Congestive heart failure (CHF) is an incapability of the heart to supply/pump bloodstream to the body as it requires in normal. CHF is an acute health issues and a long-term disease in which the passage of time could cause other physical and internal diseases that poses a threat to the fitness of the patient, and could be the reason for life limiting (American Heart Connection, 2010). This means that the poor standard of living of the individual, exacerbating health problem. Hence, those patients need to wait palliative attention to enhance the standard of living.
Palliative care for CHF patient is vital to relive or avoid the pain which may be in a position to be cause physical problems such as (respiratory disorder and rest disorder) or emotional problems such as (depression and stress). Palliative treatment is supportive health care which gives physical support, subconscious support, spiritual support and social support and that is to supply the best whenever you can to improve standard of living (Davidson, Macdonald & Newton, 2010).
From the situation Mr. Verner has complaining from several problems related to his status of physical, internal, social and religious. In the beginning I must consider appropriate place of health care either in medical center or at home if there is sufficient support in all ways (Patient UK, 2010). Then I'll focus on him a comprehensive analysis for his situation from point of view of palliative treatment includes the physical and internal, social, social and religious (existential). Mr. Verner has advanced heart and soul inability or end stage heart inability where can be determined the stage relating to Dunderdale, Thompson, Mls, Beer & Furze (2005) by the New York Heart Connection (NYHA). In addition NYHA can evaluate a variety of the physical symptoms and limitations. An important facet of Mr. Verner management is communication and listening, checking out his understanding and feelings about his health problems. Discovering concerns about the near future can offer opportunities to go over death and personal preferences for end of life care and attention (Jaarsma et al. , 2009). There are physical and internal complications triggered by CHF. For instance Mr. Verner circumstance: he will not sleep at night because he has trouble breathing, probably he has pulmonary congestion/pulmonary edema because according to (North american Heart Connection, 2010) pulmonary edema is one of the difficulties of CHF. So, medical involvement is needs to be able to address the symptoms experienced by the individual, because health care is very important to lessen patient stress and anxiety. Providing support through effective communication, skills may lift up the moral of the patient. During communication I have to be honest and fidelity also in dealing with this patient must be show kindness, compassion and esteem.
In order to assisting Mr. Verner from the palliative care perspective I must provide a good palliative sign management, psychological, spiritual and communal support provides desire and reassurance. Emotional and social support is vital aspect for CHF patient. Where the existence of family, family members and friends around of the patient would be a very strong supporter to improve the psychological status of the individual and reduce depression, anxiety, interpersonal isolation and loneliness (Jaarsma et al. , 2009). I'll ask the provider of Friendly Work to communicate with family to supply the guidance and patient needs from sociable services. Also the family members should be motivated in engaging with palliative good care team to more improve in the physical care for the patient. Additionally, he may benefit from a referral to public services and area nursing. Liaison between his primary attention team and the local palliative good care team is strongly suggested and Mr. Verner could be given contact volumes for the palliative good care services. Hospice care for further social support and respite may be beneficial.
Providing religious support is one of the essential requirement of palliative good care whether from family or from clergy, to encourage and support the patient to let him turn to the future with optimism and live with his society and day to day activities in comfortable manner until he dies (Becker, 2010).
From the situation it shows to me Mr. Verner suffering from physical and internal problems such as:
Heart disease is the main cause of worsening of his situation and increase physical issues that are:
According to Scherer et al. , (2005) lack emotional and cultural in patients with CHF makes the mental problems in development as experienced by Mr. Verner:
Vertigo all your day time
Lack of energy
Cough in night
Fear of death
Nursing medical diagnosis:
Decreased cardiac output related to lowered myocardial contractility.
Impaired gas exchange related to lung congestion resulting in trouble respiration and cough in night.
Nutrition imbalanced less than body requirements related to nausea and vomiting.
Fatigue related to lack of energy.
Disturbed sleep pattern related to trouble breathing.
Ineffective coping related to serious disease (Berman, Snyder, Kozier & Erb, 2008).
Information about the disease process, treatment and standard advice on how to proceed and what never to do.
