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Course: Medical Surgical Nursing

Topic: Heart Failure II

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Module Goals

Learners will be able to

Describe the clinical manifestations of Heart Failure (HF) - Chronic Heart Failure (CHF) (Part I).
Discuss the assessment and diagnostic findings of Heart Failure (HF) - Chronic Heart Failure (CHF) (Part I).
Discuss the complications of Heart Failure (HF) - Chronic Heart Failure (CHF) (Part I).
Describe the medical management of Heart Failure (HF) - Chronic Heart Failure (CHF) (Part I).
Discuss the nursing management of Heart Failure (HF) - Chronic Heart Failure (CHF).

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Nursing Management

Monitor vital signs, oxygen saturation
Monitor weight daily
Relieve fluid overload symptoms
Relieve symptoms of anxiety and fatigue
Promote physical activity
Increase medication compliance
Decrease adverse effects of treatment

Malik et al., 2022

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Nursing Considerations

The following assessment findings need immediate medical attention from the healthcare team:

Worsening symptoms of fluid overload
Worsening hypoxia
Uncontrolled tachycardia, regardless of the rhythm
Change in cardiac rhythm
Change in mental status
Decreased urinary output despite diuretic therapy

Malik et al., 2022

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Nurses Role: Discharge Planning

Patient Education:

Medication management
Medication compliance
Low-sodium diet 2 to 3 g/day
Fluid restriction 2 liters a day
Activity and exercise
Recommendations
Smoking cessation
Recognize the signs and symptoms of worsening HF
Follow-up appointments

Malik et al., 2022

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Nurses Role: Client Education

Nutrition

Fruits and vegetables: At least 5 portions a day
Starchy meals: Potatoes, bread, rice or pasta
Dairy or dairy alternatives
Beans, fish, eggs, meat and other sources of protein
Low levels of saturated fat, salt and sugar

NHS, 2022

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Nurses Role: Client Education

Regular Exercise

Exercise programs are provided in hospitals or community clinics.
Physiotherapists assess how much exercise is safe.

Smoking Cessation

Improves overall health and reduces risk of many health problems.
Smoking cessation services are effective in helping clients to quit smoking.

NHS, 2022

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Exercise Regularly

Regular physical activity can also help improve the symptoms and general health.

If a client has heart failure, they should be offered an exercise-based cardiac rehabilitation program.

These programs vary widely across the country, but most cover 1 or more of the following:

Exercise
Education
Emotional support

They're usually run in hospitals or community clinics by teams that include nurses, physiotherapists, occupational therapists and exercise specialists.

Before a client starts, they'll have an assessment to find out how much exercise the client can safely do.

A program of exercise can then be tailored specifically for the client.

The education part of the program will give information on healthy eating and practical ways to reduce the risk of further damage to the heart.

Stop Smoking

If a client smokes, stopping smoking can improve their overall health and reduce the risk of many other health problems.

GP or an NHS stop smoking service may help if they think they'll need help quitting. They can provide support and, if necessary, prescribe stop-smoking treatments.

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Nurses Role: Client Education

Limit Alcohol Consumption

Limiting alcohol intake to 14 servings a week
Seek care provider’s advice
Stop alcohol use if heart failure is related to drinking

Vaccination

Annual flu vaccines are recommended; pneumococcal vaccines

NHS, 2022

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Nurses Role: Client Education

Regular Review and Monitoring

Talking about the symptoms: are they worsening or affecting normal activities
Instructions about the medication, including side effects
Screenings to monitor health, such as yearly lung scans

NHS, 2022

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Nurses Role: Client Education

Traveling

Travel may resume once condition improves or the provider advises.
Avoid traveling to high altitudes, hot, or humid areas.
Maintain circulation

foot exercises (foot pumps)
wearing flight socks or compression stockings if traveling or flying long distance.

NHS, 2022

Contact info: info@nursesinternational.org

Traveling and Driving

Traveling

Having heart failure shouldn't prevent a client from traveling or going on holiday, as long as they feel well enough and the condition is well controlled. But check with the doctor before traveling.

It may be advisable to avoid traveling to high altitudes or hot, humid places because this may put extra strain on the heart.

Flying won't usually cause problems, but if the heart failure is severe, the legs and ankles may swell, and breathing may become more difficult.

If a client is flying, inform the airline of the condition. They may provide a wheelchair or electric car so the client can avoid having to walk long distances at the airport.

If a client is traveling and sitting still for a long time, either in a car, coach or on a plane, they should do simple exercises to reduce the risk of blood clots. Wearing flight socks or compression stockings while flying should also help.

It may be a good idea to take 2 sets of medication along when traveling. Carry them in different places in case lose one, and make a list of the medication being taken and what it's for.

Having heart failure shouldn't stop a client from getting travel insurance, but you may have to find a specialist company that'll insure a client with heart failure.

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Nurses Role: Client Education

Emotions, Relationship, and Sex

Heart failure diagnosis can be a shock and create anxiety, depression or anger.
If depressed, talk to General Practitioner.
Physical relationship with partner may change (worries, loss of interest in sex, inability to achieve or maintain an erection).
Recommend and refer to cardiac support group.

NHS, 2022

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Emotions, Relationships and Sex

Being diagnosed with heart failure can be a shock. Some people feel scared, anxious, depressed or angry. These feelings are completely normal.

