intervention as relates to the management of heart failure. Washburn and Hornerberger (2008) report that dietary guidelines necessary in managing CHF are lacking but, tailored guidelines ought to be provided to the patients suffering from chronic heart failure. The nutritional intervention starts with a holistic critical investigation of the nutritional status and regular dieting of the heart failure patients, factoring in their cultural, medical and social views. Dietary needs and suggestions relevant to the management of heart failure aid in reducing the inflammatory process that increases the risk of developing chronic heart failure.
Nursing intervention: The attending nurse(s) should ensure a careful control of Mr M. W’s caloric intake is because elevated blood sugar levels often aggravate cardiovascular events in patients with gradually advancing chronic cardiac failure (Washburn & Hornerberger, 2008). M. W. should be given amino acid supplementation because amino acids have been found to facilitate the capabilities for physical activity, particularly for heart failure patients of the elderly subpopulation. Also, proteins are natural antioxidants and anti-inflammatory agents. Furthermore, Mr M. W's nurse(s) should advise him dietary fat content. Piepoli et al. (2016) contend that the type of fat consumed is a fundamental aspect in deciding the risk of developing cardiovascular disease and can impart to the process of inflammation. Oils containing omega 3 are fat dietaries enriched with cardioprotective and anti-inflammatory agents. Omega 3 reduces the risks of demise in individuals with chronic heart failure when incorporated in the nutritional management (Woodruffe et al., 2015).
How does fluid management influence CHF? Chronic heart failure signs are as a result of fluid and salt retention. Weight gain as a result of fluid retention is an essential indicator of worsening heart failure hence calling for urgent treatment and, this is a usual symptom to hospitalise patients with heart failure (McMurray et al., 2012).
Nursing intervention: The aim of managing Mr M. is for him to reach his dry weight. Clark, Coletta and Cleland (2011) posit that this can be attained by losing approximately 2 litres of fluid daily, which is equal to getting rid of 2 kilograms of Mr M. W’s body weight. Mr M. W’s nurse(s) should advise him on the advantages of adhering to fluid restriction regimes. The nurses can also inform Mr M. W on how to manage fluid intake as regards how many glasses of water or cups of tea he can have daily. This will aid him in spacing out his fluid allowance. It will be essential to have Mr M. W’s cooperation and, this will best be achieved by the nurse(s) explaining the reasons for fluid restriction and consumption of salt as part of Mr M. W’s education and health, independence and well-being promotion. Hughes (2013) believes that educating patients is an integral aspect in the care of chronic heart failure patients. According to Hughes (2013), even though cutting weight is a desirable objective, it is significant to establish that this weight loss is from fluid loss because some heart failure patients may be cachexic and, this often bears a poor prognosis.
Moreover, just in case M. W. requires diuretics for the management of fluid retention, it is necessary that his attending nurse(s) advise him to reduce his salt intake. Washburn and Hornberger (2008) affirm that this has been used as the standard in the management of chronic heart failure even though much research to assess the effectiveness and recommendation of restricting sodium diet has not been conducted. The nurse(s) should recommend a daily sodium dietary intake of 2g for Mr M. even though this amount is costly and unpalatable or, Mr M. should entirely avoid sodium intake. Mr M. should be encouraged to avoid using any salt substitutes because potassium, found in many of these substitutes may negatively react with some of the medications for heart failure like spironolactone.
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McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., & Gomez-Sanchez, M. A. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European heart journal, 33(14), 1787-1847.
Milligan, F. (2013). Using exercise to improve quality of life for people with heart failure. British Journal of Nursing, 22(21), 1242-1246.
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Washburn, S. C., & Hornberger, C. A. (2008). Nurse educator guidelines for the management of heart failure. The Journal of Continuing Education in Nursing, 39(6), 263-267.
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