Physical support and managing symptoms to reduce/reduce hurting and improve health and wellness for live comfortably.
Emotional support to reduce the subconscious symptoms, where in fact the presence of family around him will be a catalyst because of this support.
Social services to provide equipment such as stair lifts, ramps, commodes and information about deals of care.
Enhance the care and attention, improve standard of living and provide end life treatment with respect culture (traditions and customs), dignity, beneficence, sympathy and empathy.
Make a nursing care plan for Verner. Explain and motivate your suggested medical interventions in accordance with the four key areas shown in the intro.
Patient with end stage of heart failure may present with a number of symptoms, which act like patients with advanced malignancy (Matzo & Sherman, 2010). An in depth history, physical examination, investigations and establishment of patient priorities can help in the management of these symptoms and improvement of standard of living. An accurate medication background is important because of the nature of complicated drug regimens. The difficulties of coping with unwanted drug aspect effects may cause patients to hesitate to article their non-concordance, which may precipitate hospital admission. Common physical symptoms are tiredness, pain, breathlessness, dizziness, cachexia, anorexia, nausea, insomnia, difficulty in walking, constipation (Jaarsma et al. , 2009).
Communication skills are very important part in palliative health care between palliative care team and patients and their own families. A couple of small things, but significant that subject to the patient and family such as: a clean, well-pressed standard; neat and tidy wild hair; an upright position; a giggle; appropriate eye contact respecting gender, age group, culture or disability; a clear advantages of self & most important of most: an attitude that echo my positive curiosity about them as a person (Becker, 2010). Also during interacting with the individual must repeat the info. It is possible because poor cerebral blood may lead to confusion and ram problems (Patient UK, 2010).
(N) Check essential signs, heartrate, blood circulation pressure and respiratory rate depth. Observe if any wheezes and crackles in lung bases or edema.
(R) This assessment will be noting and occurrence of substance in the lung with change in center and respiratory rate (Lewis et al. , 2007).
(N) Administer O2 and put patient on semi follower position.
(R) Over volume is increased in the center inability patient so, it leads to jugular vein distention 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 therefore of earlier heart surgery (Morton et al, 2005).
Ongoing Monitoring (N) Keep an eye on vital signs, degree of consciousness, oxygen saturation, cardiac rhythm, respiratory status and urinary result (Berman, 2008).
(N) Encourage the individual to eat the liquid food use a little amount of alcohol.
(R) Could be good method to stimulate desire for food and improving spirits and general self-confidence (Berman, 2008).
(N) (Dehydration) Observe skin area or mucous membrane dryness and edema. ( Ongoing Monitoring ) Monitor urinary productivity.
(R) Occurs frequently with CHF patients. Hypovolemia liquid shifts and nutritional deficits donate to poor pores and skin and edematous tissues (Morton et al, 2005).
Ongoing Monitoring (N) Help patient to do daily activities such as utilizing a wheel chair.
(R) Patient needs to fully care and attention of and need you to definitely help him in completing day to day activities at least to feel satisfied (Lewis et al. , 2007).
The main symptoms related to the truth that require specific interventions of the palliative attention team
CHF patient's feel constantly tired and lacking energy. The primary factors adding to fatigue are: abnormalities in skeletal muscle credited to reduced perfusion and neurohumoral changes; the side effects of medications; reduced activity; anaemia; insufficient cravings and muscle throwing away (Scherer et al, 2005). Tiredness causes reduced quality of life because it severely restricts patient's activities and creates troubles in walking and getting away from the house. In the end stages of center failure even controlling 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 programs may be of great benefit to reduce tiredness and can give patients increased sense of well being.
Explanation to the individual and his family about the physiological causes of exhaustion can help them understand what they can be experiencing and referral to occupational remedy of physiotherapy for advice on energy saving and exercise can be handy. Education about healthy eating and correcting anaemia can even be beneficial (Jaarsma et al. , 2009).
Commonly brought on by pulmonary oedema scheduled to failing remaining ventricular function or sometimes due to anaemia. Other notable causes such as chest infection should not be overlooked. Anxiety, depressive disorder and inactivity can also donate to breathlessness (Davidson et al. , 2010).
