Caring for a Patient with Heart Failure: Reducing Hospitalization Risk
Presented by Lisa A. Gorski
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Heart failure (HF) is a common diagnosis, affecting up to about 5.7 million adults in the US. It is a leading cause for hospitalization, with an estimated annual cost to the country of $30.7 billion (CDC, 2016). Treatment of this chronic and progressive condition includes medications, reduction of dietary sodium, and daily activity. Many hospitalizations for heart failure exacerbations are preventable when contributing factors are understood, when attention is paid to early signs/symptoms, and when the focus is on patient and family self-care management. This course provides the home care clinician with an overview of heart failure, including basic pathophysiology and medical management and evidence-based recommendations aimed at prevention of rehospitalization.
Meet your instructor
Lisa A. Gorski
Lisa A. Gorski has worked for 40 years as a clinical nurse specialist (CNS) and educator for Wheaton Franciscan Home Health & Hospice, now part of Ascension at Home, in Milwaukee, Wisconsin. As a CNS, she has played a key role in the home infusion therapy program, contributing to clinician education, policy and procedure…
Chapters & learning objectives
1. Pathophysiology of Heart Failure
Home care clinicians must understand the pathophysiology of heart failure in order to best comprehend heart failure treatment and to effectively educate patients and families. In this chapter, the following are addressed: the definition, categories, and stages of HF and the neurohormonal compensatory mechanisms that occur as the heart begins to fail.
2. Assessment and Heart Failure Disease Management
The importance of the home care nurse’s role in assessment and identification of HF signs and symptoms and potential HF exacerbation is emphasized. Nonpharmacologic and pharmacologic interventions in HF management are described.
3. What are the Components of Self-Care Management
Patient and family education is essential to managing the patient with HF. While key areas for patient education will be identified in this chapter, it is important to recognize that self-care management is more than just helping patients to understand and adhere to taking medications, eating a low sodium diet, and attending to activity and exercise. To optimally manage HF and reduce the risk for hospitalization, patients must also self-monitor for signs/symptoms of exacerbation and, should they occur, effectively evaluate and manage their condition, such as implementing medication changes and/or appropriately calling the licensed prescriber. The role of telemonitoring as an aspect of self-care management is also addressed in this section.
4. Understanding Patient Barriers to Self-Care Management
To effectively intervene and help patients to self-manage their HF, barriers must be addressed in order to develop appropriate interventions. Older adults in particular may struggle to manage their disease due to other co-morbidities, frailty, and social isolation. Additional barriers to self-care management include depression, low health literacy, mild cognitive impairment, provider-interaction style, and low self-confidence in managing HF. Case scenarios will be used to highlight strategies for intervention. The learner will also be challenged to consider questions relative to his/her practice and beliefs.