A Study of Nursing Intervention for Congestive Heart Failure: Ace-Inhibitors

A Study of Nursing Intervention for Congestive Heart Failure: ACE-inhibitors

American Sentinel University

17 March 2013

Rejiamma Antony

BSN410

Introduction

Heart failure is a clinical syndrome resulting from an inability of the heart to maintain adequate blood circulation. There is no universally accepted definition of heart failure. HF is a clinical syndrome manifested by characteristic symptoms and signs, none of which are specific, caused by an abnormality of ventricular function resulting in the inability of the heart to deliver adequate cardiac output at normal filling pressures at rest or during exercise. This number one killer in America today is a disease that can often be prevented. Since heart failure is such a prevalent ailment, there are certainly numerous methods of nursing intervention aimed at treating the disease and hindering the occurrence of it. For over 20 years I have worked in a medical surgical telemetry unit, therefore, over the years I have attended numerous patients suffering from heart failure. This previous experience is what primarily propelled me to choose this case and study the use of angiotensin-converting enzyme (ACE) inhibitors in the prevention of heart failure on those susceptible for the disease.

Targeted Population

Congestive heart failure is the most prevalent cardiovascular disease increasing in incidence. As of the year 2000, more than four million Americans have had heart failure, more than 400,000 new cases are reported each year and the numbers of cases are expected to double in the next forty years. It is estimated the population aged 65 years and over have definite/probable heart failure. Life expectancy is decreasing and the incidence of heart failure in the 75-84 years age group is 7%, and 15% in those aged 85 years and above (Antonakos & Kazanis, 2003).

Disease state and Methods of Intervention

The severity of this disease shows how important the prevention and treatment of heart failure truly is. The most awful aspect of this disease is that it is like silent MI, until the patient's condition gets worse nobody notices this disease. Patient symptoms of heart failure can vary and can often be a combination of breathlessness, peripheral edema and extreme fatigue. Echocardiogram is a major procedure in the diagnosis for congestive heart failure. Major clinical intervention involves a combination of ACE inhibitors, beta blockers, angiotensin II receptor blockers, aldosterone receptor blocker and diuretics titrated at timely intervals until either a target or maximally-tolerated dose is reached, have improved clinical knowledge and management of heart failure (Drake-Melander, S. ,2004). Optimal management of heart failure patients can be difficult to achieve and requires skilful patient assessment and intensive monitoring. Data finds that nurse-led heart failure management programmes proved successful and cost-effective through their ability to co-ordinate and implement evidence-based care. ACE inhibitors are a vasodilator; that means they dilate (or widen) the blood vessels to improve blood flow, which helps to decrease the amount of work the heart has to do. They also block some of the harmful substances in the blood (angiotensin) that are produced as a result of heart failure. Angiotensin is one of the most powerful vasoconstrictors (they narrow the blood vessels) in the body (Drake-Melander, S. ,2004). ACE inhibitors are critical in the treatment of heart failure when systolic dysfunction is present and may also be prescribed for the treatment of diastolic dysfunction.

Study of Intervention

Good evidence exists to show the benefits of ACE inhibitors on morbidity and mortality for patients with mild, moderate or severe heart failure, after myocardial infarction and in the pre-symptomatic stage. There is little such evidence for diuretics. Research in general practice has shown that only a minority of patients with heart failure receive treatment with ACE inhibitors, with mean doses usually much lower than recommended research doses. Impediments to greater usage are not fully understood, although concern over side effects may be at least partly responsible. Doctors observe cough as a common side effect in their patients and for this problem angiotensin II blockers may be better tolerated. Echocardiography is a cost-effective investigation for identifying left ventricular dysfunction associated with heart failure, but a minority of patients receives this investigation. Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Heart Failure and Nursing Practices: Clients Receiving ACE-inhibitor Therapy was used as the two main articles in order to understand and improve care the adequate nursing intervention for congestive heart failure. Three general practices in north Cumbria were selected to represent a mixture of practice size, location and fund holding status. The practices had 16 principals or assistants in general practice and two GP registrars between them, and a total patient population of 23,210 patients (Antonakos & Kazanis, 2003). Each practice allowed one of the authors (MT) to perform an audit of case records and a set of interviews with the doctors. The audit method has been previously used in studies in general practice, and was used because in general practice decisions for initiation of ACE inhibitors often rely on scrutiny of case records.

Pre-Administration Assessment

Prior to administration of the medication, the nurse needs to obtain a complete health history including recent cardiac events and any incidence of angioedema, allergies, drug history, and possible drug interactions. Obtain baseline ECG and vital signs and assess neurological status and level of consciousness (Hudson, K., 2009). In addition to this the nurse also needs to obtain blood and urine specimens for laboratory analysis. Potential nursing diagnose may include: injury, risk for, related to orthostatic hypotension. Another major diagnose may include nutrition imbalance due to the body's changes in requirement for nutrition, this primarily related to hyperkalemia. A The

Nursing Interventions and Actions

From these two studies I have learned that two major quality improvement initiatives that can be taken by us nurses include knowing the proper interventions and by improving the collaborating between us nurse and other hospital personnel. During the actual implementation