A. Investigated Disease Process
The investigated disease process, in this report, is heart failure. The selection of this disease process reflects more on the fact that heart failure remains as one of the most dynamic medical conditions in the health industry today. The dynamic nature of this disease process reflects the high number of risk factors contributing to a high possibility of the condition (Frandsen & Pennington, 2013). Some of the common risk factors may include age, nutrition, and weight status among others. The investigation of this disease will help in understanding how the disease occurs, as well as evaluating some of the treatment approaches taken as part of its treatment with the focus being towards promoting overall efficiency in dealing with the condition. The investigation will also reflect on the standards of practice associated with this disease process as a way of reflecting on best practices related to the treatment of heart failure.
As an advanced practice nurse, one is expected to have a clear understanding of how to diagnose, treat, and engage in the evaluation of patients suffering from a wide array of chronic conditions (McCance & Huether, 2018). Thus, this means that an advanced nurse is expected to understand the pathology, treatment, as well as regiments associated with specific health conditions or disease processes as part of defining overall efficiency in the treatment approaches taken. In this case, the report seeks to examine heart failure as a critical disease process that advanced practice nurses ought to understand as part of their engagement with patients.
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Heart failure is a disease process in which the heart fails to undertake its expected actions in ensuring that it can supply adequate blood into different parts of the body. The demand for blood in different parts of the body is met by the blood that is pumped through the heart, which acts as a critical factor contributing to the body maintaining its metabolic needs. However, in cases where patients suffer heart failure, the heart is not able to pump blood as per expectation attributed to a wide array of factors. Health professionals do not consider heart failure as a disease. Instead, it is regarded as a complex clinical syndrome in which the heart reduces regarding functionality, which affects the entire body system.
Heart failure is a disease process affecting millions of people around the world with over 6 million Americans suffering from the condition (Braun et al. 2016). Additionally, it must be noted that heart failure is the leading health issue resulting in hospitalization for persons over the age of 65 years, thus highlighting the significance that this health issue tends to have in the healthcare sector. In the United States, approximately 550,000 persons are diagnosed with heart failure annually with many more experiencing various risk factors that would translate to this particular condition (Albert, 2016). A significant number of the persons diagnosed with the condition tend to die from the condition, as it affects the ability for their bodies to function effectively. The most likely outcome is that some parts of the organization find themselves in a situation where they are not able to get oxygenated blood leading to acute organ failure.
A1. Pathophysiology
Heart failure is a clinical condition resulting from the inability of the heart to provide adequate blood that is required by the body in the process of meeting metabolic requirements (McCance & Huether, 2018). The primary pathophysiology of heart failure entails the inefficiency of the heart muscle to undertake normal functioning resulting in the inability to provide the required amount of blood within the heart. The reduction in the efficiency of the heart muscles results from damage or cases where part of the muscles experienced overloading, thus creating the defects that reduce the normal functioning of the blood. The damaging and overloading of the heart muscles are attributed to some conditions including myocardial infarction. Myocardial infarction is a condition whereby the heart muscles do not receive the required amount of oxygen, thus resulting in the death of the cells within the tissues (Carthon, Lasater, Sloane, & Kutney-Lee, 2015).
The heart muscle cells rely solely on oxygen to survive and separate to enhance functionality of the heart. However, the occurrence of myocardial infraction creates a situation where the heart muscle cells find themselves starved of oxygen. The resulting outcome is that the cells tend to become damaged, which, in turn, results in their ultimate death. The death of the cells produces what is described as an infarction , which is a wound or a scar within the tissue in the heart muscles. One key aspect to note is that the wound or scar can extend further depending on the areas that have been affected by oxygen starvation by the blood from the heart. In the event that there is some form of limitation in blood supply, the resulting outcome is that the infraction extends further. Hence, this serves as a clear indication of the fact that the term myocardial infarction would refer to the actual death of heart muscles. Other critical conditions that cause the heart muscles to overload and get damaged include hypertension and Amyloidosis.
In cases where a person has heart failure, the heart experiences a reduction in the contraction force, which results from the overloading of the ventricle, thus limiting the normal flow of blood within the heart. A situation of increased filling within the ventricle helps in improving the force associated with the contraction of the heart muscles thus leading to the flow of blood within the heart. The repeated contractions help in enhancing the process of air flow in and out of the heart, which helps in ensuring that vital organs receive adequate blood for normal functioning of the body. The mechanisms associated with the contraction of heart muscles attributed to the overloading of the ventricles results in the occurrence of a situation where the heart fails to perform as expected ( Brush et al. 2015 ). Additionally, cases of overstretched heart muscles create the inability to perform efficiently thus resulting in heart failure. The overstretching of the heart muscles is attributed to significant clinical conditions that affect muscles of the vital organs in the body.
An important aspect of consideration when analyzing the pathophysiology of heart failure entails the reduction in the stroke volume. Cases of reduced stroke volume result from the failure of systole and diastole, which are a crucial aspect that helps in enhancing the health conditions of an individual ( McHugh et al., 2016 ). The aspect of reduced contraction of the heart increases from the end systolic volume thus resulting in a decrease in the amount of blood pumped from the left ventricle of the heart. On the other hand, an increase in impairment of the ventricular filling results in a situation of decreased end diastolic volume, which translates to the amount of blood within the right and left ventricle at an end load. The impairment of the results in situations whereby compliance of the ventricles in the passing of blood fails thus increasing cases that influence stroke volume. Failure in compliance of the ventricle is associated with the stiffening of the ventricle walls thus reducing the capability related to the contraction to enable adequate blood flow.
The issue of cardiac output is an essential element of consideration as it helps in explaining different situations that may lead to heart failure. The human heart engages in working hard to meet the metabolic demands owing to different situations that create a massive need for oxygen in the body (Frandsen & Pennington, 2013). The heart, therefore, capitalizes on ensuring that the oxygen demand is met with the aim of providing that blood pumped to other parts of the body has adequate oxygen to assist in various metabolic requirements. A critical aspect that increases the demand for oxygen in the collection include exercises, which helps in enhancing the amount of cardiac output. In a properly functioning heart, activities such as exercises play an important role in ensuring that the heart is in a position to meet the demand of oxygen without necessarily engaging in hard work. The loss of cardiac reserves in an individual's heart creates a situation whereby the heart fails to meet the demand for oxygen during exercises and other strenuous activities thus resulting in heat failure.
A key factor associated with heart failure entails the aspect of increased heart rate, which results from sympathetic activities whose primary focus is to maintain adequate cardiac output. Maintaining a proper cardiac production plays a significant role in compensating for heart failure considering that the cardiac pressure capitalizes in maintaining healthy blood pressure and perfusion. Increased heart rates create a situation where the heart of an individual experience a significant strain on the myocardium thus growing the coronary perfusion. The increase in coronary perfusion may result in the worsening of the heart condition, which increases the risks for severe heart failure conditions ( Kane, Murtagh, Ryan, Mahon, McAdam, McQuillan, & O’Gara, 2015 ). An increase in the sympathetic activity within a human body results in fatal abnormal heart rhythms that infers with the normal flow of blood within the heart to other major organs in the body to support the various activities within the organization. In worst cases of the abnormal heart rhythms, an individual experiences difficulties in breathing due to reduced contractions thus expositing the heart to critical conditions of heart failure.
The physical size of the muscles of the heart creates an indication of a significant warning relating to heart failure. Different factors such as increased Sympathetic activity increases the physical size of the heart. The activity increases the size of the heart in a situation where the fibers of the heart muscles attempt to contract thus increasing the physical size of the heart. An increase in the size of the heart increases the stiffness of the muscles thus creating a situation of decreased capability to relax the following diastole. Other critical factors associated with the increase in the physical size of the heart include the enlargement of the ventricles thus resulting in the increase in the size and change in the shape of the heart. The ventricular volume results in the decreased levels of stroke volume, which increase the risks of heart failure based on the enlargement of the ventricles and the heart.
The aspect of cardiac output and the straining of the heart increases the risk associated with cardiac arrests based on abnormalities concerning the ventricular heart rhythms. The abnormalities interfere with the flow of blood in the vital organs thus interfering with normal functioning of the organs. Reduced cardiac out helps in promoting significant activities in the body to ensure that the heart can function efficiently without the fear and risks associated with failing ( McHugh et al., 2016 ). The first significant physiological benefit of reduced cardiac output entails controlling the blood pressure of the artery to maximize the volume of oxygen within the blood passed to vital organs. The second aspect involves the increase in the sympathetic stimulation thus leading to the secretion of antidiuretic hormone, which helps in enhancing the retention of fluids in the kidney. Analyzing the pathophysiology of heart failure entails undertaking of all critical aspects that create risks of heart failure in an individual.
A2. Standard of Practice
The standard of practice reflects more on the practice guidelines set out in creating an effective avenue from which to ensure that indeed the management approach used in dealing with heart failure matches overall expectations. The American College of Cardiology and the American Heart Association have been on the forefront in the development of the standard of practice, which involves the overall process of treatment ( Brush, Handberg, Biga, Birtcher, Bove, Casale, & Rodgers, 2015 ). The outcome of having this standard of practice is that it creates a front from which advanced practice nurses can build on practical approaches to help in the treatment process. Additionally, this also helps in the development of treatment options that would be of value in the overall process of treating patients with heart failure. In other words, this will seek to build on that creating avenue from which to ensure that indeed advanced practice nurses can achieve set objectives.
