Monday, April 1, 2019
Palliative Care in End Stage Congestive Heart Failure
Palliative C atomic number 18 in End Stage congestive feel FailureCongestive tender malledness failure (CHF) is an inability of the spirit to supply/pump stock to the body as it consumes in normal. CHF is an acute affection and a chronic disease in which the theodolite of time whitethorn suffer other physical and psychological diseases that poses a threat to the health of the unhurried, and whitethorn be the ca character of sprightliness pass (Ameri stick out Heart Association, 2010). This indicates the paltry quality of manner of the long-suffering, exacerbating health problem. Hence, those unhurrieds need to attend mitigatory nonplus out to mitigate the quality of life.Palliative veneration for CHF patient is really crucial to relive or prevent the disturb which whitethorn be able to be cause physical problems much(prenominal) as (respiratory dis enact and sleep disorder) or psychological problems such as (depression and anxiety). Palliative conduct is t akeive precaution which provides physical support, psychological support, phantasmal support and hearty support and that is to provide the top hat as such(prenominal) as possible to better quality of life (Davidson, Macdonald Newton, 2010).How feces you serve up and support Verner from the lenitive cargon perspective?From the incase Mr. Verner has complaining from several(prenominal) problems think to his state of physical, psychological, loving and spiritual. In the beginning I involve to con placementr appropriate place of burster either in infirmary or at home if there is sufficient support in all ways (Patient UK, 2010). Then Ill start with him a wide judicial decision for his situation from perspective of lenitive care includes the physical and psychological, social, pagan and spiritual (existential). Mr. Verner has advanced heart failure or end spirit level heart failure where basin be identified the leg check to Dunderdale, Thompson, Miles, Beer Furze (2005) by the New York Heart Association (NYHA). In plus NYHA can assess a variety of the physical symptoms and restrictions. An important setting of Mr. Verner management is communication and listening, exploring his understanding and feelings nigh his illness. Exploring c erstrns just about the next can provide opportunities to discuss death and preferences for end of life care (Jaarsma et al., 2009). at that place are physical and psychological complications caused by CHF. For example Mr. Verner case he does not sleep at wickedness because he has trouble breathing, in all probability he has pulmonary congestion/pulmonary edema because according to (American Heart Association, 2010) pulmonary edema is one of the complications of CHF. So, medical intervention is involve in order to address the symptoms experienced by the patient, because medical care is real important to reduce patient stress and anxiety. Providing support through effectual communication, skills may lift the moral of the patient. During communication I yield to be honest and fidelity as well as in dealing with this patient mustiness be show kindness, compassion and respect.In order to helping Mr. Verner from the palliative care perspective I have to provide a good palliative symptom management, psychological, spiritual and social support will provide hope and reassurance. Emotional and social support is very important scene for CHF patient. Where the presence of family, relatives and friends more or less of the patient would be a very rigid supporter to improve the psychological status of the patient and reduce depression, anxiety, social isolation and forlornness (Jaarsma et al., 2009). Ill ask the provider of companionable cypher to communicate with family members to provide the counseling and patient needs from social services. withal the family members should be encouraged in participating with palliative care team up to more improve in the physical care for the pat ient. Moreover, he may benefit from a referral to social services and district care for. Liaison amid his primary care team and the local palliative care team is strongly recommended and Mr. Verner could be given contact numbers for the palliative care services. Hospice care for further social support and respite may be beneficial.Providing spiritual support is one of the important tone of palliative care whether from family or from clergy, to encourage and support the patient to let him look to the future with optimism and live with his society and free-and-easy activities in comfortable manner until he dies (Becker, 2010).Which problems and needs can you identify?From the case it shows to me Mr. Verner suffering from physical and psychological problems which includeHeart disease is the main cause of worsening of his situation and increase physical problems that areAccording to Scherer et al., (2005) lack emotional and social in patients with CHF makes the psychological problem s in evolution as experienced by Mr. VernerPhysical problemsNausea,VomitingVertigo all the day time trim down appetenceLack of vigorTrouble breathingCough in night quiescency disorderPsychological problemsDepressionAnxiety accessible isolation/lonelinessHopelessnessFear of deathNursing diagnosisDecreased cardiac output related to decreased myocardial contractility.Impaired fumble ex swop related to lung congestion resulting in trouble breathing and spit out in night.Nutrition imbalanced less than body requirements related to nausea and vomiting. hold out related to lack of energy.Disturbed sleep pattern related to trouble breathing.Ineffective coping related to chronic illness (Berman, Snyder, Kozier Erb, 