Making a Safe Transistion

Making a Safe Transition
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Making a Safe Transition
Congestive Heart Failure, or simply Heart Failure (HF), is known to take place whenever a person’s heart muscle does not pump blood as properly as it should. A number of conditions for instance high blood pressure or narrowed arteries in a person’s heart – coronary artery disease – will steadily leave a person’s heart very stiff or weak to fill and pump blood in an efficient manner (Moser & Riegel, 2012). This paper mainly addresses the disease management needs of adult patients with Heart Failure (HF).
Part 1: Medication Adherence
Medications for managing HF: Three common classes of medications used in managing heart failure are diuretics, adrenergic blockers, and ACE Inhibitors. Adrenergic blockers: Beta-adrenergic blocking agents decrease the heart rate and improve heart function in patients with Heart Failure. Researchers have reported reduced hospitalization, improved survival, as well as decreased rates of worsening HF rates in stable Heart Failure patients introduced to beta-blockers (Orenstein, 2011). The moment a patient is started on beta-adrenergic blockers, it is critical to ensure follow-up. In essence, beta-adrenergic blockers block the adrenergic effects of adrenaline and therefore prevent the sick heart of the patient from being forced to work harder (Dumitru, 2012). Alpha-adrenergic blockers result in arterial and venous dilation, as well as smooth muscle relaxation of the prostatic capsule and bladder neck.
Side effects: Beta-adrenergic blockers (cardioselective) and Beta-blockers (non-selective) have several side effects. The side effects that should be reported because they are serious include impotence, can aggravate heart failure and peripheral vascular disease, and sudden withdrawal of the medicine could actually cause heart attack or angina in patients suffering from heart disease (Orenstein, 2011). Side effects that should not be reported because they are minor include dizziness, depression, wheezing, insomnia, lower exercise tolerance, and fatigue. Alpha-adenergic have the following side effects: heart palpitations, weakness, decrease in blood pressure (BP) after standing, dry mouth, headache, nasal congestion, as well as fainting. These side effects are minor and therefore should not be reported (Lainscak et al., 2011).
Special instructions: the use of Propranolol could cover the hypoglycemic effect of insulin and put a stop to the breaking down of fat in reaction to hypoglycemia. Therefore, the levels of blood glucose should be monitored (Lainscak et al., 2011). Concurrent usage of antihypertensive medicines with beta-blockers may increase the hypotensive effect of propranolol and metoprolol medicines. Clients should therefore be monitored for a drop in blood pressure (Orenstein, 2011).
Diuretics: Diuretic therapy is of major importance in both chronic and acute management of Heart Failure. Administering diuretics to patients with Heart Failure brings about a decrease in peripheral vascular resistance as well as a rise in venous capacitance and dieresis (Beckerman, 2014). There are 3 key classes of diuretics: potassium-sparing gents, loop diuretics, and thiazides. Side effects: side effects that are minor and therefore should not be reported include muscle cramps, diarrhea, fatigue, lightheadedness, constipation, and frequent urination. Side effects that are serious and should therefore be reported include gout, which is an aching type of arthritis brought about by the increase of uric acid within the patient’s body (Orenstein, 2011). Thiazide diuretics can bring about a rise in the level of sugar/glucose in the blood. In some persons, this can be sufficient to result in the diabetes illness or even to worsen their diabetes. Therefore, the levels of blood sugar have to be monitored in persons who are taking diuretics for control of blood pressure (Moser & Riegel, 2012).
Special instructions: since diuretics make the body of the patient to lose magnesium and potassium, it is recommended for the patient to have supplements of these minerals. If client is prescribed diuretics, the levels of magnesium and potassium in the patient’s blood should be checked through regular blood tests. Excessive use of dieresis elevates the risk of renal dysfunction and hypotension associated with Angiotensin-Converting Enzyme Inhibitor therapy (Moser & Riegel, 2012).
ACE (angiotensin-converting enzyme) Inhibitors: Patients who have Heart Failure generally have enhanced renin-angiotensin-aldosterone system activity, leading to a rise of angiotensin II that serves to promote retention of water and sodium. ACE Inhibitors basically work by reducing the production of angiotensin II, which then leads to improved hemodynamic function in patients with Heart Failure (Bellows, 2011). Several clinical studies have demonstrated that these medications have a significant impact in every stage of heart failure. Researchers have also reported that Angiotensin-Converting Enzyme Inhibitors have a positive effect on coronary vascular and ventricular remodeling events. These medications also decrease hospitalizations and they improve survival in patients with heart failure who previously had myocardial infarction. ACE Inhibitor therapy has in fact been proven irrefutably to decrease morbidity as well as mortality in patients with Heart Failure (Artinian, 2010).
Side effects: the side effects that should be reported because they are grave and may have disastrous consequences include retention of potassium hence those with poor kidney function have to utilize them with caution. Another grave side effect is fetal abnormalities and therefore expectant women or those attempting to become pregnant are advised against taking them (Orenstein, 2011). The other serious side effect is change in renal function as well as hypotension; impotence; and severe renal failure in individuals who have renal artery stenosis. Side effects that should not be reported because they are minor include upper abdominal pain, uremia, mental confusion, headache, skin rush, and although not often, angioneurotic edema (Artinian, 2010).
Special instructions: since some patients might feel dizzy or weak when they start taking ACE Inhibitors given that it reduces their blood pressure, these medicines have to be taken during the night prior to going bed – the patient will be lying down soon after. ACE Inhibitors may increase the levels of lithium carbonate hence the client’s levels of lithium should be monitored in order to avoid toxicity (Artinian, 2010). Using Non-Steroidal Anti-Inflammatory Drugs, commonly referred to as NSAIDs, can in fact lessen the antihypertensive effect of ACE Inhibitors hence concurrent use should be avoided. Potassium-sparing diuretics and potassium supplements elevate the risk of hyperkalemia and therefore clients must only take supplements of potassium if the provider has prescribed. Clients need to avoid taking salt substitutes which contain potassium (Orenstein, 2011).
Helping with medication adherence: the healthcare discipline in addition to a Registered Nurse is a Pharmacist. Dumitru (2012) stated that a pharmacist intervention for outpatients with HF can greatly improve adherence to cardiovascular drugs and lower the use and costs of healthcare. Pharmacists can help with medication adherence by providing patient education. Working with the Registered Nurse, a pharmacist can provide interventions that include in-patient-assessments, HF education, medication reconciliation, and assisting the patients in developing self-care goals. They can also provide follow-up with patients as necessary by email, in person, or over the phone (Simone, 2013). This will help in promoting medication adherence as well as a safe transition to home.
Part 2: Dietary Modifications
Consuming a healthy diet is of major importance to improving one’s heart failure and this basically implies making alterations in one’s current eating habits. Limit intake of sodium: people who have HF should consume a low-salt/low-sodium, healthy diet. It is of note that sodium is an essential mineral used by the body in small quantities. However, excessive sodium consumption makes a person’s body to hold on to, or retain, water, which causes the patient’s heart to strive harder in pumping blood (Beckerman, 2014). This will worsen the symptom...