The analysis of the standard of practice will help in ensuring that indeed advanced practice nurses would be in an active position from which to ensure that patients receive quality care as part of the treatment process. Patients suffering from heart failure find themselves in a situation where the condition tends to advance depending on the environment in which they are exposed (Frandsen & Pennington, 2013). In other words, this means that the environment acts as one of the critical factors of consideration in determining whether indeed patients would achieve the set-out treatment outcomes. Thus, this creates the need for having to follow the standard of practice, which will be of great value in ensuring that the advanced practice nurses would be able to provide them with the necessary environment to help build that proactive environment for favorable treatment of the condition.
On the other hand, it is important to consider the local standard of practice guidelines that have been set out within Inova Fairfax Hospital, which is located in Northern Virginia (VA), to help in the management of heart failure at the hospital level. The first area of focus after the patient comes to the hospital showing signs or symptoms of heart failure is admission. The nurse-in-charge is expected to record the patient’s vitals and any other showing signs or symptoms, which would be important in determining that the patient is actually suffering from heart failure. The hospital has doctors during every shift, who will be expected to examine the patient and recommend the necessary tests to help in determining whether indeed the patient is suffering from heart failure. However, it is important to note that the doctor is expected to recommend therapies that include oxygen therapy, as well as, pharmacological treatments, in the event that the patient is experiencing any major challenges due to his or her condition.
The second area of focus is determining the extent of the heart failure, which would be determined by the tests conducted on the patient after his or her admission. The local standards of practice in Virginia highlight the need for patients to be examined for the extent to which they have experienced heart failure, which would act as a key determinant of the steps to take as part of the treatment approaches. Determination of the extent of heart failure is important, as it helps in defining the best course of action as part of the treatment and management process of the condition. Inova Fairfax Hospital has a well-equipped heart center with the ability to provide difference forms of treatment and management approaches depending on the patients’ needs. Thus, this creates the need for having to establish the extent to which the patient may have experienced a challenge as a result of heart failure.
A2a. Pharmacological Treatments
When dealing with heart failure, one of the critical areas that advanced practice nurses ought to understand is the pharmacological treatments associated with the disease process. The pharmacological treatments undertaken reflect on the recommended medications to use when dealing with patients suffering from heart failure. Pharmacological treatment is one of the fundamental aspects associated with health care, as health professionals are expected to provide necessary medication that will help in the treatment process (McCance & Huether, 2018). In some cases, pharmacological treatments are not essential, as the disease processes involved can be treated using alternative approaches such as therapy among others. However, in the case of heart failure, patients are expected to take a wide array of recommended medication, which will help in slowing down the progress of the condition. Additionally, the medications help in ensuring that the heart can improve its functionality as a way of ensuring that indeed it meets its expected outcomes.
The evaluation of the pharmacological treatments does not necessarily reflect on the treatment expectations for health professionals. Instead, this only reflects on some of the recommended medications that would be able to project a general change in ensuring that indeed patients suffering from heart failure are protected from further impacts of the condition. Additionally, this will also reflect on the need to reverse some of the damage associated with heart failure by focusing on the patients involved. Thus, this highlights the importance of having to understand some of the medications and their benefits and risks that they may pose for the patients with heart failure. The following are an analysis of the pharmacological treatments for patients suffering from heart failure.
Ace Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are medications recommended for patients suffering from heart failure as a result of systolic dysfunction. One of the key aspects to note about this type of medication is that it only seeks to inhibit the activities associated with the enzyme ACE ( McHugh et al., 2016 ). The result is that it contributes to a significant reduction in the production of angiotensin II, which is one of the key contributors to the advancement of heart failure. Thus, the blood vessels from the heart to other parts of the body enlarge or dilate with the aim of ensuring that the amount of blood delivered to different parts of the body increases. The use of these inhibitors helps in prolonging the lives of patients with heart failure. Additionally, the inhibitors also seek to ensure that the patients lead a quality lifestyle although they have been diagnosed with heart failure.
Beta-blockers
Beta blockers are one of the most recommended pharmacological treatment when dealing with patients suffering from heart failure, as they do not only seek to improve the functionality of the heart but also seek to reverse the damage to the heart. However, the reversal of the damages is only possible in cases where patients have been diagnosed with systolic heart failure, which is one of the essential types of heart failures. Some of the common beta blockers used as part of pharmacological treatment for heart failure include carvedilol (Coreg), metoprolol (Lopressor), as well as, bisoprolol (Zebeta) ( Kane, Murtagh, Ryan, Mahon, McAdam, McQuillan, & O’Gara, 2015 ). The medication prescribed depends on the severity of the damages to the heart as part of the assessment by the advanced practice nurse, as each of the medications tends to have different impacts after constant use. The key benefit of using these medications is that they reduce the chances of a patient, diagnosed with heart failure, dying unexpectedly as a result of the condition.
Diuretics
Diuretics are a type of medication used by patients suffering from heart failure with the focus being towards the management of acute and chronic volume overload. Constant intake of diuretics results in a situation where patients tend to experience the urge to urinate much more frequently. The call to urinate arises from the fact that their body system is not able to keep fluids, which may act as contributing factors for the severity of heart failure. One of the most significant challenges to note is that patients tend to lose high levels of potassium and magnesium, thus, creating the need for intake of supplements to help in balancing these minerals in the body system.
Aldosterone Antagonists
The common aldosterone antagonists medications used for purposes of treatment for heart failure are spironolactone (Aldactone) and eplerenone (Inspra). Patients taking these medications tend to experience a higher level of heart functionality, which helps towards prolonging their lifespan regardless of their diagnosis with this particular disease process. Additionally, these medications also act as an aid towards ensuring that beta blockers achieve expected results in reversing the impacts on the heart as a result of failure. However, it is essential to take note of the fact that intake of aldosterone antagonists is much more likely to increase the potassium in the body to dangerous levels. Thus, this means that patients taking these medications are expected to go for regular checkups to determine their potassium levels.
Digoxin
Digoxin, which is also referred to as digitalis, play a crucial role towards increasing the strengths of the muscles contractions within the heart, which means that the amount of blood that the heart can pump out increases significantly ( Kane, Murtagh, Ryan, Mahon, McAdam, McQuillan, & O’Gara, 2015 ). The intake of this type of medication slows down the heart rate with the aim of increasing the strength of the contractions with the aim of ensuring that different parts of the body can get an adequate supply of blood. Continued intake of digoxin helps in reducing the symptoms associated with systolic heart failure. In most cases, this type of medication is given to patients suffering from heart rhythm problems, which may include conditions such as atrial fibrillation. The expected outcome is that it will create that positive outcome in ensuring that indeed patients can advance their expectations as part of the treatment process.
From the above pharmacological recommendations, it is clear that the intake of medication may have a crucial impact on ensuring that indeed patients can effectively deal with the symptoms associated with heart failure. However, advanced practice nurses ought to understand that they may be expected to prescribe two or more of the above medications depending on the severity of the condition. In some cases, heart failure results from issues such as cholesterol or blood clots, which may have direct impacts on the heart resulting in its inability to function adequately. Thus, the advanced practice nurse involved would need to prescribe medications that would help in lowering the cholesterol levels or promoting blood thinning apart from the heart failure medications.
In the event of a new medication or in cases where patients tend to experience worsening of their conditions, one of the critical expectations is that the advanced practice nurse involved would adjust the doses frequently. The adjustment in the doses helps in ensuring that the medications are being taken not only seek to improve on the patient‘s health outcomes but also work towards ensuring that the patient can achieve some of the intended health outcomes. The adjustment of the doses also reflects on the need for the advanced practice nurse to ensure that the heart is pumping better, as well as, relieving some of the notable symptoms that the patients are facing as a result of heart failure. The ultimate result is that the pharmacological treatments would be in a better position from which to define overall efficiency in the treatment and controlling of heart failure.
The use of the pharmacological treatments, as have been presented in the evidence-based framework above, may affect management of heart failure in the patient’s community in several ways. Firstly, the treatments help towards exposing the extent to which medication may be used as a form of management for heart failure with the view that this would help towards limiting the number of patients suffering from heart failure. In the community, North Virginia, the number of persons diagnosed with heart failure is increasing at a significant rate, which has created the need for having to set out effective treatment approaches. The pharmacological treatments are considered as being rather effective in the management process. Secondly, the pharmacological treatments are important towards limiting the general impacts associated with heart failure as a condition. Patients suffering from heart failure tend to experience a wide array of impacts, which are handled through the use of pharmacological treatments, which limit the occurrence of such impacts, thus, improving the quality of life for the persons involved.
A2b. Clinical Guidelines
In the management of heart failure, advanced practice nurses are expected to reflect on some of the essential clinical guidelines, which will guide them on some of the critical approaches that they ought to take in their bid to reduce risks of exposure for their patients. The ultimate result of having to embrace the clinical guidelines is that they will help in creating a significant shift in overall expectations towards promoting positive health outcomes. The expected goal is that the advanced care nurses would be able to establish a framework from which to ensure that their patients are protected from the risks of heart failure.
