Heart Failure and Pulmonary Edema: QSEN Competencies in Nursing

Heart Failure and Pulmonary Edema

Patient Center Care

Heart failure patients are often in critical conditions, challenging to arouse and remain disoriented. The supervising nurse should explain the patient’s conditions and required medical procedures to the latter’s family members; the patient might require mechanical ventilation and endotracheal intubation due to low oxygenation levels. The family member might feel unsure about the appropriate response because they are unsure about the patient’s preferences. During the decision-making process, the nurse and the family member should consider the nursing code of ethics, the patient’s advanced directive, the healthcare institution’s attorney, and the patient’s case manager. The family member might reject the idea of initiating mechanical ventilation and CPR on the patient. Consequently, the nurse should notify the doctor and hospital supervisor regarding the family’s decision. The nurse should also write a DNR based on the family’s wishes and communicate the same during shift reports.

Teamwork

Appropriate risk factor management and comorbidities’ treatment lower a person’s risk of developing heart failure or edema. Thus, patient education should comply with evidence-based treatment therapies for better clinical outcomes and patient satisfaction. Treating hypertension and effective diabetes management reduces heart failure occurrences by up to 50.0%. Alcoholism significantly increases the risk of heart failure (Iqbal & Gupta, 2019. The nurse should also monitor possible metabolic syndromes that could exacerbate the patient’s condition. Lastly, the patient education program should emphasize fluid and salt restriction to lower the risk of heart failure development.

Heart failure and edema treatment can be complicated based on the illness stage regardless of the therapy method available. Considering the limited impacts of the present treatment approaches on heart failure and edema progression, the interprofessional team, should establish ways to optimize the care quality and patient outcomes. They should provide relevant evidence-based preventive psychotherapy and treatment to patients with a greater risk of developing heart failure. Primary care plays a crucial role in managing the patient’s condition and risk factors and should consult healthcare experts such as pharmacists, cardiologists, nutritionists, and endocrinologists. That enables them to provide the appropriate treatment and counseling to the patient. Nurses provide patient education, monitor patients, and cooperate with doctors and healthcare team members for improved patient outcomes (Driscoll et al., 2017. On the other hand, pharmacists review prescribed medicine, educate patients and their caregivers regarding contraindications, and observe adherence. Considering the frequent re-admissions due to several non-heart failure complications, outpatient and inpatient service providers should collaborate to ensure care continuity and promote better patient outcomes.

Evidence-based Practice

Heart failure is a significant healthcare challenge and the main cause of hospital admissions among older adults in America. Hospitals record approximately one hundred thousand heart failure cases every year (Driscoll et al., 2017. The growing heart failure prevalence is secondary to reduced mortality due to better management approaches, better clinical outcomes for survivors, increased risk factors, and age-related factors. Notably, heart failure incidences are common in both males and females. Individuals above forty years have a 20.0% risk of developing heart failure, and this trend increases with age, especially those above sixty-five years (Iqbal & Gupta, 2019. Racial and ethnic factors also increase the risk of heart failure; for instance, African Americans exhibit a greater risk of developing heart failure than white people in the United States (Driscoll et al., 2017. The main heart failure-related costs cover several hospitalizations, medications, and frequent re-admissions.

Although people often use heart failure when referring to individuals with existing chronic illnesses, acute heart failure refers to rapid symptom development or worsening signs and symptoms requiring intravenous treatment. Older adults usually above seventy-five years often develop acute heart failure requiring hospitalization (King & Goldstein, 2021). Notably, older women suffer acute heart failure than men. Various metabolic and cardiovascular disorders cause heart failure, although left ventricular dysfunction causes most symptoms. Left ventricular dysfunction compromises the ejection fraction; most clinical tests focus on ejection fraction and utilize the resultant data to establish a treatment guide (King & Goldstein, 2021). Conversely, pulmonary edema linked to acute failure is caused by pulmonary fluid homeostasis dysregulation and other factors that regular the alveolar space fluid movement Heart Failure and Pulmonary Edema QSEN Competencies.

Heart failure and edema cause several short- and long-term health complications. The patient’s health status deteriorates despite undergoing aggressive treatment. Secondly, the patient may suffer organ dysfunction and kidney impairment, compromising recovery efforts. Thirdly, frequent hospital admissions strain the patient’s family’s financial and emotional status (Driscoll et al., 2017. Moreover, the patient gradually loses their ability to perform daily activities. Notably, the initial heart failure diagnosis increases the patient’s mortality and morbidity rates.

