Question

Describe essential focused assessments used by the home care nurse for patients with heart failure.

Answer 1

Heart failure is referred to congestive heart failure. It is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.Heart failure incidence is increased in number of elderly people.

Focussed assessment is a highly specified assessment performed on patients concentrating on the system or systems involved in the patient's problem. Home care nurses visit the patients in their dwelling places to conduct health care assessment , to provide care and health teaching.

During a focused assessment, the home care will use at least one of the following four basic techniques during physical examination Inspection, Auscultation, Percussion, and Palpation.

First collect the subjective data about patient .Ask relevant questions related to heart failure like whether the patient has chest pain, shortness of breath ,paroxysmal nocturnal dyspnoea,persistent cough , abdominal pain, weight gain/loss , nausea, anorexia,fatigue, leg pain, swelling in limbs,urine output and fluid intake.

Physical examination:

Inspection:

• Examine upper and lower extremities for edema or any circulatory changes
• Check Colour of the skin (central and peripheral): pink, flushed, pale, mottled, cyanosed, clubbing
• Check Capillary Refill Time (CRT): brisk (< 2 sec) or sluggish
• Presence of oedema (central and/or peripheral)
• Check for presence of superficial distended veins and colour of nail beds

Auscultation:

• Auscultate the apical pulse
• Compare peripheral pulse and apical pulse for consistency (the rate and rhythm should be similar).
• Auscultate the chest for heart sounds and abnormal sounds like  bibasilar posterior crackles which may result from fluid accumulation in lungs.Check for murmurs ,Tachycardia,juguular venous distension .
• Auscultate abdominal sounds.

Palpation:

• Check for ascites, hepatomegaly , distended jugular veins
• Measure abdominal girth as it may increase due to edema in abdomen  
• Right upper quadrant palpation for tenderness to find any venous engorgement in liver.

Ask the patient for paraxysmal nocturnal dyspnea, it is shortness of breath occuring in night times .

Patient has more micturition in night which suggests decreased cardiac workload in night .But in morning patient may have oliguria because of decreased renal perfusion .

Swelling in the feet, ankles, legs or abdomen or weight gain, pitting edema may be due to fluid retention .

Anorexia and nausea may be present because of venous engorgement and venous stasis in abdominal organs due to impaired circulation and accumulation of carbon monoxide.

Non productive , dry , cough with blood tingled sometimes may indicate pulmonary edema which may occur due to fluid excess in body.

Thus these are the foccussed assessments a home care nurse can conduct on a heart failure patient.