The American Heart Association Task Force on Practice Guidelines plays a critical role in highlight some of the clinical guidelines when dealing with health issues affecting the heart. Heart failure is one of the essential conditions a wide array of clinical guidelines have been presented to help guide advanced practice nurses in their bid to handling patients with heart failure or in preventing the disease process. The first notable clinical guideline, as per the updated practice guidelines in 2017, is on natriuretic peptide biomarker screening and early intervention with the focus being towards ensuring that advanced practice nurses can prevent the possibility of heart failure ( Braun et al., 2016 ). According to the practice guidelines lack of natriuretic peptide, biomarker screening creates a situation where the risks of heart failure are recognized at a late stage, which reduces effectiveness in prevention.
However, the practice guidelines highlight the need for advanced practice nurses to screen for the natriuretic peptide biomarker for any patient showing some of the symptoms associated with heart failure. If the biomarker is identified at an early stage, the possibility of effective treatment increases significantly, which, in turn, translates to the disease prevention process. The expectation of this is that the patients, showing symptoms associated with heart failure, would be treated effectively to help in reducing the progression of the condition. The practice guidelines indicate that this would work as one of the critical approaches that would help in reducing the number of heart failure cases not only in the United States but also in different parts of the world.
The second clinical guideline reflects on blood pressure, which is one of the critical contributors resulting in a significant progression of heart failure among patients showing signs and symptoms of the condition. In this guideline, advanced practice nurses are expected to identify the at-risk patients, who are much more likely to experience unusual symptoms associated with heart failure. Specifically, the advanced practice nurses are expected to identify patients suffering from Stage A heart failure, which is the stage in which patients experience a high risk of heart failure. In such patients, the advanced practice nurses are expected to ensure that the patients’ high blood pressure is below 130/80 mm Hg, which reduces the risk of suffering heart failure. The nurses involved are expected to create an environment in which patients would feel comfortable, as well as, take the necessary precautions if their blood pressure rises to the level indicated.
Controlling blood pressure acts as one of the critical approaches to help reduce the risks associated with heart failure, as this helps towards ensuring that the heart can function normally. By limiting the blood pressure levels, the advanced practice nurse would be in a better position from which to maximize effective measures aimed at reducing the underlying risk of heart failure. The ultimate result of this is that the patients, who are considered as being at a higher risk of heart failure, will experience a significant reduction in their risk levels. In overall, this will act as a guarantee that indeed the number of heart failure cases would reduce at a considerable rate through the adoption of the clinical guidelines.
When dealing with patients class II and III of the New York Heart Association classification of heart failure, advanced practice nurses are expected to evaluate whether the patients are experiencing iron deficiency. Iron deficiency may result from a significant reduction in ferritin levels to below <100 ng/mL, which may also translate to 100 to 300 ng/mL if the saturation is below 20% (Carthon, Lasater, Sloane, & Kutney-Lee, 2015). In such cases, the patients involved tend to experience a higher risk of heart failure considering that the heart fails to match expected muscle strength that would help in ensuring that indeed it can pump sufficient blood. Additionally, this also creates a significant risk of the patients experiencing failures in specific parts of the heart, which would result in ultimate heart failure.
In such cases, advanced practice nurses are expected to embark on an intravenous iron replacement as one of the critical approaches allowing for a reasonable improvement in functionality. Additionally, this will also result in a general increase in the quality of life for the persons involved taking into account that majority of the patients suffering from heart failure tend to face challenges touching on the variety of experiences that they lead. Intravenous iron replacement is considered as being useful in dealing with iron deficiency, as it takes into great consideration some of the equation parameters including aspects of age and weight among others. The ultimate result of this is that it not only helps in reducing the possibility of exposure to heart failure as one of the chronic health issues but also helps in ensuring that the persons affected experience a significant change in the quality of life.
Patient Education
Patient education will be of great value in highlighting the clinical guidelines for assessment and diagnosis of heart failure. Nurses will be expected to provide patients with vital information touching on the general impacts associated with heart failure as a key health condition. That will help define the need for patients to take up proactive measures that would help in the ensuring that they embark on assessment of their health to help in the diagnosis of heart failure. The nurses involved in patient education will be expected to highlight the fact that indeed early diagnosis of the condition may be of great value towards improving one’s health drastically. The ultimate focus for having to engage in patient education is that it will create the need for patient to embark on regular health assessments. The assessments are important in effective diagnosis of the condition to help towards improving general outcomes.
A2c. Standards of Practice Disease Management
In the disease management process, it is essential to take note of the specific standard of practice that would be of great value in the effective management of the condition, heart failure. The standard of practice focusing on disease management reflects more on the idea that advanced practice nurses must take into account specific aspects that would help in managing this particular condition ( Braun et al., 2016 ). The first aspect of consideration in dealing with heart failure is the fact that the advanced practice nurse would be expected to review the family history touching on the condition. Heart failure is a hereditary condition, which increases in possibility if a specific family member is diagnosed with the condition. For the advanced practice nurse, this means having to review the family history to determine whether a family member may have past away as a result of heart failure.
That would involve having to look out for sudden deaths in the family, which have come as a result of health issues including stroke or cardiac arrest suggesting the predisposition toward heart failure. In most cases, the advanced practice nurse involved would focus as far back as three generations to determine the risks that the patients may encounter as a result of heart failure. If a family member has been diagnosed or has died from heart failure, the nurse will seek to expose the patient to further testing to determine the risks faced by touching on heart failure as a disease process. The tests will help eliminate the possibility that the patient may be suffering from heart failure, which occurs as a gradual process and patients may show symptoms that may vary in one way or another.
The second approach that an advanced practice nurse ought to consider as part of the disease management process for health failure is personal behaviors that may act as key risk factors for the condition. As an advanced practice nurse, one of the critical expectation is to ensure that patients change their behaviors, which predispose them to a higher risk of heart failure. Some of the behaviors included smoking and increased drinking of alcohol, as well as, use of illegal drugs, which are much more likely to result in heart-related health issues. The advanced practice nurse will be expected to ask more questions about some of the behaviors that may expose the patient to a high risk of heart failure. That will act as a form of patient education approach with the focus being towards ensuring that indeed the patient can avoid some of these behaviors.
The crucial third management approach to take when dealing with patients that face a high risk of heart failure is evaluating the possibility of whether the patient may suffer from another health issue that may create a risk of heart failure ( Braun et al., 2016 ). Some of the possible conditions that create a high risk of heart failure include high blood pressure, diabetes, and cholesterol. In cases where patients tend to have any of these medical issues, the likelihood that the patient may suffer from heart failure increases significantly. Thus, this creates a front from which the advanced practice nurse would be able to make effective decisions on the treatment approaches to take when dealing with the patient. The treatment approach to take will depend wholly on the likelihood that a patient may experience the risk of heart failure.
However, it necessary to take note of the fact that some of the patients may not be ready or willing to share some of this information taking into account that they are not aware of the risks that they face. In such cases, the nurse involved is expected to educate the patient on the possible dangers that they face if they are diagnosed with heart failure, which occurs as an outcome of any of these health issues. Additionally, the education will also help in ensuring that the patients understand the value that they ought to place on the overall treatment process focusing on health failure as a key health outcome. In other words, this would mean that the patients would be in a better position to make conscious decisions on their health with the focus being towards building on positive health outcomes to help protect them from the possibility of heart failure.
Heart failure occurs as a result of biomarkers within the body system, which tend to create a higher risk of exposure for specific patients, which tend to have these biomarkers. These biomarkers include BNP and NT-proBNP among others, which occur as forms of protein the body system ( Brush, Handberg, Biga, Birtcher, Bove, Casale, & Rodgers, 2015 ). The critical expectation for an advanced practice nurse dealing with patients with such risks is to ensure that the patients are taken through tests that will determine whether they have these biomarkers. If a patient has the biomarkers, that would mean that the patient is at a higher risk of exposure to heart failure, thus, creating the need for having to focus on effective treatment approaches. In such cases, the advanced practice nurse would be expected to take proactive steps in ensuring that the patient is guided through the necessary tests to determine the overall risk of exposure.
Other critical aspects that advanced practice nurses would be expected to look out for in their bid to dealing with patients facing a high risk of heart failure include issues such as weight and nutrition, which are key risk factors for the condition. If an individual is not able to manage his or her weight effectively, the risk of exposure increases significantly considering that the patient faces a higher possibility of heart failure when compared to others. Additionally, the issue of weight acts as a contributing factor to other conditions such as high blood pressure, which are key risk factors for heart failure. From that view, it is clear that indeed the risks of exposure tend to increase as a result of a wide array of medical issues such as obesity.
Lastly, the disease management process will involve having to engage in a process through which to assess the heart itself to determine the shape, size, and functionality. If a patient faces a risk of heart failure, the physical structure of the heart tends to change significantly. That will serve as one of the critical aspects of focus in determining the overall risk of exposure for a patient, which will be of great value towards promoting favorable treatment of the condition. That will involve having to ensure that the patient goes through a series of tests that will help in determining whether indeed the heart is functioning as per expectations. Ultimately, this will be of great value towards assessing the risk of exposure for the patients involved, which will be of great importance in setting out positive expectations as part of the disease management process.
