2806NRS Research In Nursing
Question
Case Study
Charlie, a 75-year old overweight man, has arrived at the general practice clinic where you are currently working. He is breathless, has visible peripheral oedema, and tachycardia. Two years ago Charlie was diagnosed with chronic heart failure as a result of ischaemic cardiomyopathy and hypertension but states that in the past few days he has felt increasingly unwell.
Based on the case, three references from the reference below which you believe best summarise the evidence for the management of Charlie’s condition.
Rees, K., Dyakova, M., Ward, K., Thorogood, M., & Brunner, E. (2013). Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev, 3.
Murray, M. D., Tu, W., Wu, J., Morrow, D., Smith, F., & Brater, D. C. (2009). Factorsassociated with exacerbation of heart failure include treatment adherence and health literacy skills. Clinical Pharmacology and Therapeutics, 85, 651-658. http://dx.doi.org/10.1038/clpt.2009.7
Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J., Dalal, H. M., Lough, F., … & Taylor, R. S. (2015). Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart, 2(1), e000163.
Answer
Introduction
The paper deals with the study of Charlie a 75-year old overweight man. The patient has history of heart failure as a result of ischaemic cardiomyopathy and hypertension. His present condition is not well. While working in general practice clinic it was noticed that Charlie is breathless, has visible peripheral oedema, and tachycardia. Heart failure is a chronic health condition characterized by weakened heart muscle due to which it cannot pump adequate blood and meet the oxygen demands of the body (Berger et al., 2016). Since the patient is hypertensive and is experiencing shortness of breath he is at higher risk of heart failure. Further, overweight can increase the blood cholesterol level, blood pressure and type 2 diabetes. Therefore, there is a need of managing the illness considering multiple aspects. In this paper, three scholarly articles are used that best summarises the evidence for the management of Charlie’s condition. The justification for the chosen per reviewed article will be provided with other supporting evidences from literature.
Annotated bibliography
Justification and recommendation
Justification and recommendations
These results were found significant at 95% confident interval. Hence, the study findings can be used by the physicians, pharmacists and the nurses to provide careful instructions to the patients. Therefore, it was justified to choose the above article for annotated bibliography. In this case Charlie’s condition can be improved if he is informed by the nurses about taking medications on time. Emphasising on this factor may help Charlie to avoid negligence and take more precautions. He might feel more motivated if explained that taking medications could be beneficial. Non-adherence to treatment can result in poor outcomes such as mortality and morbidity as observed by Moser et al. (2015) in case of rural patients with heart failure. The outcome was mainly associated to poor health literacy. Similarly, increasing health literacy will help Charlie to better understand the activities that will promote his health. He will be aware of the consequences of not refilling the medicines. Nurses can take initiative to increase his prescription reading skills so as to prevent missing on any important guidelines.
Justification and recommendations
Selecting this article as evidenced based management option for Charlie is justified because he has already experienced heart failure two years ago. Considering his present symptoms, it can be interpreted that he is highly vulnerable to future heart failure. Therefore, secondary prevention is important in this case. The health care professionals can use this article as evidence based option for management of Charlie’s condition. Since cardiac rehabilitation involves other programs as well it may give Charlie an additive effect. For instance, psychological interventions may help Charlie overcome anxiety and depression related to his vulnerable condition. If not cardiac rehabilitation Charlie can be advocated to uptake exercise based program in home setting. According to Bäck et al. (2017) there is an equivalent preference for centre based and home based exercise programs among heart failure patients. However, the study found that in either case the patients had similar health benefits. The evidence of justification can also be given from the randomized clinical trial of Kitzman et al. (2016). This trial was conducted for patients with heart failure who are overweight and obese. The trial showed that aerobic exercise and calorie restriction increased the peak oxygen consumption. Höllriegel et al. (2016) investigated the effect of long term exercise training in patients with heart failure and in advanced chronic state. The results showed that training over a period of 12 months resulted in improved exercise capacity. It was beneficial in reversing of left ventricular remodeling. Therefore, these beneficial adaptations for Charlie may improve his current condition.
Conclusion
It can be concluded from the literature review that heart failure is a delicate condition and involve potential risks and comorbidities. The best way to manage heart failure patients is to increase their health literacy, physical activity and advice dietary changes. This recommendations based on the evidence generated from the annotated bibliography. It will improve self care behavior such as medication adherence, participation in health promoting activities in Charlie. Eventually, it may reduce the risk of future cardiovascular events. Implementing this evidence based options is found to improve the quality of life measure and hospitalizations in various studies. Therefore, it may delay the risk of death in case of Charlie.
References
Bäck, M., Öberg, B., & Krevers, B. (2017). Important aspects in relation to patients’ attendance at exercise-based cardiac rehabilitation–facilitators, barriers and physiotherapist’s role: a qualitative study. BMC Cardiovascular Disorders, 17(1), 77.
Berger, J. S., Peterson, E., Laliberté, F., Germain, G., Lejeune, D., Schein, J., … & Weir, M. (2016). Risk of Ischemic Stroke in Newly Diagnosed Heart Failure Patients.
Höllriegel, R., Winzer, E. B., Linke, A., Adams, V., Mangner, N., Sandri, M., … & Erbs, S. (2016). Long-term exercise training in patients with advanced chronic heart failure: sustained benefits on left ventricular performance and exercise capacity. Journal of cardiopulmonary rehabilitation and prevention, 36(2), 117-124.
Hooper, L., Summerbell, C. D., Thompson, R., Sills, D., Roberts, F. G., Moore, H. J., & Smith, G. D. (2016). Reduced or modified dietary fat for preventing cardiovascular disease. Sao Paulo Medical Journal, 134(2), 182-183.
Johansson, P., van der Wal, M. H., Strömberg, A., Waldréus, N., & Jaarsma, T. (2016). Fluid restriction in patients with heart failure: how should we think?. European Journal of Cardiovascular Nursing, 15(5), 301-304.
Kitzman, D. W., Brubaker, P., Morgan, T., Haykowsky, M., Hundley, G., Kraus, W. E., … & Nicklas, B. J. (2016). Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. Jama, 315(1), 36-46.
Matsuoka, S., Tsuchihashi-Makaya, M., Kayane, T., Yamada, M., Wakabayashi, R., Kato, N. P., & Yazawa, M. (2016). Health literacy is independently associated with self-care behavior in patients with heart failure. Patient education and counseling, 99(6), 1026-1032.
McNaughton, C. D., Jacobson, T. A., & Kripalani, S. (2014). Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease. Patient education and counseling, 96(2), 165-170.
Moser, D. K., Robinson, S., Biddle, M. J., Pelter, M. M., Nesbitt, T. S., Southard, J., … & Dracup, K. (2015). Health literacy predicts morbidity and mortality in rural patients with heart failure. Journal of cardiac failure, 21(8), 612-618.
Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes, and obesity. Circulation, 133(2), 187-225.
Murray, M. D., Tu, W., Wu, J., Morrow, D., Smith, F., & Brater, D. C. (2009). Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clinical Pharmacology and Therapeutics, 85, 651-658. https://dx.doi.org/10.1038/clpt.2009.7
Rees, K., Dyakova, M., Ward, K., Thorogood, M., & Brunner, E. (2013). Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev, 3.
Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J., Dalal, H. M., Lough, F., … & Taylor, R. S. (2015). Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart, 2(1), e000163.
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