Quality Improvement

Disease classification enables healthcare providers to determine the appropriate assessment and treatment options. The physicians focus on identifying and treating life threats where a patient suffers acute heart failure and edema (Iqbal & Gupta, 2019. different classifications exist for assessing heart failure based on the symptoms; they influence the condition’s prognosis and treatment. In essence, heart failure categories depend on anatomic findings, the heart chamber involved, and the patient’s symptoms (King & Goldstein, 2021). Notably, the heart failure stages are described based on risks involved, structural heart disease, and active heart failure presence.

The heart failure stage and symptoms’ severity determine the treatment’s focus. When a person has acute heart failure or edema, the treatment should focus on enhancing hemodynamic status by reducing vascular congestion and enhancing myocardial contractility, preload and afterload (Iqbal & Gupta, 2019. Healthcare providers utilize similar initial treatment and management goals for patients with flash pulmonary edema and acute heart failure. Treatment options include diuretics because most patients have various volume overload forms; healthcare givers prefer IV administration over oral medication to increase the drug’s bioavailability and clinical outcomes (King & Goldstein, 2021). Furosemide exhibits diuretic and anti-vasoconstriction properties, making it ideal for heart failure and edema treatment. The doctor should examine the patient’s airway, breathing, and circulation during early assessment and start relevant management depending on the patient’s health status Heart Failure and Pulmonary Edema QSEN Competencies.

The healthcare team should hook the patient up to cardiorespiratory monitoring for acute heart failure, administer oxygen if the patient is hypoxic, perform ECG, and conduct laboratory tests for suspicious conditions. Vasodilators are also effective for patients with acute heart failure and edema; they promote vasodilation and smooth muscle relaxation to lower preload and afterload across the CGMP pathway (Iqbal & Gupta, 2019. Notably, vasodilation enhances left ventricular afterload and preload while easing pulmonary vascular congestion. Examples of effective vasodilators include sodium nitroprusside and nitroglycerin. Other treatment options include ionotropic medications, coronary revascularization, and hospitalization (Iqbal & Gupta, 2019. Where necessary, the patient can undergo homecare treatment based on their symptoms’ severity.

Informatics

Advanced heart failure treatment and early prevention efforts may slow its progression and increase the patient’s survival chances. Because the condition requires a comprehensive management approach, regular and effective communication is an essential care component. Different studies indicate that using the telephone for communication between patients and healthcare providers reduces re-admissions and improves the former’s morbidity rates (Driscoll et al., 2017). Hospitals can also utilize hardware monitoring systems to communicate with patients and record critical signs. Such systems enhance heart management, but they are costly when addressing large patient populations. Most heart failure patients can use a scale and a sphygmomanometer to relay their vital symptoms, weight, and weight to the hospital’s data center without requiring a sophisticated system except the internet. Hospitals also use such systems to monitor heart failure patients and provide care guidelines. Thus, using internet-based communication systems such as electronic health records reduce hospitalization cases and establishes stable heart failure status without regular hospital visits.

Patient Safety

A national plan is crucial when improving heart failure-related re-hospitalization. It requires benchmarking and cooperation between healthcare providers especially focusing on advancing patient care systems for monitoring heart failure patients (Driscoll et al., 2017). Patients require an efficient and safe transition to home-based care to reduce re-hospitalization chances. The primary challenge is facilitating a smooth transition to home-based care without compromising compliance to evidence-based practice and retaining a connection with heart failure specialists. Transitional patient care involves heart failure initiatives in outpatient and community facilities (King & Goldstein, 2021). Various studies support the enforcement of nurse-led outpatient and community clinics because they help reduce patient mortality and re-hospitalization Heart Failure and Pulmonary Edema QSEN Competencies.

Many caregivers utilize specific measures to improve heart failure patients after discharge, reducing mortality and re-admission rates. Improving patient care services for heart failure patients requires healthcare providers to remain focused on several co-occurring factors. That entails identifying individuals hospitalized due to heart failure-related disorders and medical issues such as timely drug administration (Driscoll et al., 2017). Appropriate patient education also ensures patients understand relevant self-care after hospital discharge. It also enables them to identify and utilize available resources after discharge, which requires effective leadership and coordination. In essence, cooperation between caregivers and specialists is essential to improving patient safety following heart failure diagnosis and after hospital discharge.

References

Driscoll, A., Meagher, S., Kennedy, R., Hay, M., Banerji, J., Campbell, D., … & Patsamanis, H. (2017). What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic Review BMC Cardiovascular Disorders . 16 (1) 1-20.

Iqbal, M. A., & Gupta, M. (2019). Cardiogenic pulmonary edema.

King, K. C., & Goldstein, S. (2021). Congestive heart failure and pulmonary edema. StatPearls [Internet] . Heart Failure and Pulmonary Edema QSEN Competencies