In the patient’s community, North Virginia, one of the key standard of practice to consider is on the effective evaluation of patients to determine the extent to which their heart has been damaged as a result of heart failure. At the state level, it is clear that specific guidelines apply as part of the treatment processes with the view that this would seek to build on a proactive avenue for effective management of the condition. The patient would be expected to view some of the local heart centers including Inova Fairfax Hospital, which would help in conducting all the relevant tests to determine the level of heart failure. On the other hand, the state has also provided guidelines touching on areas such as pharmacological treatments and therapies, which are essential for purposes of improving the health status of the patients. The expected outcomes of this is that they would help ensure that the patient would be in a better position through which to manager heart failure as a key condition.
A3. Managed Disease Process
The management process of heart failure requires undertaking a multimodal approach the entails combining various aspects that help towards managing the condition. Engaging in the management process of the diseases capitalizes on reducing the severity of the disease to ensure that the patient maintains a healthy life regardless of the heart condition ( Braun et al., 2016 ). The first aspect of consideration during the management of the disease entails engaging in lifestyle changes to improve the signs and symptoms associated with the condition. Healthcare professionals providing medical care to the patients educate them on aspects that necessitate lifestyle changes that help in managing the requirement to ensure that they lead a healthy life. The healthcare professionals capitalize on measures that assist the patients to control the disease gradually based on the severity of the disease.
Some of the measures that are capitalized by the healthcare professionals regarding the lifestyle changes involve engaging in physical activities, weight reduction, and dietary programs. When focusing on the aspect of participating in physical activities for patients with heart failure, it is necessary to capitalize on the severity of the symptoms associated with the condition. In mild cases of heart failure, patients are required to engage in moderate physical activities to ensure that the situation does not worsen owing to factors such as straining the body. In severe cases of heart failure, patients are required to undertake bedrest to help in ensuring that the patient recovers from the acute condition. The second aspect of consideration involving lifestyle changes includes identification of the possibilities of the existence of sleep apnea, which is considered a significant risk factor for the condition.
In this case, the management process requires that patients with sleep apnea receive proper medical treatment to ensure that the condition does not pose more risk to the patient concerning the worsening of the heart condition. Another critical aspect in the management of heart failure focuses on weight monitoring and weight reduction to reduce cases associated with obesity. Obesity among heart failure patients increases the severity of the disease thus making it difficult to manage the disease ( Rasmusson, Flattery, & Baas, 2015 ). Engaging in dietary modification and exercises assist the patients to overcome obesity-related issue thus preventing the patients from worsened cases of heart failure. Lastly, the process of managing heart failure through lifestyle changes capitalizes on the reduction of sodium intake among the patients with the aim of reducing cases of reoccurrences of heart failure. Increased sodium intake among heart failure patients is a significant risk factor that contributes to the worsening of the disease.
The second aspect of consideration in the managing process of heart failure includes medication, which capitalizes on the use of various medicines that focuses on overcoming risk factors and symptoms and risk factors associated with heart failure. The medicine used in the treatment of the disease aims at relieving significant symptoms related to the condition and maintain the fluid balance in the circulatory system of the patients. Additionally, the medications used in managing heart failure focuses on making improvements in the development of the condition by delaying the progression of the disease among the patients. Impeding the progress of the disease among the heart failure patients play an essential role in the reduction of cardiovascular risks associated with the development of heart failure. The administration of the medications to the patients focuses on the severity of the disease to determine the appropriate remedy that would be best at any given time.
The medications administered during to manage heart failure involved the use of drugs such as diuretic agents, vasodilator agents, and ACE inhibitors. Other drugs used by the heart failure patients include beta-blockers and aldosterone antagonists, which have different functions in managing the condition. The use of ACE inhibitors among patients with heart failure helps in reducing the mortality rates associated with the situation by dealing with the symptoms associated with the disease. During the management process of the condition, patients are required to undertake the ACE inhibitor therapy regardless of whether patients have other underlying issues such as blood pressure ( Rasmusson, Flattery, & Baas, 2015 ). The medication provided to the patient helps to improve the functionality of the heart by reducing ventricular hypertrophy. Ventricular hypertrophy is a significant issue that plays a vital role in escalating the risk of heart failure among the patients considering it involves the thickening of the walls of the ventricle of the heart.
Another critical medication administered to the patients during the management of the disease include the diuretic drugs that play a significant role in overcoming major risk factors associated with the worsening of the disease among the patients. The diuretic medication capitalizes on relieving significant congestive symptoms that hinder the proper functioning of the human heart. The most common diuretic medications administered during the management of the condition include the loop diuretics, Potassium-sparing diuretics, Spironolactone, and the Thiazide diuretics. Based on the critical nature of the disease, patients with heart failure receive the different recommendation for the diuretics to manage and treat the condition at a different level. The combination of the diuretic medications helps in enhancing the health conditions of the patients to capitalize on the proper management of the disease to prevent worsening that result in the death of the patients.
Other medication options administered during the management of the disease involved the use of Recombinant neuroendocrine hormones, vasopressin receptor antagonists, and alternative vasodilators to ensure that the patients are in a better position to overcome symptoms associated with the worsening of the disease. The administration of the medication help in reducing major risk factors such as thickening of the ventricle walls of the heart to ensure smooth flow of blood in an out of the heart effectively. The hormonal medication helps in assisting the body in dealing with the symptoms by suppressing the severity of the condition to allow the heart of the patients to function effectively. Additionally, the combination of the mentioned medications focuses on treating the underlying conditions such increase blood pressure that increases the risk for worsening of the disease.
The final aspect of consideration during the management process of the disease entails the use of devices such as cardiac resynchronization therapy and Cardiac contractility modulation to provide treatment options for the condition. The cardiac resynchronization therapy helps in enhancing the functionality of the ventricles to allow the flow of blood in the heart to reduce cases of heart failure. The managed disease process, as has been presented above, reflects on several notable inequalities, which is essential to consider in a bid to making effective decisions on the process involved in the management of heart failure. The disparities arise from a wide array of factors including access to health facilities, race/ethnicity, and specialization among others. Understanding these disparities is essential in ensuring that indeed health facilities can set up effective avenues from which to ensure that indeed their patients achieve the best possible health outcomes ( Rasmusson, Flattery, & Baas, 2015 ). Additionally, this will also create that effective outcome from which to ensure that indeed health facilities would be able to set out effective mechanisms allowing them to deliver on best practices. The expected goal is that this will help create a change in the healthcare sector to ensure that patients achieve the best possible health outcomes.
Access to Health Facilities
The first notable disparity that arises when dealing with heart failure is on access to health facilities that would be able to provide quality and affordable care in the management of this particular health issue. Majority of the healthcare facilities not only in the United States but also in different parts of the world do not have a heart care center with the capacity to offer quality heart treatment and management of the condition. Thus, this means that a significant number of people find themselves in a position where they cannot access quality and affordable care for their conditions. The result of this is that a substantial number of the patients find themselves in a position where the condition tends to act as a burden, as they are not able to manage it effectively.
The disparity arising as result of access to health care creates the need for governments to take proactive steps in their bid to ensure that they equip a significant number of health facilities with modern equipment to deal with heart failure. The treatment of heart failure is considered as a complex and delicate process, which require high-level expertise, thus, creating the need for investment on the part of the governments. Governments would be expected to increase funding to the healthcare sector in a bid to ensuring that health facilities can acquire the latest technologies allowing them to deliver on positive results. Additionally, this will also mean that health facilities would be expected to focus their attention on utilizing the funds that they get towards equipping their facilities to handle heart-related issues including heart failure as one of these issues.
Race/Ethnicity
Race and ethnicity act as crucial factors creating disparities in heart failure management due to the socioeconomic gap within different communities. In the United States, for example, minority communities face significant challenges due to issues of high unemployment, which means that they are not able to afford quality care ( Rasmusson, Flattery, & Baas, 2015 ). Thus, this means that persons suffering from heart failure within this community may experience a significant disparity regarding access to quality care as a result of the differentiation created. The outcome of this is that some of the areas in which minority communities live tend to experience significant challenges in promoting access to quality health care services. In some cases, this occurs as a result of a lack of facilities with the capacity to handle such health issues.
Specialization
The disparity in dealing with the management of heart failure also results from the specialization required for health professionals with the capacity to deal with heart failure effectively. Health professionals with the understanding of heart-related issues tend to need further education, which creates a challenge considering that majority of the professionals working in the healthcare sector today do not have a clear understanding of issues touching on the heart. For advanced practice nurses, the idea of having to study more on such matters becomes a challenge due to the time is taken, as well as, the cost of such courses. Consequently, this limits the expectations in dealing with heart failure significantly, as the number of professionals with the understanding of how to deal with the issue effectively is somewhat limited. The disparity arises from the fact that the number of people with the ability to access such expectations of care is slightly restricted.
The disparities, as have been discussed, tend to create a situation where it becomes difficult for patients suffering from heart failure to access the expected quality of care allowing them to make effective decisions on effective management of the condition. However, this only seeks to create a situation where it becomes challenging not only for the patients but also for the health professionals in their bid to dealing with the condition effectively. The outcome of this is that the professionals tend to find themselves in a situation where it becomes difficult for them to make a conclusive decision on best practices. However, this will help create a case where the treatment expectations tend to vary from one patient to another depending on the disparities.
