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Chronic Disease Health Promotion and Maintenance for adults age 35–65

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Chronic Disease Health Promotion and Maintenance for adults age 35–65

Heart failure is one of such chronic illness that requires collaborative and comprehensive care. Chronic heart failure is defined as a progressive and debilitating disease. The management of a patient with chronic disease from hearth failure demands non-pharmacologic, pharmacologic, and invasive procedures, depending on the context and the necessity of the intervention. Interventions in chronic heart failure intend to promote and restore the quality of life.

Chronic heart failure (CHF) requires evidenced-based management. The evidenced-based intervention has been associated with long-term survival in patients with heart failure, but there are unintended consequences regarding increased longevity (Alpert et al., 2017). The unwanted consequence revolves around the increasing burden of symptoms. It is not only typical symptoms like dyspnea and edema, which patients with HF suffer from, but also other symptoms that include pain, fatigue, gastrointestinal disturbances, and depression, and this symptom when untreated impacts negatively in the quality of life. The HF symptoms account for hospitalizations, emergency departments’ visitation, morbidities, and mortalities.

Chronic heart failure management is approached from two fundamental strategies, i.e., comprehensive symptom assessment and adequate knowledge about the available interventions of mitigating the symptom (Alpert et al., 2017). CHF management is addressed holistically, where it is not only about physical treatment but also must extend to include emotional, social, and spiritual interventions.

Healthcare providers should strive to educate patients on symptom recognition and subtle changes. Significant involvement of the patient should be encouraged in symptom recognition, and the patient’s symptom diary can aid the patient track any changes. The older or senior patients with existing comorbidities may express declining cognitive dysfunction, which makes them fail in the interpretation of symptoms; this may require more family involvement that is combined with more clinical engagements to identify nonverbal cues associated with suffering (Alpert et al., 2017).

Various tools are designed for assessment. One example of the assessment tool is the Edmonton Symptom Assessment Scale (ESAS), which is effective and efficient: ESAS is composed of ten-question symptomatic evaluation to assess the level of distress associated with pain, nausea, fatigue, depression, anxiety, sleepiness, dyspnea, appetite, anxiety, and any other symptom on a scale of 1-10. Another example is the measurement of the severity of the disease biomarkers, e.g., B-type natriuretic peptide) and NT-proBNP (N-terminal pro-B-type natriuretic peptide), to establish the diagnosis and prognosis (Yancy et al., 2017)

Pain is troublesome in CHF patients. Pain contributes to suffering, and this requires urgent improvement. Patients with pain show lower medication adherence, worse self-care, and are more likely to get depression and anxiety, leading sleeplessness, anxiety, fear, declined cognitive functioning, hopelessness, suicidal ideation, and more hospitalization (Alpert et al.,2017). Arguably, pain is cardiac, or angina pain is controlled by both pharmacologic and revascularization approaches, but some analgesics are contraindicated in HF patients (Alpert et al., 2017). Furthermore, there are effective adjuvants in the pain control that are non-pharmacologic, and they include acupuncture, physical therapy, music, mindfulness-based stress reduction, and exercise, among others. According to Alpert et al.,(2017), non-steroidal anti-inflammatory drugs are contraindicated in a patient with HF because they increase the risk of fluid retention, gastrointestinal, bleeding, and kidney injury. Acetaminophen and topical lidocaine preparations are promising in control of neuropathic pain, and opioids medication like Tramadol, oxycodone, hydromorphone, and fentanyl are, have shown satisfactory be safety levels and effectiveness (Alpert et al., 2017).

Non-pharmacologic approaches can be implemented based on the severity of the HF, and these measures include fluid restriction, dietary sodium reduction. The common pharmacological interventions involve the use of diuretics, beta-blockers, digoxin, anticoagulants, and vasodilators. Invasive interventions can be done, which include cardiac resynchronization therapy (CRT), use of implantable cardioverter-defibrillators, coronary artery bypass grafting (revascularization procedure), ventricular restoration, valve replacement, and percutaneous coronary intervention, among others.

Dyspnea is breathlessness that causes discomfort in breathing, and this symptom explains many visitations to the emergency departments. Supplemental oxygen can remedy dyspnea but is not more superior to ambient room air at rest, but may prove beneficial during exertion. Breathlessness can resolve if it is treated suitably; non-pharmacological approaches such as oscillating fans and open windows can help address the problem of dyspnea.

Depression in CHF patients must be recognized and addressed. It is challenging to diagnose depression, but the heightened suspension of depression can occur when there are worsening symptoms of fatigue, dwindling appetite, and sleep disturbances, among others. Psychotherapy can be complemented by antidepressants like selective serotonin reuptake inhibitors (SSRIs) (Alpert et al., 2017).

Gastrointestinal disturbances like nausea, anorexia, and constipation can be managed to improve the quality of life. Phenothiazines, stool softeners, osmotic laxatives, and Dronabinol, can be used to manage gastrointestinal problems (Alpert et al., 2017).

The CHF patients and their families undergo stress and suffering related to disease experience. Palliative care is a potential intervention to address suffering from HF, and improve the quality of life, regardless of the prognosis. A lot has not been learned on palliative care in the context of CHF patients, but the evidence is quite promising that palliative care through physical, emotional, and advanced care planning interventions may help in addressing unmet palliative care needs (Kavalieratos et al., 2017). Healthcare providers and patients with HF must share responsibility for the development of assessment and reporting tools of symptoms. Findings indicate that patients with severe symptoms are the most unlikely to visit clinics, and this observation may indicate a mismatch between providers and patients in urgent need of care (Alpert et al., 2017).


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