safe Transition • in October 2012, made Medicare payment rules. Hospitals penalized a patient returns 30 days treatment problem. One targeted medical diagnoses payment change heart failure (HF).
Making a safe transition
Heart failure medication
Medications used to treat heart failure and why they are used
Beta adrenergic blockers, diuretics and ACE inhibitors are some of the common classes of drugs used to manage heart failure. Beta adrenergic blockers are used because they are able to slow the heart rate allowing the left ventricle, which is the main pumping chamber, to fill with blood completely. They can also help to open blood vessels wider thus reducing the blood pressure and improving the flow of blood. This helps to improve the percentage of blood that is pumped from the left ventricle per heartbeat, also known as the ejection fraction, and to slow the progression of heart failure. Diuretics are also used to treat heart failure. They lower the blood pressure and reduce swelling of the body (edema) thus allowing smooth flow of blood in the veins. ACE inhibitors prevent damage to the heart after a heart attack or failure.
Common side effects of these medications
Some of the common side effects associated with diuretics, ACE inhibitors and beta adrenergic blockers include dizziness or lightheadedness, as a result of the strong effect of the first dose of the drugs this can also result in the patient feeling tired. ACE inhibitors, especially are associated with a cough, sore throat, mouth sores, confusion, and swelling or skin rush. Diuretics are associated with frequent urination that may last up to four hours after taking each dose, thirst and dehydration that are associated with frequent urination, skin rash, fever, sore throat, cough, confusion, nausea, vomiting, and muscle cramps. Some patients also experience, blurred vision, and restlessness. Beta adrenergic blockers are mostly associated with tiredness, restlessness, dizziness, and insomnia.
Special instruction associated with these medications
When taking ACE inhibitors, the patient should avoid taking any salt substitutes since they contain potassium and can cause the body to retain a lot of potassium. Over-the-counter non-steroidal anti-inflammatory medication such as aspirin, ibuprofen, and naproxen should also be avoided since they can lead the body to retain too much sodium and water and decrease the effect of the drug. For beta adrenergic blockers, there are no specific instructions when taking the medication. When taking diuretics, the patient should consider taking the last dose (if on a bi-daily course) no later than 4pm so that the body functions can be normalized during the evening and at night.
Health care discipline best suited to help with medication adherence
Apart from RN, the other health care discipline that is best suited to help the patients with medication adherence is the pharmacy team. The entire pharmacy team is in charge of medication management and they also have a role to play in educating patients and improving medication adherence Sharma & Taylor, 2012.
This team member will collaborate with the RN by educating the patient regarding the medication, how it works, and side effects in order for the patient and their family to understand the importance of medication adherence. They can also provide support facilities such as leaflets and other handouts for patients to read in order for them to understand the importance of medication adherence.
Role of diet in managing HF
As part of treatment for heart failure, there are certain dietary modifications that the patient should make in order to manage the condition better. The first modification relates to intake of fluids. Patients with severe congestive cardiac failure (CCF) should restrict their fluid intake considerably. The patient should take only the sufficient amount of fluids in order to promote fluid retention in the body and reduce their risk of diabetes and other illnesses. Taking adequate amount of fluids also helps to avoid dehydration, especially in patients taking high doses of diuretics.
Patients should obtain adequate nutrition from balanced diets. This means that the obese patients should be supported to reduce their dietary intake in order to reduce their weight. Patients who are cachectic should be assessed by a dietician to achieve their optimal intake for their body weight. Patients taking angiotensin-converting enzyme (ACE) inhibitors should avoid taking foods that have a high content of salt and they should not add salt to their dietary food intake. Experts recommend that these patients should not take more than 2-3g of salt per day. Generally, heart failure patients should not consider low-salt alternatives in their foods since these have high content of potassium and may cause issues in potassium retention.
Obstacles that might be encountered when informing the patient about the changes in diet
Patient adherence is a serious concern, especially when informing patients about the required dietary changes. Patients often feel that the dietary changes are necessary to prevent similar occurrence of heart failure though some patients frown upon these changes. One obstacle that is expected relates to cognitive factors. Some patients understand what they are supported to do regarding dietary changes, however, they lack the will to undertake this changes Chen, Tseng, & Cheng, 2013.
This means that their willingness to adhere is present though their ability to adhere is wanting.
The second obstacle that exists in the patients is language barrier. Language barriers often inhibit the comprehension of patients and in most cases, their literacy and comprehension are central to their willingness and ability to adhere. The third obstacle is the health beliefs of patients. Patient's health beliefs contribute to their non-adherence since their literacy is closely linked to the communication that they receive and how they understand it. When the communication of dietary changes colludes with their health beliefs, they tend to have a hard time adhering to the required dietary changes since they do not believe in them.
The physician-patient relationship is also central to the adherence of patients to the dietary changes required. When the patient is actively encouraged and educated by the physician, they feel more motivated to adhere to the dietary changes required. Cohesive partnerships between the patient and the physician help the patients follow physician recommendations since they feel these are mutually agreed-upon.
Health care discipline best suited to help with dietary modifications
The nutrition discipline is best suited to help with patient dietary modifications. The nutrition department can help to influence factors that affect patient's ability and willingness to initiate and sustain dietary changes. This is because they are best suited to educate patients and address the common misconceptions that affect patient adherence. They also have the best understanding of the dietary requirements of the patient and thus can provide the best suggestions for improving the nutrition of the patient. This team member will collaborate with the RN by providing advice to the patient and organizing separate sessions where they address the patient's concerns to ensure they understand the rationale behind the dietary changes and thus become committed.
Role of physical activity in managing HF
Exercise is important in managing HF since it helps obese patients to reduce their weight and it also helps other patients to keep fit when part of a cardiac rehabilitation program. Many HF patients experience exercise intolerance and this is often improved by using exercise training. When the patient is provided with a suitable exercise program based on their required duration, desired improvements, peak oxygen levels, etc., the patient can also experience improved muscle mitochondria that improves body functions while decreasing the strain on the body. Exercise also helps to improve patient ventilation considerably by allowing the patient to be conditioned to normal breathing during exercise rather than rapid or shallow breathing.
Promoting adherence to daily physical activity routine
To promote adherence to a daily physical activity routine, the RN should educate the patient on the benefits of the exercise routine, especially in relieving the symptoms and conditions that the patient is experiencing such as insomnia, circulation of blood, self-esteem, and body weight. When the patient understands the importance of the system, they are more likely to commit to the exercise schedule. The other way is to assign a person to train with the patient. This could be a trainer in the physiotherapy department or other person who can train and motivate the patient.
Health care discipline best suited to help with physical activity
A person from the physiotherapy department is the best person to help with physical activity. This is because this person is well versed on the best exercise programs for the patient, alternative physical activities in case the patient is straining to adhere to some particular activities, how best to fit the program to the patient's schedule, as well as preparing the right goals for the program Weinberg, Cooney-Miner, Perloff, Babington, & Avgar, 2011.
This person will be available to train the patient and help them adhere to the training schedule in order to achieve the desired benefits.
Evaluating effectiveness of interdisciplinary team
Evaluating the effectiveness of an interdisciplinary team is a complex…