A3a. Disparities
The state of Virginia has been on the forefront towards setting out effective policies and practice guidelines that seek to define the overall structure of health service delivery with the focus being towards building a progressive platform for management of heart failure. When comparing the practice guidelines in Virginia to those set out in California, it is clear that they present several notable disparities, which must be highlighted effectively. The first key disparity to note is on access to care as part of the management expectations when dealing with health failure, which is a key issue of great consideration. In Virginia, the number heart centers is somewhat limited due to lack of effective investment in the health care sector, especially by private investors. However, this is different in California, as the number of heart centers with the ability to handle heart failure is somewhat significant, thus, increasing access towards a significant level. The issue of consideration is that this seeks to create some form of disparity on what would be expected in terms of effective management of heart failure.
The second key disparity is on the funding for research focusing on the issue of heart failure. When comparing the levels of funding in these two states, it is clear that California has a higher funding rate when compared to Virginia. The disparity in funding has created a significant gap in the management of the condition in these two states taking into account that it becomes much easier for state governments to reflect in possible projections focusing on the area of effective management. The differentiation in the funding levels has created a situation where California tends to have a higher level of advancement in technology for purposes of managing heart failure.
The third notable disparity noted is on the issue of best practice guidelines implemented in Virginia and California, which seek to present several notable disparities. In Virginia, the best practice guidelines for management of heart failure focus more on ensuring that heart professional seek to evaluate the patient to determine the severity of heart failure. However, this is different in California, as the best practice guidelines focus more on adoption of an approach that seeks to ensure that health practitioners focus on management of the symptoms shown before embarking on evaluation. In other words, California’s best practice guidelines seek to ensure that the health practitioners are well positioned towards dealing with the health symptoms that can be seen. However, this is different in Virginia, as the best practice guidelines reflect more on ensuring that indeed health professionals would be able to deal with the issue at its firsthand level to avoid further exposure to symptoms.
On the other hand, it is important to take note of the fact that the United States, in comparison with Kenya, presents a major difference in terms of overall capacities to deliver on effective management of heart failure. On the issue of access to care, the United States is rather ahead when compared to Kenya considering that the United States government has invested significantly in development of heart centers to help improve on access to care. However, this is different in Kenya, as the country still faces a key challenge in trying to advance the overall projection of having to improve on expected margins for access to quality care for heart failure. Insurance coverage also presents a major disparity between these two countries. In the United States, the federal government rolled out Medicare and Medicaid as part of the insurance coverage that seeks to advance access to affordable care. However, this is not the case in Kenya, as majority of the people do not have access to medical insurance, which acts as a key challenge for them touching on the quality and affordability of heart failure management services.
A4. Managed Disease Factors
Managed disease factors refer to specific elements that would seek to ensure that patients with heart failure are treated effectively. The treatment process for heart failure focuses on several key factors, which act as determinants of whether indeed the treatment process can meet the set-out standards and expectations. Having a clear understanding of the managed disease factors will seek to determine the overall expectations for health professionals in their bid to the treatment of the condition. In any given healthcare setting, it is essential to take note of the managed disease factors relating to a given health care issue in a bid to building overall effectiveness while focusing on a given treatment process. In this case, the focus is on heart failure as one of the critical health issues that affect a significant number of patients affected by unusual symptoms.
Patient Insurance
The first managed disease factor to consider is patient insurance, which would mean that the patient can access quality health care services without having to focus more on the costs associated with such treatments ( Jurgens et al., 2015 ). Lack of insurance has been noted as one of the critical issues affecting the healthcare industry not only in the United States but also in different parts of the world. If patients do not have insurance, the costs of health care tend to be significantly high, which affects their affordability. From that view, it becomes challenging for these patients to seek quality health care services that would meet their set out objectives. Instead, a significant number of these patients tend to focus on treatment options that only serve to alleviate the suffering that they are experiencing as a result of their condition.
Having insurance would mean that health facilities would be in a better position from which to improve on the services that they offer taking into account that the insurance covers will be able to cover the same. The United States government recognized this as one of the critical issues that would help in promoting effective management of health conditions affecting a diverse population in the country. One of the target populations is patients over the age of 65 years, who are prone to heart-related issues including heart failure. Thus, this led to the introduction of Medicare and Medicaid, both of which are insurance covers that offer low-cost insurance to the populations in the country. The opening of these insurance covers has played a critical role in building an effective avenue through which patients with heart failure can access quality care.
Living within Cities
Living within cities may also act as one of the critical managed disease factors taking into account that people living within cities tend to have more access to cardiologists and heart centers ( Jurgens et al., 2015 ). Majority of the health facilities within cities are well equipped in their bid to dealing with heart failure, as they tend to invest significantly towards creating centers that would be able to handle the increasing number of heart issues. Additionally, the facilities also focus on the hiring of cardiologists with the knowledge and understanding of what it means to manage patients with heart-related problems. The outcome of this is that the majority of the patients with heart failure living within cities find it much easier in their bid to seek effective treatment.
A significant number of health care facilities in rural areas lack the equipment and staff with the capacity and understanding of what is expected in dealing with heart-related issues including heart failure. For a majority of the patients within cities, this would mean that they are better placed to manage the condition taking into account that they tend to focus much of their attention towards building that proactive step concentrate on accessing quality care. Additionally, this will also ensure that these patients can access the health care facilities if they face any notable issues as a result of their heart failure disease process. The outcome of this is that indeed this creates a better avenue from which to define overall performance in ensuring that patients achieve the best possible results in their bid towards promoting effective treatment.
Staffing
Staffing may also act as one of the managed disease factors of significant consideration in dealing with heart failure, as health facilities with an adequate number of staff find themselves in a better position from which to build overall effectiveness in dealing with such cases. One of the critical challenges that majority of health facilities face in their bid to promoting management of heart failure and other conditions is staffing. Most health facilities find themselves in a position where they tend to experience a significant challenge in ensuring that each of the patients with heart failure is managed effectively. That results in a situation where it becomes difficult for the patients to meet some of their set out health care goals as part of the treatment process for heart failure.
For health facilities to achieve their set goals in the effective treatment of the condition they must work towards hiring more staff including advanced practice nurses with the understanding of heart-related issues. However, it is essential to take note of the fact that a majority of the facilities lack the funding that would allow them to hire more staff to handle the increasing number of patients with heart failure. That would mean that the health facilities would need to shift their focus towards seeking alternative ways of funding, which include finding sponsors that would determine the overall shift in terms improving quality outcomes. By enhancing staffing within these facilities, patients within heart failure will have access to health professionals that would provide them with information on effective management of the condition. Additionally, this would mean that they would have access to health professionals with a clear-cut understanding of how to handle some of the underlying symptoms associated with heart failure in given populations.
The managed disease factors, as have been identified and discussed, reflect more on the understanding that effective treatment and management of heart failure reflects on a delicate balance in trying to build overall efficiency in a wide array of areas. For example, the factors seek to reflect on the issue of cost, which acts as one of the critical elements that would create a situation where it becomes difficult for patients to achieve their set health objectives. The elements reflect on health insurance as one of the critical ways in which persons suffering from heart failure would be able to establish themselves as part of the treatment process.
The factors that have been identified, above, clearly show the fact that the management of heart failure would be much more effective taking into account that these factors seek to ensure that patients are able to receive the best quality of care. An analysis of the factors indicates that they seek to ensure that patients understand the nature of their condition, as well as, work towards improving overall possibilities in the management of this particular condition, heart failure. Additionally, the factors seek to create a new approach through which to improve on patient care as a key expectation in trying to establish a positive framework for positive outcomes. In overall, the factors are considered as being effective in trying to create a positive framework through which to ensure that patients achieve the best possible outcomes after effective management of heart failure.
A4a. Unmanaged Disease Factors
Unmanaged disease factors refer to a set of elements, which seek to determine the fact that indeed the condition has not been managed in an effective manner, which is part of the expectations for the patients and health professionals involved. On the other hand, it is essential to look out for the unmanaged disease factors, which are necessary to consider in a bid to understanding some of the critical factors that would determine the non-effective management of the condition. Understanding these factors is essential, as it seeks to change the way in which the healthcare sector aims to deal with patients suffering from heart failure, which is a chronic condition. Additionally, this will also help towards reflecting more on the fact that indeed this will seek to change the way in which health professionals handle patients suffering from heart failure.
Patient Insurance
The first key factor to consider in defining the overall structure of unmanaged disease factors for heart failure is lack of an effective framework through which to ensure that patients are able to access insurance. Insurance coverage helps towards ensuring that patients are able to achieve quality and affordable care services. However, a significant number of patients find themselves in a situation where it becomes challenging for them to access insurance. Thus, this creates a situation where their abilities to access quality care when dealing with heart failure is somewhat limited. The limitation stretches to the fact majority of these patients are not able to afford heart failure management services that would allow them to pay cash (Hoefer et al., 2017). The ultimate result of this is that majority of these patients end up suffering with the disease condition due to their inability to access the expected quality of care to help in promoting effective management.
The patient may use his or her symptoms as critical measures of the health outcomes considering that the critical expectation when dealing with effective treatment is that the symptoms will reduce. Additionally, this means that the patient will experience a significant change regarding his or her health as a result of the treatment approaches taken. However, if the symptoms do not change or the patient does not feel any better after the treatment process. That would mean that indeed the treatment is not as effective as expected. That will act as an unmanaged disease factor, which will help in highlighting the fact that indeed the disease management process has failed. Thus, this would mean that the health professional involved would need to change his or her approaches in a bid to improving the patient’s ability to meet set out health outcomes.
