Congestive Heart Failure: Case Management

Congestive Heart Failure: Case Management

CHF Case Management

Congestive Heart Failure is a disease that affects many and it is serious one because it can lead to so many other life threatening ailments. With this disease, the heart does not pump enough blood to the rest of the body. Patients diagnosed with congestive heart failure must be certain to follow the advice given to them by healthcare professionals on improving and maintaining their health. If not, this disease can have a snowball effect which will exacerbate or bring about other conditions making the patient's life at risk. There are other illnesses which are closely related to congestive heart failure and they are: coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), diabetes, gastrointestinal issues, and hypertension. The congestive heart failure patient may develop some or all of the diseases listed and this is the reason why managing these patients closely is so important. The illnesses listed above will be discussed in greater detail to illustrate how closely they are related to congestive heart failure and what the patient can do to minimize or eliminate the risks.

II. CHF AND CLOSELY RELATED ILLNESSES

Coronary Artery Disease (CAD)

With coronary artery disease, plaque builds up in the artery walls making it difficult for blood, oxygen and other nutrients to reach the heart. This disease is one of the main causes of congestive heart failure. It is extremely important that the patient diagnosed with CAD follows a strict diet and exercise program to discourage this disease. A diet low in unhealthy fats and high in fruits and vegetables in necessary as is physical activity such as walking or swimming. Many patients will need to take medication to lessen the buildup of plaque along the artery walls so that the blood can flow more freely. If the patient is not following guidelines to prevent the clogged arteries, the risk of having a heart attack or even a stroke is very likely.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease is a progressive disease which makes breathing difficult. This disease is usually a result of heavy cigarette smoking. With congestive heart failure, a shorter supply of oxygen cannot reach the heart nor is it circulated throughout the body. The patient diagnosed with congestive heart failure and chronic obstructive pulmonary disease will most definitely have severe difficulty breathing. This can further weaken the heart. The first step is to cease smoking immediately. Since the disease is progressive, it will only get worse if the patient continues to smoke. Also, smoking will negate any treatment the patient is given to improve the situation.

Diabetes

Diabetes is a disease where the body produces too much blood sugar. There are three types of diabetes:

Type 1: This is when the body does not produce enough insulin.

Type 2: This is when the cells of the body do not respond to the insulin produced (insulin resistance).

Gestational Diabetes: This develops in pregnant women causing them to have high blood sugar levels during pregnancy.

Patients with diabetes are very likely to develop heart disease which makes managing this disease extremely important. Blood glucose levels should be monitored several times a day to be sure the levels do not fall below or rise above what is considered the normal range. Also, proper diet and exercise is mandatory for the patient with diabetes.

Gastrointestinal Disease

Our bodies are amazing machines and it works in sync to keep us healthy. However, when one thing goes wrong with our bodies, it can trigger other processes within us to start malfunctioning. A person with gastrointestinal issues may have bouts of constipation or diarrhea. Sometimes treating the symptoms of congestive heart failure in the patient, depending on the medication used, gastrointestinal issues can result. It is highly likely that the patient with severe gastrointestinal disorders could develop colon cancer. With the body in an already weakened state from the congestive heart failure, the patient is at even more risk if he develops cancer. Steps can be taken to prevent the onset of gastrointestinal disorders. They are as follows:

Eating a diet high in fiber

Not resisting the urge to have a bowel movement

Getting plenty of exercise

Cutting back or cutting out certain medications

Eliminating the need for laxatives

The nurse case manager must stress to the patient not to expect his diagnosis of congestive heart failure to bring about gastrointestinal issues because in most cases, these types of issues can be reduced or eliminated altogether.

