NURS23111 Principles Of Adult Critical And Intensive Care Nursing

Part A

Patients with complex and chronic conditions experience many morbidities which often require the attention of multiple healthcare providers (Kuluski et al., 2013, pp.111-123) for example people with cardiovascular issues. In Australia, Chronic Heart Failure (CHF) is a significant chronic and complex cardiovascular condition that has a prevalence of about one million people (Chan et al., 2015, p.446). CHF is a leading stressor of the Australian healthcare system with high rates of preventable admission and readmission to healthcare facilities (Chew et al., 2016, pp.128-133). These high rates of preventable readmission offer a chance for improvement of the CFH outcomes at both individual and societal through levels policy changes that enhance improved quality care (Davidson et al., 2015, pp.2225-2233).

An excellent example of such a policy is the NSW clinical service framework for CHF 2016 which is composed of nine-evidence based guidelines that help the healthcare professionals to manage CHF (Chew et al., 2016, pp.128-133). The framework helps in the prevention, detection and interventions on the condition to generally improve the health of the nation.

The first standard is the prevention of CHF by preventing myocardial destruction which often results in CHF. Diseases such as Coronary heart disease and hypertension are the major diseases that damage the myocardial muscles (Heush et al., 2014, pp.1993-1943). A study conducted in 2004-2005 on the Aboriginal people shows that 53% of the population had three or four predisposing factors for a cardiovascular condition. These factors were smoking, physical inactivity, high alcohol consumption, eating less than five serves of vegetables in a day, eating less than two serves of fruits daily, hypertension, obesity, long-term kidney maladies and diabetes (Hoy, Mott and McDonald, 2016, pp.916-922).

Next is to detect and control factors that bring about and advance CHF. All clinicians need to be aware of the cardiac factors that cause and advance the disease so as to focus at identifying, preventing and treating them. The factors include myocardial ischemia, elevated blood pressure and arrhythmias and other non-cardiac factors such as anaemia. The Australian Health workers (AHWs) are to be educated on these factors as well to facilitate a concerted effort towards combating the disease.

Standard number three requires a comprehensive diagnosis of the disease through clinical assessment and investigations to assess the severity of the condition and identification of the reversible interventions (Atherton et al., 2018, pp.1123-1128).

The next guideline is the treatment of the acute symptoms of CHF by relieving these symptoms thereby promoting cardiac functioning. Upon facilitating the cardiac operation then follows the pharmacological management of the condition. Sticking to the recommended pharmacological therapy in the right dosage is vital to ensure optimal control of the disease and quality of life for the patients.

The healthcare providers should then consider providing the CHF patients with suitable devices and surgical therapies that may improve the quality of life as well as reduce other adverse events related to the treatments and mortality cases. The patient should be subjected to receiving multidisciplinary continuing care and rehabilitation. Proper coordination between primary care clinicians and general physicians reduces admissions cases improving the prognosis for CHF patients (Atherton et al., 2018, pp.1123-1128). Other physician specialties such as respiratory specialist may also have an input into the management of CHF facilitating optimal care for the patients.

The other standard promotes palliative care on patients even those with a substantial likelihood of death within a year through having access to quality primary care from the multidisciplinary workforce. The ninth standard ensures there is monitoring of quality of the services as well as the result indicators. Both the hospitalized and community managed patients have to be monitored to ascertain the effectiveness of the care given to these patients. From this monitoring, gaps are identified, and appropriate changes are made.

Part B

Person-Centered care (PCC) is a model of care delivery that underpins a collaborative approach in the care of patients and their healthcare professionals. Studies have shown that PCC reduces financial expenditures on chronic conditions and it reduces the length of hospitalised CHF patients with a significant reduction in the rate of hospital readmission. The PCC facilitates a quality health-related life among patients with chronic conditions (Hansson et al., 2016, pp.276-284).

Mr. Harry requires a PCC to enhance a quality healthy life. His age, 68 years old is a risk factor in itself to chronic myocardial dysfunction. He has led a lonely life since the demise of his wife five years ago. His loneliness is compounded by the fact that his children are all grownups that have their homes. Although sometimes his son pays him visits they are for brief periods and periodical.

Further, he has secluded himself from the men’s shed for feeling not fit to manage trips to and from such sites despite having recovered from his chronic condition by adopting an active physical life. His physical activities were achieved by tending his rose garden and participating at the Bowling Club. Now he no longer goes to this club for fear that his health cannot enable him to be physically active. Harry purchases ready to cook foods which are mostly processed foods for he rarely uses fresh produce anymore.

His children believe that he developed hypochondriasis which is the psychological worry of having a severe illness even though diagnosis indicates otherwise (Mcguire et al., 2014, pp.106-116).

Regarding Harry’s needs, this PCC will consider the management of his behavioural risk factors that is nutrition, social behaviours, physical activity and healthy weight. Also, it is important to evaluate his biomedical risk factors on lipids, blood pressure and diabetes which are commonly associated with CHF.  Lastly, the plan will cover the management of his condition pharmacologically (Woodruffe et al., 2015, pp.430-441).