Living within Cities
Living within cities has been noted as a key factor promoting management of this condition, as cities tend to have the expected number of heart centers to help in effective management of heart failure. However, it is important to take note of the fact that the populations living outside the cities tend to experience major challenges that impact on the overall outcomes associated with access to some of these centers. Majority of the rural areas lack heart centers or health facilities with the ability to handle patients with heart failure (Fitchett et al., 2016). The issue stretches from the fact that investment in heart centers has only focused on urban cities while ignoring the fact that rural areas have populations facing key challenges due to heart failure. From that perspective, it is clear that indeed the idea of living outside a city may be considered as a factor that promotes non-effective expectations touching on the management of heart failure.
Another unmanaged disease factor reflects more on the fact that specific areas may lack heart centers that would be able to take in patients suffering from a wide array of heart issues including heart failure. The critical expectation for health professionals in such situations is that they would focus their attention towards changing the way in which they handle the patients considering that they do not have the equipment necessary. In such cases, the possibility of effective treatment or ensuring that the patient meets his or her set out health outcomes reduces significantly. That means that the patient would need to travel to another region or area in a bid to accessing the expected quality of care. Additionally, this would mean that the individual would need to shift his or her focus towards other areas in a bid to accessing the expected quality of care.
In most cases, the lack of heart centers results from a situation where setting up of heart centers is considered as being costly for the facilities. Thus, this creates a situation where a majority of these facilities tend to focus much of their attention towards other conditions while ignoring patients with heart issues. In such cases, the possibility of a patient with heart failure failing to improve increases significantly considering that the treatments offered does not match the expectations for real treatment. Additionally, this will also mean that patients may experience a significant disparity in their ability to access quality heart care considering that this will force them to focus on other regions with the required machines to help improve on their health outcomes.
The consideration of the unmanaged disease factors is essential, as it seeks to ensure that indeed patients with heart failure can build on their respective capacities to deliver positive results as part of the treatment expectations ( Jurgens et al., 2015 ). Additionally, this will mean that indeed the health professionals involved would be in a better position from which to ensure that the quality of services that they offer match the overall expectations. Health facilities intending to handle patients with heart failure must take note of the unmanaged disease factors, as they seek to create an approach from which to change their overall structure in a bid to ensuring that the quality of services the offer match patient expectations. The ultimate result of this that patients would be in a better position from which to achieve positive health outcomes as part of promoting positive expectations.
Staffing
Staffing in health care facilities is important towards creating an effective approach that would help in the management of heart failure. However, it must be noted that a significant number of health facilities lack the professional staffs that would be able to handle such issues touching on heart failure (Fitchett et al., 2016). Thus, this becomes a key issue of consideration in defining the unmanaged disease factors considering that it becomes challenging for patients to access quality care. Staffing helps in ensuring that patients are able to access the expected quality of care to help in effective management of the disease condition. However, it must also be noted that the issue reflects more on the idea that a significant number of persons suffering from heart failure find themselves in positions where it becomes difficult for them to access the same quality of care. The ultimate result of this is that patients tend to experience major challenges in trying to advance their management expectations with the focus being on heart failure.
A4ai. Unmanaged Disease Characteristics
Non-effective management of heart failure may have dire consequences among patients considering that it creates a situation where patients find themselves exposed to a wide array of adverse outcomes. Most of these unmanaged disease characteristics result from a situation where the patients, suffering from heart failure, have not been able to manage the condition effectively. Ultimately, this creates a situation where the symptoms associated with the condition tend to advance further, thus, impacting on the general health of the patient. Additionally, this also results in a situation where the patients tend to face notable risks of other health issues taking into account that heart failure acts as a significant risk factor. The following are some of the unmanaged disease characteristics that are evident in patients suffering from heart failure.
Fatigue
Patients suffering from heart failure tend to experience fatigue regularly, which occurs due to the inability for the heart to function effectively. Heart failure results in a situation where the heart is not able to pump adequate blood to meet the demands in the body system. Thus, this creates a situation where some of the less vital parts of the body including the arms and legs are deprived of blood, as it is directed to the essential organs. Consequently, this results in constant cases of fatigue, as the arms and legs do not have the standard blood capacities allowing them to function effectively. Additionally, this creates a situation where the patients tend to experience difficulties in undertaking everyday activities including walking, jogging, or exercising. In most cases, this creates acts as a risk factor for other conditions including obesity and high blood pressure among others.
As the rate of heart failure persists due to poor management of the condition, the patient experiences significant challenges in undertaking regular activities as a result of fatigue. Additionally, this also comes about due to the increasing fluids within the body tissues due to the inability of the heart to function effectively. It is common for fluids to mount within the lungs in cases where patients are experiencing challenges in dealing with lung failure ( Albert, 2016 ). In that same way, patients with heart failure find themselves in a situation where it becomes difficult for them to manage the number of fluids within the body tissues. Thus, this results in swelling considering that the body finds itself having excessive amounts of fluids within the tissues that it cannot be able to excrete. The swelling also creates a challenge for the patients in their bid to engage in everyday activities.
Lack of Appetite or Nausea
As has been indicated in the previous section, heart failure creates a situation where blood is directed toward vital organs of the body with some of the non-vital organs being deprived of blood. One of the critical systems that are affected significantly due to heart failure is the digestive system, which experiences a significant challenge regarding its ability to function effectively considering that the system does not have the expected amounts of blood. Thus, this creates a situation where patients with heart failure find themselves facing critical challenges regarding their appetite. In other words, the appetite levels reduce significantly as a result of heart failure, as the digestive system is not in any position to handle significant amounts of food for purposes of digestion.
On the other hand, patients find themselves in situations where they tend to feel nauseous at frequent intervals resulting from the inability for the digestive system to function effectively. The feeling of nausea results from a situation where the system finds itself irritated based on the amounts of food that the patient may take, which is lower than individuals that have not been diagnosed with heart failure. The ultimate result of this is that the patients tend to experience a significant challenge in their bid to maintaining proper eating habits, as they do not have the appetite allowing them to consume such foods. In most cases, this results in further exposure to malnutrition considering that the body is not able to get the required amounts of nutrients that would allow it to function effectively.
Increased Heart Rate
Another essential characteristic to note is that the patient, suffering from heart failure, may experience an increased heart rate as a result of the condition considering that the heart needs to function harder in a bid to meeting the demands for blood in the body. Patients with heart failure find themselves in a situation where the rate at which their heart is a function is notably high when compared to the expected heart rate. That creates a high possibility of palpitations in which the heart tends to throb at a much higher rate in a bid to ensuring that it can pump enough blood into different parts of the body. Non-effective management of the condition results in a situation where the heart rate tends to increase significantly in a bid to promote overall efficiency regarding meeting blood demands in the body.
Confusion
Non-management of heart failure creates a situation where patients tend to experience significant challenges occurring due to complexity and trouble in thinking. In some cases, this also creates a high possibility of disorientation considering that the amount of blood reaching the brain from the heart is somewhat limited. Although the brain is regarded as one of the vital organs in the body, the amount of blood reaching the brain remains limited, as the blood is expected to be distributed to other parts of the body. Thus, this results in a situation where the brain is deprived of oxygen, which is vital towards ensuring that it functions effectively. The outcome is that the overall level of brain functionality reduces at a significant rate meaning that patients are much more likely to experience disorientation or memory loss ( Albert, 2016 ). As the heart failure progresses, the effects on the brain tend to increase regarding their severity, which would affect overall functionality.
The unmanaged disease characteristics, as have been identified, increase depending on whether the patient can effectively manage the condition. In cases where patients are not able to achieve the set-out expectations, the severity of these characteristics tends to become more severe. Ultimately, this exposes patients to a higher risk of mortality considering that some of these characteristics tend to have severe impacts on the overall health of the patients. Management of heart failure helps towards limiting the general implications of the condition for the majority of the patients as a way of ensuring that indeed they can control the ultimate outcomes associated with heart failure.
B. Patients, Families, and Populations
Exposure to heart failure tends to have notable impacts on patients, families, and populations from varied perspectives. Examining these impacts its important, as it seeks to find effective avenues through which patients are able to deal with the condition in an effective manner. The effects may involve aspects such as costs taking into account that the management of heart failure required patients to receive health care services regularly. Additionally, the effects may also revolve around the fact that patients find themselves in situation where they are not able to work effectively considering that this is a condition that may become more severe in the event that a patient would experience any form of strain. In some cases, family members experience notable pressures resulting in situation where it would require them to take up second jobs in a bid to taking care of the finances associated with handling patients with heart failure. The following is an in-depth analysis of how heart failure affects patients, families, and populations touching on several key areas.
B1. Cost
One of the greatest challenges noted in the management of heart failure is the fact that the costs of management and treatment of this condition are significantly high. On a national level, the United States government spends approximately $39.2 billion in the management of heart failure, which is approximately 2% of the total budget allocated for health care. That has created the need for patients to focus much of their attention towards getting insurance covers, as this would help limit their exposure to the high costs of treatment focusing on heart failure as a key condition of focus. In the event that a patient does not have an insurance cover, the cost of treatment for the condition may range from $7,500 - $8,500 on a weekly basis. That means that a significant number of patients experience major challenges in their bid to accessing such health expectations for purposes of managing heart failure.