Hypertension

Often called the silent killer, hypertension is a disease that affects many, yet many are unaware that they have it. Regular doctor visits will help detect whether a patient has hypertension or not because the healthcare practitioner will be able to establish a pattern with previous blood pressure readings. A diagnosis of congestive heart failure and hypertension can be deadly. The CHF patient's heart cannot pump enough blood to the body and this coupled with hypertension which makes the heart pump even more to get the blood circulating is serious. Usually, patients with congestive heart failure and hypertension are prone to fluid retention. This is also serious because the body is retaining more fluid that necessary, causing swelling in the hands, feet, ankles and sometimes even the face. The excess fluid usually makes the heart pump harder and the blood pressure readings higher.

III. BIOPSYCHOLOGY AND CONGESTIVE HEART FAILURE

The congestive heart failure patient should be actively managed because the way that the person feels and thinks about his condition can have a serious effect on the person's overall health (Jones, Edwards, and Gifford, 2002). Given this, the case manager cannot afford to focus the attention on the biological aspects of this disease. This is not to suggest the biological part of the illness does not matter. It is important for the case manager to know why the patient's body is behaving in a physical way that would bring on congestive heart failure and the other illnesses that are closely related to it. In some cases, the illness can be hereditary and while the patient may be more prone to the disease than others, there are still treatments that can be administered to prevent the onset of the disease or lessen the severity and symptoms. In other cases, a person's lifestyle can trigger the onset of congestive heart failure. Not eating properly and not getting enough physical activity can be a catalyst for developing the disease and the case manager should not ignore this. However, the psychological aspects as well as the social aspects of the patient will have an effect on how well the disease is managed. In order to provide the patient with a well rounded course of action, these two aspects must be examined.

A person's frame of mind can make a huge difference in how the body reacts and responds physically. We continue to hear increasingly about the power of positive thinking and many in the healthcare field have adapted to this belief. The case manager must take note of the patient's frame of mind and must be in tune with whether or not the person appears depressed or unhappy. When a person is in this frame of mind, there is always the chance that the thinking that accompanies depression can interfere with the patient's ability to follow the care plan that the case manager has developed. Not following things such as taking medication on a predetermined schedule, not eating properly and not exercising can have a profound effect on the physical aspects of the disease. Also, if the patient is depressed, the case manager should spend some time trying to determine the cause of depression. In many cases the patient's social life and surroundings greatly affect how he thinks and feels.

The social aspect of the biopsychosocial model is important and one that the case manager must also take into account. The socio economic status of a person can have a profound effect on whether he or she can maintain the health care management plan that the case manager has developed. If a single parent is living in poverty and cannot afford to prepare healthful and nutritious meals, then the patient's diet will be affected. Not only will the diet be affected, but if the patient is constantly worried about child rearing or not being able to make ends meet or any of the social ills in society then they will not be motivated to think positively and do what it takes to maintain good health.

The biopsychosocial model is important in the treatment of congestive heart failure because it shows the case manager that there are different aspects of the disease and that each component of the model should be taken into account when the patient's health care plan is developed. The biological, psychological and social aspects are all intertwined and each affects the other. The case manager should not seek to treat only the physical symptoms, but should realize that the psychological and social issues the patient is confronting will have an effect on the biological health. Questions regarding all three aspects should be asked during intake because this disease should be treated holistically meaning that everything should be factored in.

IV. DISEASE Management MODEL

A disease management plan is necessary for the congestive heart failure patient because so many other illnesses are associated with this disease. The plan is designed to improve the patient's health, while at the same time reducing medical costs.

Disease Management Model

Purpose

To manage as well as reduce congestive heart failure and the illnesses generally associated with it.

Target Population

Patients who already have congestive heart failure or those who are at risk.

Goals

To reduce the chances of developing other illnesses and diseases associated with congestive heart failure.

To cut down on hospital admissions by ensuring patients follow instructions for at home care as well as regular follow up visits.

To cut down on medical costs by monitoring patients at home self-care programs and encouraging them to stick with it.

In addition to closely monitoring and recording each patient's progress, patients will be given a short survey to fill out at each office visit to gauge how they feel about their management plan and other criteria.