presented by Lisa Gorski
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.
Lisa Gorski MS, RN, HHCNS-BC, CRNI, FAAN, has worked for over 30 years as a Clinical Nurse Specialist (CNS) for Wheaton Franciscan Home Health & Hospice, now part of Ascension at Home in Milwaukee, Wisconsin. As a CNS, she has developed and oversees the home infusion therapy program, provides staff education, is involved in agency quality assessment, performance improvement, infection control and surveillance, and also provides direct patient care. Lisa received both her bachelor’s and master’s degree from the University of Milwaukee, Wisconsin College of Nursing. Her graduate school work focused on the chronically ill patient population. Within her home care agency, she has also focused extensively on preventing hospitalizations, including a focus on the heart failure and chronic obstructive pulmonary disease patient populations. Lisa served on the American Nurses Association committee and helped develop the American Nurses Association Home Health Nursing Scope and Standards of Practice, most recently published in 2015. Lisa is the author of over 50 book chapters and journal articles on home care and infusion therapy topics. She is also the author of several books, including the 7th edition of the Manual of IV Therapeutics: Evidence-Based Practice for Infusion Therapy (2018) and the 2017 book: Fast Facts for Nurses About Home Infusion Therapy. Lisa has been actively involved with the Infusion Nurses Society (INS) for many years. She served as the 2007-2008 INS President, is the 2017-2019 Chairperson of the Infusion Nurses Certification Corporation, is the chair of the INS Standards of Practice Committee, and led the INS Vesicant Task Force. She is an editor for INS 2010 textbook, Infusion Nursing: An Evidence-Based Approach and also for the forthcoming 2019 edition, which is in progress. In 2006, Lisa was inducted as a Fellow into the American Academy of Nursing. She was named the 2003 CRNI of the Year by INS and the 2011 CNS of the Year by the National Association of Clinical Nurse Specialists. She speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care. Over the past few years, Lisa has presented well-received presentations addressing standards of practice relative to care of vascular access devices and infusion administration in the US, China, Europe, and Middle Eastern and Latin American countries.
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.
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.
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.
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.