According to the NSW policy on the management of CHF, the first step entails the prevention of the chronic condition, therefore I will have to conduct various assessments on Harry. The plan will involve regular measurements of blood pressure at Central Coast Local Health District to check for the possibility of hypertension. The regularity of the measures is influenced by the absolute cardiovascular risk assessment at the facility whereby if the risk is high then it will be conducted at an interval of every 6-12 weeks. Tests on blood pressure will help reduce the risk for hypertension and other cardiovascular risks (Sindone et al., 2013, p.634). Blood lipids will also be measured after every five years to ensure dietary saturated fats are kept at low levels by the aid of lipid levels profile information. Among other nutritional requirements, Harry requires plant-based foods such as fruits, vegetables, pulse and whole grain to maintain his saturated fatty acid levels below 7% and that of the Trans fatty acids to less than 1% of the intake (Davis et al., 2015, p.35). To implement this plan, I will suggest plant produce to substitute for his favourite processed foods. Such a diet is also important in preventing obesity and maintaining health weight.

Harry feels not fit to get back into his physically active life because of hypochondriasis. He has avoided the social sites that could relieve him of his loneliness. These are symptoms for a mental condition. The goals of this plan are to ensure that Harry is socially active and engage in physical activities such as walking and some exercise with the Bowl club. He should continue to tend his rose garden and do some walking around the compound when he feels too weak to walk far distances.

I would also recommend him to a mental healthcare professional at the Central Coast Local Health District to help him with his hypochondriasis situation. Hypochondriasis is the primary reason for his physical inactivity for he feels that the chronic condition he had some time back is not yet recovered. To further aid the alleviation of this condition I would request his son to visit him more often and create more time with him. The visitations would reduce boredom and stress that may have compounded as a result of losing his companion.

If Harry’s condition does not change positively upon the implementation of the PCC and pharmacological therapy, then an assessment for palliative care will be done. Also, it might be vital to consider devices in the management of CHF if the condition continues to deteriorate. Upon consultation and discussion with the cardiologist together with the patient, if necessary cardiac surgery may be recommended. The assessment will be done according to the Central Coast Local Health District guidelines. Lastly, a monitoring strategy to evaluate the effectiveness of the plan will be assessed.

In conclusion, CHF is an essential complex chronic condition that affects quite some Australians. The multiple comorbidities exhibited by patients of CHF are responsible for the escalated budgetary expenditure on managing it. Risk factors such as ageing are evident among the Australian population necessitate for change in policy to reduce the health impacts of CHF and improve health outcomes. The NSW policy on CHF advocates for a multidisciplinary approach to the control of this cardiovascular condition. Besides, PCC improves the general health and aids the recovery process of the patients.  These models of health care provision cut on cost by reducing rates of hospital admissions and readmissions.

References

Atherton, J.J., Sindone, A., De Pasquale, C.G., Driscoll, A., MacDonald, P.S., Hopper, I., Kistler, P.M., Briffa, T., Wong, J., Abhayaratna, W. and Thomas, L., 2018. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart, Lung and Circulation, 27(10), pp.1123-1208.

Chan, Y.K., Gerber, T., Tuttle, C., Ball, J., Teng, T.H.K., Ahamed, Y. and Carrington, M., 2015. Rediscovering heart failure: the contemporary burden and profile of heart failure in Australia. Heart, Lung and Circulation, 24, S446. doi:10.1016/j.hlc.2015.06.773

Chew, D.P., Scott, I.A., Cullen, L., French, J.K., Briffa, T.G., Tideman, P.A., Woodruffe, S., Kerr, A., Branagan, M. and Aylward, P.E., 2016. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Medical Journal of Australia, 205(3), pp.128-133.

Davidson, P.M., Newton, P.J., Tankumpuan, T., Paull, G. and Dennison-Himmelfarb, C., 2015. Multidisciplinary management of chronic heart failure: principles and future trends. Clinical therapeutics, 37(10), pp.2225-2233.

Davis, C.R., Bryan, J., Hodgson, J.M., Wilson, C., Dhillon, V. and Murphy, K.J., 2015. A randomised controlled intervention trial evaluating the efficacy of an Australianised Mediterranean diet compared to the habitual Australian diet on cognitive function, psychological wellbeing and cardiovascular health in healthy older adults (MedLey study): Protocol paper. BMC Nutrition, 1(1), p.35.

Hansson, E., Ekman, I., Swedberg, K., Wolf, A., Dudas, K., Ehlers, L. and Olsson, L.E., 2016. Person-centred care for patients with chronic heart failure–a cost–utility analysis. European journal of cardiovascular nursing, 15(4), pp.276-284.

Heusch, G., Libby, P., Gersh, B., Yellon, D., Böhm, M., Lopaschuk, G. and Opie, L., 2014. Cardiovascular remodelling in coronary artery disease and heart failure. The Lancet, 383(9932), pp.1933-1943.

Hoy, W.E., Mott, S.A. and Mc Donald, S.P., 2016. An expanded nationwide view of chronic kidney disease in Aboriginal Australians. Nephrology, 21(11), pp.916-922.

Kuluski, K., Hoang, S.N., Schaink, A.K., Alvaro, C., Lyons, R.F., Tobias, R. and Bensimon, C.M., 2013. The care delivery experience of hospitalized patients with complex chronic disease. Health Expectations, 16(4), pp.e111-e123.

Sindone, A., Erlich, J., Perkovic, V., Suranyi, M., Newman, H., Lee, C., Barin, E. and Roger, S.D., 2013. ACEIs for cardiovascular risk reduction: Have we taken our eye off the ball?. Australian family physician, 42(9), p.634.Availabe at: <https://elibrary.cclhd.health.nsw.gov.au/centralcoastjspui/handle/1/258> [Accessed March, 27, 2019]

Woodruffe, S., Neubeck, L., Clark, R.A., Gray, K., Ferry, C., Finan, J., Sanderson, S. and Briffa, T.G., 2015. Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Heart, Lung and Circulation, 24(5), pp.430-441.