Question

what is the best resource for transitional care from hospital to home after heart failure. telemon itoring, home health care, or referral to health care clinic. and why

Answer 1

Ans) The nurse provides patient education and involves the patient and family in the therapeutic regimen to promote understanding and adherence to the plan.

- When the patient recognizes that the diagnosis of HF can be successfully managed with lifestyle changes and medications, recurrences of acute HF lessen, unnecessary hospitalizations decrease, and life expectancy increases.

- Nursesplay a key role in instructing patients and their families about medication management, a low-sodium diet, moderate alcohol consumption, activity and exercise recommendations, smoking cessation, how to recognize the signs and symptoms of worsening HF, and when to contact the primary provider.

- Successful management of HF requires adherence to a complex medical regimen that includes multiple lifestyle changes for most patients.

- Assistance may be provided through a number of options that optimize evidence-based recommendations for effective management of HF.

- Depending on the patient's physical status and the availability of family assistance, a home care referral or another type of disease management program may be indicated for a patient who has been hospitalized.

- Transitional care programs (hospital to home) that include telephone contact along with home visits have been shown to decrease rehospitalizations and increase patient quality of life

- Home visits by trained HF nurses provide assessment and management tailored to specific individualized patient needs.

- Older patients and those who have long-standing heart disease with compromised physical stamina often require assistance with the transition to home after hospitalization for an acute episode of HF.

- The home care nurse assesses the physical environment of the home and makes suggestions for adapting the home environment to meet the patient's activity limitations.

- If stairs are a concern, the patient can plan the day's activities so that stair-climbing is minimized; for some patients, a temporary bedroom may be set up on the main level of the home.

- The home care nurse works with the patient and family to maximize the benefits of these changes.

- The home care nurse also reinforces and clarifies information about dietary changes and fluid restrictions, the need to monitor symptoms and daily body weight, and the importance of obtaining follow-up care with the primary provider's office or clinic.

- Assistance may be given in scheduling and keeping appointments as well.

- The patient is encouraged to gradually increase their self-care and responsibility for carrying out the therapeutic regimen.

Evidence-based HF guidelines also recommend patient referral to HF clinics, which provide intensive nursing management along with medical care in a collaborative model.

- Many of these clinics are managed by advanced practice nurses.

- Referral to an HF clinic gives the patient ready access to continuing education, professional nursing and medical staff, and timely adjustments to treatment regimens.

- HF clinics can also provide outpatient treatment (e.g., IV diuretics, laboratory monitoring) as an alternative to hospitalization.

- Because of the additional support and coordination of care, patients managed through HF clinics have fewer exacerbations of HF, fewer hospitalizations, decreased costs of medical care, and increased quality of life

- Other disease management programs are carried out through telemonitoring, using telephones or computers to maintain contact with patients and to obtain patient data.

- This enables nurses and others to assess and manage patients on a frequent basis, without requiring patients to make frequent visits to health care providers.

- A variety of techniques ranging from simple telephone monitoring to sophisticated computer and video connections that monitor symptoms, daily weight, vital signs, heart sounds, and breath sounds may be used.

- Patient data may also include hemodynamics and other parameters transmitted from implantable devices.

- Studies have shown that telehealth management can decrease costs and hospitalizations for exacerbations of HF.

- More research is needed to determine which patients can benefit most from these interventions.