Some people also become depressed. Speak to the GP or care team if a client feels unable to enjoy the things they used to or cope with everyday life.

A client may find that the physical relationship with their partner changes after the diagnosis because of worries about having a heart attack or because they lose interest in sex or are unable to get an erection, which can sometimes be caused by heart failure medicines.

A client can discuss any worries or problems they have with their GP or care team if they feel unable to talk to their family or friends. They'll be able to advise the client and arrange support.

Clients may also find it helpful to join a heart support group, where they can talk to other people with heart conditions whose circumstances are similar to theirs.

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Nurse Education to the Caregiver or Family

Heart failure can be disabling and distressing to the client. A caregiver provides significant relief to the client.
Encourage the client to ask questions; note the answers provided.
Encourage client to provide additional information or insight about the condition.
Educate the caregivers about the warning signs.
Encourage reporting of any new signs and symptoms to the care provider.

NHS, 2022

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Caring for Someone with Heart Failure

Looking after someone with heart failure can mean anything from helping with hospital or GP visits and collecting prescriptions to full-time caring.

There are many ways a caregiver can support someone with heart failure.

Heart failure can be disabling and distressing, and many people with the condition find it a huge relief to share their concerns and fears with someone.

The caregiver should attend GP and hospital appointments with the person with heart failure. By doing so, the caregiver can encourage the client to ask the right questions while the caregiver notes down the answers.

A caregiver could also provide the doctor with additional information or insights into the person's condition, which can be helpful for planning the right treatment.

Another way a caregiver can help is by watching for warning signs that the person's heart failure is getting worse or they're not responding to treatment.

Contact the person's doctor if they notice a new symptom or their current symptoms are getting worse.

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Nurse Education to the Caregiver or Family

Signs to report to caregiver:

Shortness of breath that isn't related to exercise or activity
Increased swelling of the legs or ankles
Significant weight gain over a few days
Swelling or pain in the abdomen
Trouble sleeping or waking up short of breath
Dry, hacking cough
Increased tiredness or feeling tired all the time

NHS, 2022

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

Create a comprehensive nursing plan to address fatigue in the client with heart failure.

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Education and Support: Provide education to the patient and their family about heart failure, its symptoms, and the importance of managing anxiety and fatigue. Offer reassurance and emotional support to alleviate any fears or concerns they may have.
Medication Management: Ensure that the patient is taking their prescribed medications for heart failure as directed. Some medications may help alleviate symptoms of anxiety and fatigue, such as beta-blockers or diuretics. Educate the patient about the purpose, dosage, and potential side effects of their medications.

Anxiety Management Techniques:

a. Deep Breathing: Teach the patient deep breathing exercises to help them relax and reduce anxiety. Instruct them to inhale deeply through the nose, hold their breath for a few seconds, and then exhale slowly through the mouth.

b. Relaxation Techniques: Encourage the patient to practice relaxation techniques such as progressive muscle relaxation, guided imagery, or meditation. Provide resources or referrals to professionals who can further guide them in these techniques.

c. Distraction: Suggest engaging in activities that can divert their attention from anxious thoughts, such as listening to music, reading, or engaging in hobbies they enjoy.
Energy Conservation: Instruct the patient on energy conservation techniques to manage fatigue effectively. Encourage them to prioritize activities and delegate tasks when possible. Teach them to plan rest periods throughout the day to prevent exhaustion.

Physical Activity and Exercise:

a. Gradual Increase: Encourage the patient to engage in regular physical activity as tolerated. Advise them to start slowly and gradually increase the duration and intensity of their exercise, following their healthcare provider's recommendations.

Cardiac Rehabilitation: If available, refer the patient to a cardiac rehabilitation program, where they can receive specialized guidance on exercise and physical activity suitable for their condition.
Sleep Hygiene: Provide education on maintaining good sleep hygiene to improve fatigue. Encourage the patient to establish a regular sleep schedule, create a comfortable sleep environment, and practice relaxation techniques before bedtime.
Nutritional Support: Collaborate with a registered dietitian to ensure the patient is following a heart-healthy diet that provides adequate nutrition and supports energy levels. Encourage a well-balanced diet with appropriate portions of fruits, vegetables, whole grains, lean proteins, and limited sodium and saturated fats.
Social Support: Encourage the patient to maintain a strong support network and engage in social activities that bring them joy and emotional support. Suggest joining support groups for individuals with heart failure to connect with others who may share similar experiences.
Monitor and Report: Instruct the patient to monitor and keep a record of their symptoms, including anxiety levels and fatigue severity. Advise them to report any significant changes or concerns to their healthcare provider promptly.
Collaborative Care: Work collaboratively with the healthcare team, including physicians, nurses, social workers, and other specialists, to ensure comprehensive care and address any specific concerns related to anxiety and fatigue.

Remember to individualize care and consider the patient's preferences, cultural background, and overall health status when providing instructions for symptom management. Regularly assess their progress and adjust the plan as needed to optimize their quality of life and overall well-being.

Regenerate response

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in healthcare decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be okay in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References

Agency for Healthcare Research and Quality (AHRQ). (2020). Home. https://www.ahrq.gov/

Malik A, Brito D, Vaqar S, et al. ( 2022, Sep 19). Congestive Heart Failure (Nursing) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574497/

NHS. (2022, May 19). Heart Failure: Treatment. https://www.nhs.uk/conditions/heart-failure/treatment/

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