Question

Mr. Martin, an 82-year-old African American patient, is ready for discharge from the medical unit after a 3-day hospitalization resulting from exacerbation of heart failure. Prior to discharge from the hospital, his nurse reviews the medication orders and provides Mr. Martin with standard patient education materials related to control of heart failure symptoms. If you were the nurse in this scenario, reflect on how your own cultural norms and biases may affect the interaction with this patient.

Answer 1

Hello Mr .Martin ,

Hope you are doing well today ? As you are getting discharged today I would like to provide you some information to control the symptoms of heart failure.

  

Four of five people who die from cardiovascular disease are killed by a heart attack or a stroke, and one third of these deaths occur in people under 70 years of age. Heart attacks and strokes, which are often avoidable outcomes, cause a lot of suffering for individuals and families affected. They also impose a substantial cost on society, particularly in low- and middle-income countries , where over three quarters of deaths from these conditions occur. Millions of people worldwide struggle to control the risk factors that lead to cardiovascular disease, many others remain unaware that they are at high risk. A large number of heart attacks and strokes can be prevented by controlling major risk factors through lifestyle interventions and drug treatment as necessary.

STETHCS SCE

Standard patient education material related to control of heart failure symptoms

Four main risk factors that exacerbate heart failure symptoms are

• Tobacco use

• Physical inactivity

• Unhealthy diets

• Harmful alcohol use

I will like to give you counselling on lifestyle changes, including tobacco cessation, dietary modification, avoiding harmful use of alcohol and increasing physical activity, involves systematic, targeted use of information and techniques to support individual behavioural change to reduce the occurrence of heart failure symptoms.The aim is to promote the necessary knowledge, motivation and skills.  

Stoping of smoking and eating better food and exercising more will help in reducing occurrence of heart failure symptoms

Essential technologies (e.g. accurate devices for blood pressure measurement, risk-assessment charts, weighing scales, height measuring equipment, blood sugar and blood cholesterol measurement devices with strips, and urine strips for albumin assay) and medicines (e.g. aspirin, a statin, a thiazide diuretic, an angiotensin-converting enzyme inhibitor, a calcium-channel blocker, a beta-blocker, metformin and insulin) should be utilized and by proper check up occurrence of symptoms can be prevented.

A)PROPER CHECK UP CAN HELP IN CONTROL AND PREVENTION OF HEART FAILURE SYMPTOMS THAT IS GIVEN BELOW

• Measure blood pressure, look for pitting oedema

• Palpate apex beat for heaving and displacement

• Auscultate heart (rhythm and murmurs)

• Auscultate lungs (bilateral basal crepitations)

• Examine abdomen (tender liver)

• In DM patients examine feet; sensations, pulses, and ulcers

• Urine ketones (in newly diagnosed DM) and protein

• Total cholesterol

• Fasting or random blood sugar (diabetes= fasting blood sugar≥7 mmol/l (126 mg/dl)) or random blood sugar ≥11.1 mmol/l (200 mg/dl))(Point of care devices can be used for testing blood sugar if laboratory facilities are not available)

ADVICE TO PATIENTS AND FAMILY

• Avoid table salt and reduce salty foods such as pickles, salty fish, fast food, processed food, canned food and stock cubes

• Have your blood glucose level, blood pressure and urine checked regularly

ADVICE SPECIFIC FOR DM

• Advise overweight patients to reduce weight by reducing their food intake.

• Advise all patients to give preference to low glycaemic-index foods ( e.g.beans, lentils, oats and unsweetened fruit) as the source of carbohydrates in their diet

• Avoid walking barefoot or without socks

• Wash feet in lukewarm water and dry well especially between the toes

• Do not cut calluses or corns, and do not use chemical agents on them

• Look at your feet every day and if you see a problem or an injury, go to your health worker

B) Steps to follow to control heart failure symptoms

• Take regular physical activity

• Eat a “heart healthy” diet

• Stop tobacco and avoid harmful use of alcohol

• Attend regular medical follow-up

TAKE REGULAR PHYSICAL ACTIVITY:

• Progressively increase physical activity to moderate levels (such as brisk walking); at least 150 minutes per week

• Control body weight and avoid overweight by reducing high calorie food and taking adequate physical activity

EAT A HEART HEALTHY DIET:

Salt (sodium chloride) -Restrict to less than 5 grams (1 teaspoon) per day

• Reduce salt when cooking, limit processed and fast foods

Fruits and vegetables- 5 servings (400-500 grams) of fruits and vegetable per day. 1 serving is equivalent to 1 orange, apple, mango, banana or 3 tablespoons of cooked vegetables

• Limit fatty meat, dairy fat and cooking oil (less than two tablespoons per day)

• Replace palm and coconut oil with olive, soya, corn, rapeseed or safflower oil

• Replace other meat with chicken (without skin)

STOP TOBACCO AND AVOID HARMFUL USE OF ALCOHOL:

• Encourage all non-smokers not to start smoking

• Strongly advise all smokers to stop smoking and support them in their efforts

• Individuals who use other forms of tobacco should be advised to quit

• Alcohol abstinence should be reinforced.

• People should not be advised to start taking alcohol for health reasons

• Advise patients not to use alcohol when additional risks are present, such as:

I. driving or operating machinery

II. pregnant or breast feeding

III. taking medications that interact with alcohol

IV. having medical conditions made worse by alcohol

V. having difficulties in controlling drinking

ADHERENCE TO TREATMENT:

• If the patient is prescribed a medicine/s:

• teach the patient how to take it at home:

• explain the difference between medicines for long- term control (e.g. blood pressure) and medicines for quick relief (e.g. for wheezing)

• tell the patient the reason for prescribing the medicine/s

• Show the patient the appropriate dose

• Explain how many times a day to take the medicine

• Label and package the tablets

• Explain the importance of keeping an adequate supply of the medications

• the need to take the medicines regularly as advised even if there are no symptoms occur

Nitroglycerin can be administered if symptoms like angina occurs to relive angina by dilation of blood vessels.