2008).Patients needsInformation about the disease process, treatment and public advice on what to do and what not to do.Physical support and managing symptoms to calm/reduce suffering and improve general health for live comfortably.Emotional support to reduce the psychologic al symptoms, where the presence of family around him will be a catalyst for this support.Social services to provide equipment such as stair lifts, ramps, commodes and information about packages of care.Enhance the care, improve quality of life and provide end life care with respect culture (customs and traditions), dignity, beneficence, sympathy and empathy.Make a nursing care plan for Verner. Explain and motivate your suggested nursing interventions in accordance with the four identify areas listed in the introduction.Patient with end stage of heart failure may present with a variety of symptoms, which are a standardised to patients with advanced cancer (Matzo Sherman, 2010). A detailed history, physical examination, investigations and establishment of patient priorities will help in the management of their symptoms and improvement of quality of life. An veracious dose history is important cod to the nature of complex drug regimens. The difficulties of coping with unwanted d rug side cause may cause patients to be afraid to report their non-concordance, which may precipitate hospital admission. familiar physical symptoms are tire, distract, sobbing, dizziness, cachexia, anorexia, nausea, insomnia, difficulty in walking, constipation (Jaarsma et al., 2009).Communication skills are very important part in palliative care amongst palliative care team and patients and their families. There are small things, unless significant that matter to the patient and family such as a clean, well-pressed equal neat and tidy hair an upright posture a pull a face appropriate eye contact respecting gender, age, culture or disability a clear introduction of self and most important of all an positioning that reflect my positive interest in them as a soulfulness (Becker, 2010). Also during communicating with the patient must repeat the information. It is possible because poor cerebral blood may lead to confusion and memory problems (Patient UK, 2010). natural SYMPT OMSSYMPTOM CONTROLTrouble breathing, Cough in night and Sleeping disorderINTERVENTIONS (N) AND RATIONAL (R)Initial(N) Check vital signs, heart rate, blood pressure and respiratory rate depth. Observe if any wheezes and crackles in lung bases or edema.(R) This assessment will be noting and presence of fluid in the lung with change in heart and respiratory rate (Lewis et al., 2007).(N) Administer O2 and put patient on semi follower position.(R) Over volume is increased in the heart failure patient so, it results in jugular vein dilation and increased hepatojugular vein also (Morton, Fontaine, Hudak, Gallo, 2005).(N) Control pain if any, discomfort feeling.(R) Patients may experience chronic pain such as oedematous limbs or osteoarthritis, or as a result of previous heart surgery (Morton et al, 2005). current superviseing (N) Monitor vital signs, level of consciousness, oxygen saturation, cardiac rhythm, respiratory status and urinary output (Berman, 2008).Nausea, Vomiting, Decreased passion and Lack of energy(N) Encourage the patient to eat the liquid food use a small amount of alcohol.(R) Could be good method to stimulate appetite and improving mood and general self esteem (Berman, 2008).(N) (Dehydration) Observe strip down or mucous membrane dryness and edema. ( Ongoing Monitoring ) Monitor urinary output.(R) Occurs most much with CHF patients. Hypovolemia fluid shifts and nutritional deficits supply to poor skin and edematous tissue (Morton et al, 2005).Ongoing Monitoring (N) care patient to do daily activities such as using a wheel chair.(R) Patient needs to fully care of and need somebody to help him in accomplishing daily activities at least to feel meet (Lewis et al., 2007).The main symptoms related to the case that require specific interventions of the palliative care teamCauses and effects on CHF patientsManaging symptomFatigueCHF patients feel forever and a day tired and lacking energy. The main factors contri onlying to fatigue are abnormaliti es in skeletal muscle due to reduced perfusion and neurohumoral changes the side effects of medications reduced activity anaemia lack of appetite and muscle wasting (Scherer et al, 2005). Fatigue causes reduced quality of life because it severely restricts patients activities and creates difficulties in walking and getting out of the house. In the end stages of heart failure even managing personal hygiene and dressing can be difficult. Fatigue can also compound other physical symptoms such as constipation, oedema and pain (Davidson et al., 2010).Access to exercise programmes may be of benefit to reduce fatigue and can give patients greater sense of well being.Explanation to the patient and his family about the physiological causes of fatigue can help them understand what they are experiencing and referral to occupational therapy of physiotherapy for advice on energy conservation and exercise can be useful. Education about healthy eating and correcting anaemia can also be beneficial (Jaarsma et al., 2009).BreathlessnessCommonly caused by pulmonary oedema due to failing left ventricular function or sometimes due to anaemia. Other causes such as chest transmitting should not be overlooked. Anxiety, depression and inactivity can also establish to breathlessness (Davidson et al., 2010).Increasing diuretics is the first line treatment for breathlessness due to increasing congestion and providing by Respiratory Consultant. Home oxygen may be useful for patients