Increasing diuretics is the first series treatment for breathlessness credited to increasing congestion and providing by Respiratory Consultant. Home air may be helpful for patients with daytime low blood oxygen saturations. The use of breathing and leisure exercises can help reduce the anxiety, which often accompanies breathlessness (Davidson et al. , 2010).
Diagnosis of heart failure could make emotional stress. Major depression, anxiety, cultural isolation and loneliness are common symptoms experienced by patient with end level heart failure. The shortage emotional and interpersonal support can be an important predictor of morbidity and when patient become isolated and lack the ability to cope along with his disease this can be a substantial predictor of mortality (Jaarsma et al. , 2009). A patient's connection with melancholy 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 impede hope for the future. From my experience as i give an chance to the individual as Mr. Verner condition, will certainly discuss dying. Worries of how he may perish? How of pain?
Emotional support is important for the patient. Effective communication with patient and his carer is necessary from medical diagnosis and throughout the span of the illness. To keep anticipation, patients can be offered good palliation of their symptoms and exploration of their choices for good care. Information needs to be accessible about the condition process, common emotions experienced and local public support services. Referral to psychology services or counselors may be required plus some patients may benefit from an antidepressant (Jaarsma et al. , 2009). Tricyclic antidepressants aren't usually advised because of their pro-arthymic side results. Selective serotonin reuptake inhibitor antidepressants (e. g. fluoxetine 20 mg once daily) are more commonly prescribed (Morton et al. , 2005).
Social and family support is vital element, which interesting sociable services are a high priority may have an impact on adversely on some mental health problems such as interpersonal isolation, loneliness and sadness etc. Specifically the interpersonal aspect may be involved in the next problems: financial status, capacity to self care, adherence with lifestyle and carer burden (Davidson et al. , 2010).
Mr. Verner misses his children and grandchildren because he doesn't have energy to talk on mobile phone. And that produce him in bad condition.
And help out with conversing with family and give advice to family to become near Mr. Verner, even if the move to live along with his children. The existence of family, family members and friends around of the individual would be a quite strong supporter to increase the psychological state of the patient and reduce depressive disorder, anxiety, communal isolation and loneliness.
Spiritual support can be an important aspect in palliative care. CHF mirrored a gradual lack of identity and increased dependence and his health issues make him incapacitate. Where it feel's the burden on population and loses a feeling of worthwhile and so this means. Some patients have religious beliefs and feel safe than other patients who blame god, the father and say, Where is all this time? Why the God made me like this case? (Christian medical fellowship, 2011).
Spiritual support is provided by way of a clinically skilled interfaith chaplain and a professional by the palliative care and attention team. And chaplain role in this is to revive anticipation and existential then make the patient to cope the reality (School of Iowa Private hospitals and Clinics, 2011). And small things can make Mr. Thomas in contentment or make a huge difference, such as to bring his kitty or a visit from a close friend or motivation in fine art, poetry, music (Becker, 2010). CONCLUSION
Patients with CHF often experience a variety of symptoms that affect adversely on the general health therefore it may happen to them to get sudden fatality. Contribution with palliative treatment team is necessary to lessen the symptoms, supply the best as much as possible to improve standard of living and provide end life attention with dignity. Nursing attention performs an important role in the teamwork for patients with CHF, which can attended to with a variety of interventions, to alleviate physical and psychological hurting, including treatment of pain, respiration difficulties and sleeping disorders. Communication is vital between palliative good care team and patients and their own families to adoption key work of good care methodology could improve patients' usage of appropriate palliative care and attention. Furthermore, good communication between those caring people for the patient in both main and secondary care is essential. However, palliative attention needs to be accessible early in the condition starting because in the advanced periods patients may got worsened their health insurance and then your team cannot provide the desired good care. Finally I choose this case because I think the palliative attention process as a practice in health part simply for malignancy patients but after interacting with Mr. Verner circumstance I add to my nursing knowledge more specialised skills about the palliative health care.