July, 2018 What you will learn: - Definition of TRIBUTETTTTR … · 2018. 9. 9. · Heart Failure Coronary heart disease (CAD): Is the most common type of heart disease & heart attacks.

The Tribute

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-Volunteers-

Heart Failure

Heart failure affects about 5.7 million adults in the United States and about half of those who develop heart failure die within 5 years of the diagnosis. According to the CDC Heart disease is the leading cause of death for both men and women. However, the 2015 NHPCO data reports only 19.3% of hospice patients have a cardiac/circulatory diagnosis. Research indicates the lack of clear communication from health care providers regarding the disease and the uncertainty of the prognosis are barriers to patients being informed of hospice in a timely manner. There is a strong correlation between patients enrolling in hospice when their health care provider discusses end of life and the Medicare hospice benefit with them. Hospice cares for patients when they have reached End Stage Heart Failure or Advanced Heart Failure. Generally this is when the medications and any other treatment that has been effective for treating the heart failure no longer are working. According to research patients admitted to hospice earlier rather than later have the highest potential of having their end-of-life needs met and family satisfaction is greater. Hospice Volunteers can be helpful to these patients as some of the common issues with hospice patients with a cardiac diagnosis are social isolation, depression and the uncertainty of their life. These issues may improve with visits, presence, listening and the demonstration of genuine care, concern and compassion for the patient, their caregiver and the family.

What you will learn:

- Definition of Heart Failure - Symptoms of Heart Failure - Interventions for volunteers

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What is Heart Failure? Heart failure is a serious condition, but it does not mean that the heart has stopped beating. Congestive Heart failure (CHF) or heart failure as these are used interchangeably happens when the heart, which is a muscle, weakens and does not pump the blood as well as is needed for the body to get adequate blood supply to all organs and cells. When congestive heart failure occurs, the blood does not move through the circulatory system properly and it will begin to back up. The backup increases the pressure in the blood vessels and forces fluid from the blood vessels into body tissues. Congestive heart failure is a diagnosis that we often see in hospice. The leading causes of heart failure are diseases that damage the heart. Examples include coronary artery disease (CAD), high blood pressure, and diabetes which will be defined on the next page. Patients experiencing CHF may complain of shortness of breath (SOB). This happens because the blood backs up, and causes fluid to build up in the lungs, which in turn may cause the patient to be short of breath and have a hacky cough. Other manifestations of fluid retention are swelling (edema) of the legs, ankles and feet. Sometimes their legs may look blue (cyanotic) which is caused from the lack of oxygenated blood flow to their extremities. The patient’s heart is working harder to try to supply the body with oxygenated blood when heart failure is present. The body depends on the heart's pumping action to deliver oxygen and nutrient rich blood to the body's cells. When the cells are nourished properly, the body can function normally. With heart failure, the weakened heart can't supply the cells with enough blood; this results in fatigue (tiredness), decreased alertness and some people have coughing with blood tinged sputum. Everyday activities such as walking, climbing stairs or carrying groceries become very difficult. Sometimes fluid collects in the lungs and interferes with breathing, especially when the patient is lying down. This is called pulmonary edema. If pulmonary edema is left untreated, it will cause respiratory distress and even death. Heart failure also affects the kidneys' ability to dispose of sodium and water. This retained water also increases swelling in the body's tissues and there may be a sudden weight gain as well as fluid retention in the abdomen.

“A paradigm shift of viewing palliative care or hospice as a gift instead of seeing it as

giving up has the potential to change the way we experience advanced age.” ― Lisa J. Shultz

The Tribute is a monthly newsletter published for member agencies in honor of our Hospice volunteers.

© Copyright AHHC 2018 May be reproduced for Hospice Volunteers. Editor: Cindy Morgan, RN, MSN, CHC, CHPN, VP for Hospice, Palliative Care & Clinical Innovations.

July, 2018

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Heart Failure Signs and Symptoms

Shortness of breath (dyspnea) when you exert yourself or when you lie down

Fatigue and weakness

Swelling (edema) in your legs, ankles & feet

Rapid or irregular heartbeat

Decreased ability to exercise

Persistent cough or wheezing with white or pink blood-tinged phlegm

Increased need to urinate at night

Swelling of the abdomen (ascites)

Very rapid weight gain from fluid retention

Lack of appetite and nausea

Difficulty concentrating/ decreased alertness

Sudden, severe shortness of breath and coughing up pink, foamy mucus

Chest pain if your heart failure is caused by a heart attack

The Volunteer’s Role in Caring for the

Heart Failure Patient

Observation: While visiting with the patient observe for signs of

Heart Failure such as those listed under Heart

Failure Signs and Symptoms

Listen: Actively listen to the patient and his or her

concerns. Does their conversation indicate any

information related to their physical diagnosis of

heart failure? Does their conversation indicate any

psychosocial needs or spiritual needs? This should

also include the family when appropriate.

Validate what they are saying to you. This is

important to the patient.

Does the patient or caregiver mention a sudden

weight gain of more than 2-2.5lbs?

Interventions: If the patient expresses a hobby such as reading,

playing cards, puzzles, looking out the window at

birds, or nature then assist them or join them in

their activity if possible.

Encourage to utilize the treatments such as Oxygen

therapy for their own comfort. Remind of safety

precautions with Oxygen use as needed.

Encourage conserving energy.

Report: All significant information you obtain from the

patient/caregiver/family should be reported to your

volunteer manager and documented in the medical

record.

Credits: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786355/; Lisa J. Shultz, A Chance to Say Goodbye: Reflections on Losing a Parent; Atul Gawande, Being Mortal: Medicine and What Matters in the End; https://www.healthline.com/health/pulmonary-edema#call-a-doctor

“Our ultimate goal after all is not a good death, but a good life until the very end.”

~ Atul Gawande

Some Diseases That Increase Risk for

Heart Failure

Coronary heart disease (CAD): Is the most common

type of heart disease & heart attacks. The cause of

CAD is a buildup of plaque in the walls of the arteries

that supply blood to the heart & the body. Over time the

plaque results in narrowed arteries & decreases blood

flow.

High blood pressure: Blood pressure (BP) is the

force of blood against your artery walls as it circulates

through your body. It is normal for BP to rise & fall

throughout the day. IF it stays high constantly it can

cause health problems. High BP is known as the “silent

killer.”

Diabetes: Diabetes is a chronic disease that affects

how the body turns food into energy. When too much

blood sugar stays in the bloodstream, too long it can

cause serious health problems.

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CDC