Evidence-Based Practice: Congestive Heart Failure This article is a study about patients with congestive heart failure, the impact it has on their lives and the lives of their family. A part of the focus is the stress and life changes that are caused after a diagnosis like CHF. Conduction of Study Article review was conducted using three databases, using several words pertaining to heart failure, family, and caregivers. They had requirements for the articles they would select. They must be written in English, be peer reviewed, must involve informal caregivers, etc (p. 595) They found sixteen articles that qualified for review according to the criteria stated. Evidence for Nursing Care This study shows a correlation to nursing care, because as nurses, we care for the patients and family. A disease like CHF can cause many different things to happen socially and emotionally for the patient and the people that care about them. Knowledge about how this disease affects different aspects of a persons life can help us to handle the situation properly and help those people as much as possible. limitations of study The article states that most of the study used quantitative cross-sectional studies, and that they could not find any randomized controlled studies for CHF patients. It also states that more studies need to be done to assess impact of interventions for caregivers of CHF. So the authors understand that it can contribute to evidence based practice, but isnt enough evidence for proof of the diseases effect on patients and families. I feel like the study has validity and reliability because the methods of the study are sound. They seem to cover all the variables. More articles
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could have been found for the literature review, but sixteen is a satisfactory amount. Different age groups CHF is a disease most common in aging adults, but it can strike people of all ages. When caring for the younger generations with CHF, the family can become more distressed. Parents usually react to a chronic disease diagnosis differently than someone older being diagnosed. Young people are stereotyped as healthy, so a single CHF diagnosis can have a huge impact on many people involved. CHF also causes fatigue and intolerance for activity, which can be hard to deal with as a child that wants to fun around and play. This is not only a physical disease, but it affects the psychological and emotional side of patients.
Relevance to nursing This study is relevant to nursing because CHF patients are often hospitalized, and nurses must know how to be able to communicate and provide education or therapeutic communication when needed. According to the article, care given by family members can lead to better outcomes (p.593). Unfortunately, caregivers of this disease have higher incidence of depression, anxiety, and stress (p.599). This results in a need for informed and knowledgeable nurses to step in and provide relief from responsibilities, and assist wherever possible to alleviate some of the role strain associated with caring for a CHF patient.
Appendix A: Patient Plan of Care Excess fluid volume r/t disease process Pt. will have lung sounds clear of excess fluid symptoms and have no signs of dyspnea
Monitor daily weights and edema levels Monitor intake and output for excess fluid retention
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Decreased cardiac output r/t disease process Pt. will maintain normal blood pressure, normal pulse, and acceptable EKG Administer oxygen per dr. order Assess pulse oximetry regularly or continuously Potential for decreased endurance r/t dysfunctional oxygen perfusion Pt. will participate in prescribed physical activity with appropriate changes in heart rate, blood pressure and breathing rate Minimize cardiovascular reconditioning by placing bedridden client upright several times daily if possible. Refer client to physical therapy to help increase activity levels and strength.
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References Ladwig, G.B., Ackley, B.J. (2011). Guide to Nursing Diagnosis. Mosby Elsevier. ISBN: 978-0- 323-07172-7 Molloy, G.J., Johnston, D.W., Witham, M.D. (2005). Family Caregiving and Congestive Heart Failure: Review and analysis. European Journal Of Heart Failure. doi:10.1016/j.ejheart.2004.07.00