The fact that the United States government has been on the forefront towards advocating for health insurance acts as a clear reflection of the fact that indeed the costs of managing heart failure would be viable for all persons. Medicare, which is an insurance cover for low-income populations and older persons, is much more effective in reducing the cost burdens for the families and community. Currently, approximately 1.3 million people have a Medicare cover, which provides them with an insurance that would guarantee them effective outcomes in the treatment and management of the condition. The adoption of patient education is expected to focus more on trying to ensure that a lot more people are able to take up medical insurance as a way of improving on their general expectations in the management of the condition. The uptake of medical insurance would mean that the high risk populations would be able to receive the best quality of care at all times for effective outcomes ( Jurgens et al., 2015 ).
In some cases, patients find themselves in situations where they are not able to access quality management of heart failure as a result of the fact that they are not able to work effectively. The greatest challenge that patients encounter is that it becomes somewhat challenging for them to deliver on set out goals or objectives while in different employment positions. Thus, this means that patients find it difficult to hold jobs for long periods. The challenge reflects on the fact that it becomes harder for the patients to access quality and affordable care with regard to the management of heart failure. The issue of cost is important to consider when intending to find viable solutions to the problems, as patients must be able to afford the services that they receive. Additionally, this also means that the patients must also be expected to advance their capacities towards providing for themselves regardless of this particular health condition.
B2. Impacts of Heart Failure on Patients
One of the key aspect to note is that majority of the patients exposed to heart failure find themselves in a situation where it becomes challenging or difficult for them to work especially in labor-intensive environments. The issue stretches to the fact that the patients are not expected to strain, as this may have a significant impact on their heart (Yancy et al., 2016). The ultimate result of this is that a significant number of the patients tend to experience major challenges in trying to find employment that would suit their respective expectations. The issue also goes beyond the fact that it becomes challenging or difficult for the patients to be able to meet their economic expectations. The projected outcome of this is that majority of these patients find themselves in situation where they tend to depend on their families for everything. The issue not only affects the patients but also affects the other family members, who must find alternative ways of having to take care of the patients based on their health condition.
The high-risk patients include individuals with a history of heart failure condition that reoccurs upon being exposed to various risk factors that result in the occurrence in episodes of heart failure. Other high-risk patients include individuals, who have had coronary heart diseases, cardiovascular diseases, diabetes, or hypertension. The underlying medical conditions present a high risk of heart failure considering the patients are exposed to factors that are highly associated with increased cases of heart failure. The diagnosis of the mentioned conditions among the patients requires that patients receive proper care to ensure that the patients receive adequate supervision to prevent them from being exposed to other critical situations such as heart failure. The healthcare professionals providing care to such patients should capitalize on educating the patients on healthy heart behaviors to ensure that they are protected from having conditions such as heart failure.
Another key impact to note is that patients find themselves in situation where their function is affected as a result of blockage occurring within the heart as a result of heart failure, which affects the quality of life that the patients lead. Considering that heart failure is a result of improper functioning of the heart caused by blockages within the ventricles that help in allowing free flow of blood in the heart, conditions such as obesity and high cholesterol can be a significant risk factor that contributes to heart failure. To capitalize on reducing the risk among the patients, it is necessary to focus on the provision of appropriate medication and lifestyle training that provides patients with the ability to fight and overcome the risk of exposure to heart failure. Lastly, patients diagnosed with cigarette smoking addictions are regarded as high-risk patients considering the health risks associated with the issue of smoking. Smoking exposes individuals to medical conditions such as heart failure due to factors such as blockage of the ventricles thus hindering the free flow of blood in the heart.
B3. Impact of Heart Failure on Families
On the family, heart failure tends to have several key impacts, which are important to consider in a bid to ensuring that indeed viable solutions are adopted. The condition tends to have serious financial implications on families considering that it becomes essential for families to consolidate their money in a bid to ensuring that their kin is able to access quality care. However, in some cases, this requires family members to seek financial help from other family members and friends attributed to the high costs associated with heart failure care. In most cases, heart failure creates pressure among specific family members, as it becomes essential for them to get second or third jobs in a bid to ensuring that they are able to meet their economic expectations. The patients suffering from heart failure often find themselves in situations where they are not in a position to work. Thus, this means that other family members are expected to work hard in a bid to catering for the gap created by the fact that their kin may not be in a position to work due to his or her health condition.
To determine the level of risk associated with the development of heart failure condition in a family, it is necessary to investigate the history of the family on issues relating to heart failure conditions to develop measures that would be necessary for overcoming the risks. Another category of families considered to be at high risk of heart failure entails families with existing cases of coronary heart disease and Dyslipidaemias. Dyslipidaemias is a condition that requires the existence of abnormal levels of lipids in the blood of a patient thus increasing case of clogged arteries, which results in stokes and significant complications associated with the circulatory system. The occurrence of the Dyslipidaemias condition is common among related relatives, which is an indicator that the situation can be passed among individuals in the same family.
In this case, families with the condition tend to be at risk of heart failure considering the disease results in the clogging of the arteries and ventricles thus hindering the free flow of blood on the heart. The management of the condition in such families requires undertaking proper measures that help in reducing risks and suppressing factors that result in Dyslipidaemias to ensure that the members of the families are not exposed to heart failure condition. Families with the poor lifestyle behaviors are considered to be at high risks considering that heart failures are attributed to lifestyle elements that increase the risk. Considering one of the critical risk factors of heart failure is obesity, and high levels of cholesterol in the body, families that engage in the poor dieting within minimal or no exercises tend to be at a higher risk of heart failure.
The adoption of different lifestyle such as the engaging in exercise, engaging in proper nutrition is defined as a family level thus influencing the behavior of an individual. In this case, families that value the aspect of adequate health through exercises and proper dieting tend to impact all members within the family, which is an aspect that plays an integral role in creating a positive family history. Additionally, families that are affected by cases of smoking tend to be at a significant risk of heart failure. Although smoking may be an individual issue, the negative influences of smoking influence the environment through aspects such as passive smoking where the non-smokers experience the adverse effect.
B4. Impact of Heart Failure on Population
The impact of heart failure on the population is evident from the fact that the government finds itself in a situation where it is expected to increase expenditure in the health care sector in a bid to ensuring that the persons suffering from heart failure are accorded positive management. That does not affect specific individuals but affects the society as a whole considering that it places the burden on every individual in the society, who pays taxes, leading to a situation where it becomes the responsibility for every individual to understand the impacts of heart failure. The increasing number of heart failure patients means that the government would be expected to spend more funds to achieve positive results in effective management of the condition. Thus, this means that the most likely outcome is that the people in the society may find themselves being affected by heart failure in one way or the other. From general perspective, it is important to take note of the fact that indeed heart failure is a condition that must be considered in the society as a whole attributed to its impacts on the population as a whole.
Heart failure is a condition that is more prevalent among the elderly compared to children and young adults. According to Carthon, Lasater, Sloane, & Kutney-Lee (2015), approximately 65% of individuals aged 60 and above presents, a greater risk of heart failure due to factors associated with other conditions such as hypertension. Majority of the older adults in the society tend to experience decreased immunity to fight various minor and major diseases, which results in the exposure to risk factors that causes heart failure. Another population that tends to be at risks of heart failure entails the uneducated persons in any given society. Illiteracy plays a significant role in exposing an individual to heart failure considering the lack of adequate information concerning the management of the disease. Additionally, unemployment increases cases of heart failure because lack of employment results in poverty thus inability to engage in proper nutrition.
C. Best Practices Promotion
Promotion within the Department
The promotion of best practices within the department will focus on several approaches, which would seek to ensure that indeed every person within the department has a clear-cut understanding of how the health facility seeks to improve on management of heart failure. The first key approach would involve blackboard positing of all the changes in the management of the condition. That would include some of the key areas where the department intends to change its approach for purposes of achieving positive outcomes in the management of this condition. Secondly, the department will be expected to hold a seminar including all staff members, who will be educated on some of the changes that are expected to be implemented within this facility. The changes will help towards determining the extent to which the department is able to provide its patients with quality care. The seminar will provide each member of staff within the department with an opportunity of having to ask any questions touching on the adoption of best practices as part of management of heart failure as a key health condition.
Promotion among the Patients
Dealing with heart failure condition requires the implementation of best practices that may help in reducing the risk factors associated with the condition and capitalize on enhancing a healthy lifestyle. The aim of implementing the best practices is to ensure that the patients diagnosed with heart failure are in a position to overcome the condition and experience a reduction in cases associated with readmission. The healthcare professionals engaging in the implementation of the best practices should focus on understanding and recognizing the potential causes of heart failure to define practices that may help in suppressing risk factors associated with the disease. Additionally, the aim of implementing the best practices focuses on reducing mortality rates associated with the prevalence of the condition among patients with severe heart failure condition.
Assessment and Follow Up
The first practice that is implemented in the clinical management of heart failure entails engaging in evaluations and follow up of the patients diagnosed with heart failure. An essential aspect of managing heart failure requires assessing the level of severity of the condition among the patients to develop appropriate strategies that would be helpful to assist patients to overcome the situation. Engaging in a constant assessment of the patient helps in determining the progress of patients concerning improvement or worsening of the disease. On the aspect of making follow up, it is necessary as it helps in reducing readmission cases. The process of making follow-ups for the patients diagnosed with heart failure mandate the healthcare practitioners to establish measures that would be appropriate in reaching out to patients upon being discharged from hospitals. The assessment and follow-ups are considered best practices considering they play a critical role in enhancing home care for the patients with the aim of maintaining a proper health situation.
