The Impact of Heart Failure on Patient’s Wellbeing, and the Role of Nurses

Introduction

Heart failure is a very common diagnosis in patients on the cardiovascular unit. It can be very devastating depending on when it was diagnosed and the methods of treatment. Each patient may react differently to each treatment regimen, so it is important for nurses to be aware that there is not one single treatment for heart failure. Heart failure fits into a variety of concepts covered during class this semester. It is a part of the fluid and electrolyte concept because heart failure and its treatment often can cause imbalances in electrolytes such as potassium and sodium. Also, if a patient has congestive heart failure, they likely have a large buildup of fluid in the pericardial space and throughout the body. Heart failure also relates to the concepts of gas exchange, perfusion, functional ability, and wellness. Because of the fluid buildup around the heart and lungs, many patients quickly become short of breath. Shortness of breath can decrease the rate of gas exchange and perfusion. It also causes the patient to have a greater difficulty completing their activities daily living. This essay will discuss how heart failure affects the patient and why it is vital that patient is tended to both physically and mentally. Based on much research there are a variety of ways to help the patient’s mental wellbeing and also many ways to prevent readmission by improving their physical wellbeing.

Pathophysiology of Heart Failure

We can define Heart Failure as the pathophysiological and clinical state in which a cardiac abnormality is responsible for the heart not responding normally to the peripheral irrigation requirements or operating with high filling pressures. Variations in preload, afterload, and contractility are the main factors that allow the heart to adapt to peripheral demands. Different pathological situations can produce sustained or exaggerated increases in pre or post-load ('overloads') or deterioration of contractility or compliance, with loss of said ability to adapt. (Hoes et al., 2020)

When the alterations are severe and of sudden installation (e.g., myocardial infarction, valve rupture, etc.), a serious deterioration of cardiac function occurs, which translates into a decrease in cardiac output and retrograde elevation of venous pressures in the pulmonary and systemic territory, with a clinical picture of Acute Heart Failure, usually of progressive course and poor prognosis. (Sinha et al., 2020) However, the most frequent is that the overloads or the deterioration of the cardiac function are of slow installation and are accompanied by changes in the heart, circulatory system, and neurohormonal system, which will produce a new balance between the peripheral demands and cardiac function. They are the so-called adaptation or compensation mechanisms.

The pathological situations that most frequently determine changes in the heart mechanics are volume overload, pressure overload, decreased contractility, and decreased compliance. The most important initial phenomenon observed secondarily is the increase in ventricular volume, which is accompanied by an elongation of the sarcomere and the consequent increase in its work capacity. If functional deterioration or overload is maintained over time, anatomical changes of great functional significance occur in cardiac hypertrophy.

Depression in patients with heart failure

Many patients with heart failure often experience depression. Up to 77% of heart failure patients will also be experiencing depression (Woltz, et al., 2012). Depression is especially important to be aware of in these patients because it can cause further exacerbations of heart failure once they are discharged. Common treatments and therapies for patient’s experiencing depression are the use of selective serotonin inhibitors, exercise, cognitive behavioral therapy, and complementary and alternative medicine have been proven effective (Woltz, et al., 2012).

Among patients receiving treatment for heart failure and receiving selective serotonin inhibitors for depression, depression scores were lower, and they had no adverse reactions to the depression medication (Woltz, et al., 2012). Selective serotonin inhibitors, however, are typically only used in patient that had clinical depression prior to diagnosis of heart failure (Woltz, et al., 2012). Exercise has been proven in many studies to decrease symptoms of depression in many patients. However, in many patients that have heart failure, exercise is often contraindicated due to the increased shortness of breath and fatigue (Woltz, et al., 2012). When patients are educated on of the main points is balancing rest with exercise, which means they are no longer able to participate in exercise in ways they used to. Complementary and alternative medicine practices hold a lot of promise for the future. Many of theses practices, such as tai chi, meditation, and yoga have been proven to be very effective in patients experiencing depression (Woltz, et al., 2012). Patient’s can practice methods of mindfulness and meditation while they are in the hospital and would not have any interactions with their current medication regimen and would not increase their shortness of breath. Another intervention used to improve depression in patients is cognitive behavioral therapy. This is used in patients with clinical depression and has been proven to improve their mindset and depression symptoms (Woltz, et al., 2012). Overall, there are many different methods of improving symptoms of depression in patients with heart failure, but there may be limitations depending on the patient.

The Role of Nurses 

Nurses also need to be educating their patients throughout their stay in the hospital to prevent readmission due to an exacerbation of heart failure. The nurses need to stay vigilant and talk to their patients about all of the medications they are taking, including over the counter medicines and other non-pharmacologic therapy modalities (Corso, Bondiani, Zanolla, & Vassanelli, 2007). In order for the patients to be educated appropriately, the nurses also need to have the appropriate knowledge to share. According to an article in the European Journal of Cardiovascular Nursing all nurses should be educated on the use of non-prescription therapies and the risks that surround them, especially when used concurrently with the pharmacological treatment of heart failure (Corso, Bondiani, Zanolla, & Vassanelli, 2007).