with daytime low blood oxygen saturations. The use of breathing and relaxation exercises can help reduce the anxiety, which often accompanies breathlessness (Davidson et al., 2010).PSYCHOLOGICAL (EMOTIONAL) SYMPTOMSCauses and effects on CHF patientsManaging symptom/ ManagementDiagnosis of heart failure may make emotional stress. Depression, anxiety, social isolation and loneliness are habitual symptoms experienced by patient with end stage heart failure. The lack emotional and social support is an importan t soothsayer of morbidity and when patient become isolated and lack the ability to dispense with his disease this can also be a significant predictor of mortality (Jaarsma et al., 2009). A patients experience of depression is often compounded by their physical symptoms. Psychological symptoms are can reduce quality of life. Mr. Verner says I am not my disease, which can hinder hope for the future. From my experience when I give an opportunity to the patient as Mr. Verner condition, certainly will intercourse about dying. Fears of how he may die? How of pain?Emotional support is important for the patient. Effective communication with patient and his carer is needed from diagnosis and end-to-end the course of the illness. To maintain hope, patients can be offered good palliation of their symptoms and geographic expedition of their preferences for care. Information needs to be available about the disease process, common feelings experienced and local social support services. Refer ral to psychology services or counselors may be required and some patients may benefit from an antidepressant (Jaarsma et al., 2009). Tricyclic antidepressants are not usually advised due to their pro-arthymic side effects. Selective serotonin reuptake inhibitor antidepressants (e.g. fluoxetine 20 mg once daily) are more commonly prescribed (Morton et al., 2005).SOCIAL AND FAMILY SUPPORTCauses and effects on CHF patientsManagementSocial and family support is very important element, which salty social services are a high priority may affect adversely on some psychological problems such as social isolation, loneliness and sadness etc. Specifically the social aspect may be involved in the following problems financial status, depicted object to self care, adherence with lifestyle and carer burden (Davidson et al., 2010).Mr. Verner misses his children and grandchildren because he does not have energy to talk on telephone. And that make him in bad condition.Social services to provide e quipment such as stair lifts, ramps, commodes and information about packages of care District nurses for assessment of symptoms and support. District nurses are often not aware of patients living with CHF until they become hospitalized Community physiotherapy and occupational therapy for assessment and advice on exercise, energy conservation and home adaptations to aid in activities of daily living Benefits advice patients may be eligible for disability or attendance allowance (Dunderdale, Thompson, Miles, Beer, Furze, 2005).And assist in communicating with family and give advice to family in order to be near Mr. Verner, even if the move to live with his children. The presence of family, relatives and friends around of the patient would be a very strong supporter to improve the psychological state of the patient and reduce depression, anxiety, social isolation and loneliness. spectral (EXISTENTIAL) SUPPORTSpiritual support is an important aspect in palliative care. CHF reflected a gradual loss of identity and increased dependence and his illness make him incapacitate. Where it feels the burden on society and loses a sense of outlay and meaning. Some patients have religious beliefs and feel comfortable than other patients who tear the Lord and say, Where is all this time? Why the God made me like this case? (Christian medical fellowship, 2011).Spiritual support is provided by a clinically certified interfaith chaplain and a qualified by the palliative care team. And chaplain role in this is to restore hope and existential and so make the patient to cope the reality (University of Iowa Hospitals and Clinics, 2011). And small things will make Mr. doubting Thomas in happiness or make a huge difference, such as to bring his cat or a visit from a close friend or inspiration in art, poetry, music (Becker, 2010).CONCLUSIONPatients with CHF often experience a multitude of symptoms that affect adversely on their general health therefore it may happen to them to get sudden death. appointment with palliative care team is necessary to reduce the symptoms, provide the best as much as possible to improve quality of life and provide end life care with dignity. Nursing care plays an important role in the teamwork for patients with CHF, which can addressed with a variety of interventions, to relieve physical and psychological suffering, including treatment of pain, breathing difficulties and sleeping disorders. Communication is very important between palliative care team and patients and their families to adoption key work of care approach could improve patients access to appropriate palliative care. In addition, good communication between all those caring plenty for the patient in both primary and secondary care is essential. However, palliative care needs to be accessible early in the disease beginning because in the advanced stages patients may had worsened their health and then the team cannot provide the desired care. Finally I choose this case because I think the palliative care process as a practice in health part just for cancer patients but after dealing with Mr. Verner case I add to my nursing friendship more specialized skills about the palliative care.