Medication Management
The second best practice that is implemented in the clinical management of heart failure entails medication management. Engaging in the proper use of medication for any given medical condition helps in enhancing the recovery process of individuals. In this practice, it is necessary for the healthcare professionals to capitalize on ensuring that the patients receive appropriate medication that helps in suppressing the condition and promote positive health outcomes among the patients. The healthcare providers should benefit on providing that the patients are aware of the nature of medication administered to them to understand the importance of following the medication instruction. The aim of engaging in a proper medication management therapy is to reduce cases associated with hospital readmissions through improving the condition of the patients in matters concerning the reoccurrence of heart failure condition. To improve medication management, it is necessary to capitalize on ensuring a proper reconciliation of medications upon an admission of the patients and engage them in the given process.
Diet
Another important aspect of consideration when dealing with the clinical management of heart failure involves diet. Engaging in a proper diet helps in ensuring that the patients are healthy thus, reducing the risk factors associated with the prevalence of heart failure condition. Healthcare professionals caring for the heart failure patients are required to establish programs that help in educating the patients on critical aspects that concerns proper dieting, which is part of ensuring that the patients receive proper nutrients in the body to ensure proper functioning. The acquisition of adequate information concerning critical aspects of dieting helps the patients to reduce factors such as obesity, which are key contributors to heart failure condition.
C1. Implementation Plan
The implementation of the best practices, as have been identified, will focus on several critical approaches in a bid to meeting the set-out goals and objectives. The crucial first approach to determine the implementation will be the level of adherence that the patient would have towards the medication used in the treatment of heart failure. Pharmacological treatments have been noted as some of the critical approaches that would be of value in dealing with heart failure, as the condition can be treated using a wide array of medications. However, the implementation of the best practices would need to create a practical approach from which to ensure that indeed the patients adhere to the prescriptions. As an advanced practice nurse, the focus will be on patient education, which will be of great value in promoting adherence considering that the patients would have a clear understanding of the negative impacts of non-adherence.
The advanced practice nurse will also make follow-ups with the patients to determine whether indeed they are observing the prescriptions given as part of the treatment expectations. The general outcomes of this are that indeed patients would be in a better position from which to achieve the best practices in the management of heart failure. The crucial second approach to consider as part of an implementation of the best practices is the diet in which patients would be expected to adhere to a given dietary plan. Effective management of heart failure ensures that indeed patients improve on their eating habits considering that excessive consumption of specific foods may have a direct impact on the patients' health. The advanced practice nurse will be expected to discuss this expectation with the patient in a bid to improving on the foods that they consume for better management of the condition.
The advanced practice nurse will be expected to come up with a practical approach from which to make follow-ups on the patient to ensure that indeed he or she is following the dietary plan set out. In overall, this would mean that the nurse would be in a better position from which to build on positive expectations towards promoting positive health outcomes for the patients. Additionally, this will also translate to a general improvement inability for the patient to deal with the underlying impacts of the condition. However, this reflects more on the fact the patient would need to understand the importance of having to follow a strict dietary plan in the treatment of the condition. The advanced practice nurse must engage in discussions with the patients to help provide them with information on the importance of nutrition in ensuring that indeed the patient can meet some of the set-out health objectives.
The follow-ups on the diet will also be inclined towards ensuring that the patients engage in regular exercise in a bid to maintain their health outcomes in the best way possible. Practices have been noted as some of the critical expectations for patients suffering from heart failure in a bid to improving their capacities to meet specific health outcomes. Consequently, this creates the need for an advanced practice nurse to educate the patients on the importance of having to embark on regular exercise programs. The implementation process will focus more on creating an exercise plan for the patient through which the patient would be able to exercise effectively. The exercises will improve the overall possibilities of meeting general expectations in dealing with the condition while reducing some of the underlying symptoms that the patients may be exposed.
The other notable approach towards implementation of the best practices is coming up with a plan through which patients would be able to go for regular check-ups in a bid to ensuring that indeed they are moving in the right direction regarding their treatment outcomes. Regular check-ups are essential for patients with heart failure taking into account that this condition can worsen at any given time, resulting in fatal consequences for the patients. The importance of having to go for regular check-ups can be seen from the fact that these check-ups will determine whether the treatment options taken are sufficient. In the event of non-efficiency, the advanced practice nurse will seek to change the treatment approach to help reflect on a better outcome for the patient involved.
However, the patient would need to understand the importance of having to avoid some of the lifestyle behaviors, which may expose them to a higher possibility of the condition. Some of the critical behaviors that the patient would need to avoid include smoking and excessive intake of alcohol. The primary expectation for the advanced practice nurse is that he or she would need to create an advanced platform from which to reduce overall possibilities associated with engagement in such activities. If the patient is a smoker, that would mean that he or she would need to enroll in a smoking cessation program. Such programs will help reduce exposure to heart failure as a result of lifestyle behaviors. Additionally, this will also mean that the patient is better placed towards improving on his or her health outcomes in dealing with heart failure.
C2. Evaluation Method
Evaluation of the best practices will serve as the determinants of whether indeed the practices, as implemented are well positioned towards meeting the general expectations. Assessment will occur in different ways as a way of ensuring that indeed the practices implemented have the capacity or ability to improve a patient's health outcomes. Firstly, the evaluation of the best practices will reflect on the idea of having to use questionnaire for the patients within periods of 3 months, 6 months, and 9 months after they begin their treatment. The use of this questionnaire seeks to determine whether indeed the measures that have been implemented are effective to help in the management of heart failure. Additionally, this will also seek to expound on the possible expectations in trying to improve on the health of the patients, as it becomes much easier to weigh in on key area that may require improvements. The use of the questionnaire within these periods will help towards determining how the measures implemented affect the patients within different patients for effective outcomes.
The advanced practice nurse involved in handling the patient with heart failure will be expected to evaluate the patient's symptoms over a given period to determine whether indeed the symptoms are reducing in a bid to promoting positive health outcomes for the patients. Secondly, the evaluation will focus on whether the patient has cut some of the critical behaviors or lifestyles that are much more likely to expose him or her to a higher risk of heart failure. In other words, this means that the advanced practice nurse would need to make follow-ups focusing on areas such as smoking or intake of alcohol. The follow-ups will help in determining whether the patient is working towards the improvement of his or her health outcomes while reflecting on the possible consequences as part of the treatment processes. The ultimate result of this is that the advanced practice nurse would be in a better position from which to make effective decisions on the patients.
Thirdly, the evaluation will touch on whether the patient is making efforts towards engaging in regular check-ups focusing on the condition, as this will work as one of how to minimize the impacts of the situation. The patient will be expected to focus on regular check-ups with the health professionals to determine his or her progress as part of the treatment outcomes. Thus, this paves the way for adequate evaluation of the patient to determine whether indeed the follow-ups and check-ups have had any significant impact on promoting positive health outcomes. In overall, this would mean that the patient would be in a better position from which to advance his or her set out expectations in building that proactive avenue from which to improve on expected health outcomes.
Lastly, the evaluation will focus on determining whether the patient education process taken by the advanced practice nurse has had any impacts on the patient in trying to promote overall progress in dealing with the condition. Throughout the treatment of the state, the advanced practice nurse will be expected to engage in conventional patient education approaches aimed at educating the patient on a wide array of aspects associated with the condition. Consequently, this highlights the importance of having to evaluate the effectiveness of the education process on the patient in a bid to determining the generalized expectations in promoting positive health outcomes. Through this evaluation, it will be much easier to learn whether the patient is well positioned towards meeting specific health objectives as part of dealing with heart failure.
Closing Summary
The investigated disease process, in this report, is heart failure. The selection of this disease process reflects more on the fact that heart failure remains as one of the most dynamic medical conditions in the health industry today. Heart failure is a disease process in which the heart fails to undertake its expected actions in ensuring that it can supply adequate blood into different parts of the body. In the United States, approximately 550,000 persons are diagnosed with heart failure annually with many more experiencing different risk factors that would translate to this particular condition. The reduction in the efficiency of the heart muscles results from damage or cases where part of the muscles experienced overloading thus creating the defects that reduce the normal functioning of the blood.
The physical size of the muscles of the heart creates an indication of a significant warning relating to heart failure. Reduced cardiac out helps in promoting substantial activities in the body to ensure that the heart can function efficiently without the fear and risks associated with failing. Pharmacological treatments are not essential, as the disease processes involved can be treated using alternative approaches such as therapy among others. The American Heart Association Task Force on Practice Guidelines plays a critical role in highlight some of the clinical guidelines when dealing with health issues affecting the heart. Advanced practice nurses are expected to identify the at-risk patients, who are much more likely to experience unusual symptoms associated with heart failure.
Some of the measures that are capitalized by the healthcare professionals regarding the lifestyle changes involve engaging in physical activities, weight reduction, and dietary programs. The disparities arise from a wide array of factors including access to health facilities, race/ethnicity, and specialization among others. The variance in the risks causes a varying level in the severity of the disease among the patients. To determine the level of risk associated with the development of heart failure condition in a family. The healthcare professionals engaging in the implementation of the best practices should focus on understanding and recognizing the potential causes of heart failure to define practices that may help in suppressing risk factors associated with the disease.
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