It has been reported that around fifteen percent of patients also use a form of alternative of complementary medicine (Corso, Bondiani, Zanolla, & Vassanelli, 2007). The most common alternative treatment is homeopathy, which is a method of treatment that works to have the body restore itself based on what caused the initial problem. Nearly 75% of heart failure patients reported the concurrent use of over the counter drugs (Corso, Bondiani, Zanolla, & Vassanelli, 2007). This important for nurses to be aware of because there may be incompatibilities or increased risk for adverse reactions when introducing a new medication into the regimen without prior authorization by their doctor or pharmacist. It is important for patients to be aware of this risk before this occurs. It was reported that nearly twenty percent of individuals with heart failure used herbal remedies both as an alternative and as an adjunct therapy with their current medical treatment (Corso, Bondiani, Zanolla, & Vassanelli, 2007). Nurses need to be aware of the interactions and need to instruct their patients to disclose their use of herbal remedies with their doctor (Corso, Bondiani, Zanolla, & Vassanelli, 2007). Herbal remedies also can have adverse effects. Common adverse effects are sodium retention, hypertension, nausea, and may inhibit the ability to absorb iron appropriately (Corso, Bondiani, Zanolla, & Vassanelli, 2007). When combined with common heart failure medications there is an increased risk for hypokalemia and digoxin toxicity, increased bleeding when on warfarin, and arrhythmias (Corso, Bondiani, Zanolla, & Vassanelli, 2007). It is important when educating the patients about these risks the nurse remains unbiased and present the facts (Corso, Bondiani, Zanolla, & Vassanelli, 2007). Ultimately, the nurse must respect the patient’s decisions, even if they do not agree with them. Should the patient make an adjustment to their therapy with over the counter medicine or an herbal remedy, the nurse should contact other members of the health care team to alert them of the decision so that all may be on the same page.

Another part of patient education that is vital to positive patient outcomes is providing ways for the patient to prevent readmission. Patients with heart failure have a 20%-25% risk of readmission within the first month after discharge, which is considered very high (Messina, 2016). In order to prevent readmission and to save both patients and hospitals money nurses must provide education to the patients. One method used to reduce readmission in a VA hospital in central Florida is the use of a home telehealth and phone care. Home telehealth is a method of communicating between the patient and a nurse after they were discharged from the hospital (Messina, 2016). This method of communication saved both the nurses and the patients time because it does not require either to travel to a specific location to meet and discuss their condition. It also allows the patient to actively participate in their care and ask questions as needed (Messina, 2016). According to this study, about 85% of patients who actively used home telehealth and phone care for four months after discharge avoided the need for readmission to the hospital (Messina, 2016). Phone care is a simple option that nearly all patients can participate in just by calling the hospital or office in order to get their questions answered. Participating in home telehealth and phone care was an option presented to the patients and allows them and their families to become more active and autonomous in their care (Messina, 2016).

When caring for patients diagnosed with heart failure there are a variety of steps a nurse can take to ensure the patient experiences adequate care both while they are in the hospital setting and once they are discharged. The most important aspect to remember is that these patients need to be cared for in both their physical health and mental health. Heart failure causes many people to change aspects of their lives in order to prevent further exacerbation. It also can impact their mental health, especially if they had a history of mental health issues. It is important for the nurse to be active in their care. The nurse must provide clear communication to the patient about interactions of medication and modes of therapy that could be used to improve the patient’s symptoms of depression. When talking with the patient it is also important that the nurse educates the patient about the importance of being transparent and disclosing the use of complementary and alternative treatments. These can be as small as the use of an over the counter medication for pain or as large as using homeopathy as the main treatment modality. All treatments not specifically prescribed by the doctor need to be brought up so that the patient does not experience any adverse effects from the combination of such methods. It is also important that care lasts longer than just while the patient is in the hospital. Having methods of communication outside of the hospital or office can help all patients prevent an exacerbation of heart failure.

Overall, there are a lot of areas that nurses need to be educated about so that they can then educate their patients about. It is important for these patients to experience good care because it allows the patient to have a greater chance at positive outcomes while they are in the hospital and once they are discharged.   

Conclusion

In conclusion, heart failure is a complex condition that requires a comprehensive approach to patient care. Nurses play a crucial role in understanding the pathophysiology of heart failure and its implications for treatment. They need to recognize that heart failure fits into various concepts covered in their training, including fluid and electrolyte balance, gas exchange, perfusion, functional ability, and wellness. By understanding these concepts, nurses can provide holistic care that addresses the physical and mental well-being of patients.