Page 600 - Cardiac Nursing

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576 PA R T I V / Pathophysiology and Management of Heart Disease
in patients with HF. 160 Risk factor modification, management of Topics for Patient, Family, and Caregiver
nutrition, biobehavioral therapy, drug management, and exercise DISPLAY 24-1 Education and Counseling
training are just some of the interventions shown to benefit patients
with HF. 160 Home management of HF may relate to stabilizing the General Counseling, with Explanations of
patient’s condition after hospital discharge, providing care before car- Heart failure and the reason for symptoms
diac transplantation, or hospice care for those patients with end- Cause or probable cause of heart failure
stage HF. 161 Expected symptoms
When the patient is admitted to the hospital, the problems Symptoms of worsening heart failure
associated with HF may have become more advanced and may What to do if symptoms worsen
require supervised administration of medications as well as other Self-monitoring with daily weights
measures to reduce edema and improve myocardial performance. Treatment/care plan
The overall plan of care for patients with HF is to reduce cardiac Patient responsibilities
workload, improve cardiac output, prevent complications, and ed- Importance of cessation of tobacco use
ucate the patient regarding follow-up care. Display 24-1 presents Role of family members or other caregivers in the
treatment/care plan
topics for patient, family, and caregiver education.
Availability and value of qualified local support group
Self-Care Expectations. Self-care is the process by which per- Importance of obtaining vaccinations against influenza
sons function on their own behalf to promote health and to prevent and pneumococcal disease
and treat disease. 162 Important components of self-care in patients Prognosis
living with HF include recognizing symptoms, weighing daily, and
adhering to activity recommendations and medications. 162 Self-care Life expectancy
behaviors have been shown to improve in patients involved in HF Advance directives
disease management programs. 144,149,153 Self-care in patients Advice for family members in the event of sudden death
with HF has been divided into “maintenance” and “management” Activity Recommendations
processes. Reigel et al. 163 classified the concrete “rule following”
activities of patients with HF as “maintenance” behaviors. How- Recreation, leisure, and work activity
ever, a patient’s independent decision or choice to engage in these Exercise
activities (restricting dietary sodium intake, home daily weights, Sexual activity, sexual difficulties, and coping strategies
and daily exercise) remains complex. Sneed and Paul 164 found Dietary Recommendations
that while most patients report consistently adhering to recom-
mended “maintenance” behaviors, only 39% reported engaging in Consistent and restricted sodium intake (2 to 5 mg/day)
regular exercise while 94% reported consumption of a high- Relationship of excess sodium intake to subsequent
symptoms or weight gain
sodium food product within the preceding 24 hours. 163,164 “Man- Fluid moderation, no restriction
agement” behaviors, as Reigel et al. have labeled the behaviors that Small, frequent meals
required integration of multifaceted data, include the perception Calorie-appropriate diet
and/or recognition of symptoms, decisions involved in articulating Alcohol moderation or restriction if heart failure secondary
and reporting changes in status, independent or guided alternatives to alcohol use
in treatment plans and complex evaluation of responses. 163,165
Each of these vital steps is linked to the aforementioned complex- Medications
ity of the phenomena we term behavior. Effects of medications on quality of life and survival
Dosing
Complexity of Patient Behavior. Patient behavior is a complex Likely side effects and what to do if they occur
phenomenon. Knowledge, motivation, 166 hope, 149 self-efficacy, Coping mechanisms for complicated medical regimens
health beliefs, social support, 167 cognitive capacity, 134 and perceived Availability of lower-cost medications or financial assistance
support 168 are just a few of the variables that have been shown to Avoiding dangerous interactions with over-the-counter
impact behavior of patients with HF. Each of these variables serves medications, herbal supplements, and home remedies
as a filter through which patients perceive and integrate informa-
tion, and establish resultant behavior. While patients’ perceptions Importance of Participation in and Adherence to
of the severity of symptoms of HF have been shown to correlate the Treatment/Care Plan
with the assessments of their health care providers, 169 the studies
in this area are few. In a small, prospective qualitative study,
Reigel and Carlson 165 explored the impact of HF on patients’ lives 143,171
and identified symptoms and misconceptions as major barriers to pitalization. In the hospital setting, daily weights provide an
performing self-care behaviors. Patient education and symptom assessment of volume status and are a critical tool used by nurses and
severity predicted behavior, such as recognizing, reporting, and providers caring for patient with HF. Patient’s home monitoring of
evaluating symptoms. 170 Reflective listing, negotiating a plan, and daily weights has been proposed as an effective way to monitor vol-
154
bridging the transition to home also lead to a patient’s successful ume status. There are emerging data to support an association be-
adherence to self-care regimens. 162 tween hospital admission and weight gain beginning 1 week prior to
admission. 172 However, little is known about the home self-weigh-
Daily Weight. Lack of adherence to a prescribed outpatient reg- ing behavior experience of patients with chronic HF.
imen, resulting in volume overload and leading to shortness of Patient-directed home monitoring of daily weights can be an
breath, has been cited as the primary reason patients require rehos- effective tool to detect subtle (2 to 5 lb) changes in volume status,