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Running head: HEART FAILURE
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Health Promotion for Patients with Heart Failure
Angela Ekema and Lisa Sage
Ferris State University
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Abstract
Congestive heart failure is a debilitating disorder which takes the lives of many
individuals daily. Patients being admitted to the hospital with diagnosis of heart failure are
escalading. Education is a major part of the health promotion for these patients. Teaching these
individuals the need to maintain a low sodium diet and monitor for symptoms of heart failure are
some of the educational steps healthcare professionals need to take. Providing them with a scale,
daily log sheets, meal plans, and physical activities to do will help heart failure patients succeed
in survival. There are currently studies which show that life-style changes can decrease the
symptoms of congestive heart failure better than some current medical treatments available.
When life-style changes are unable to stop the progression of heart failure and medication is
need, it may become beneficial for those patients to seek support in daily activities. Some areas
that are available for help include meal preparation, laundry service, and home health aide.
Providing patients with a health promotion plan is a vital tool to those with congestive heart
failure.
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Health Promotion for Patients with Heart Failure
Congestive heart failure (CHF) is a chronic debilitating disorder that has become a major
health problem worldwide. Currently, about five million Americans have heart failure, with
550,000 new cases diagnosed every year (Left Ventricular, 2010). One in five of those new
diagnosed individuals will die within one year of their diagnosis. To survive this condition longterm it is imperative to be compliant with therapy. CHF is not reversible, but it is treatable.
Heart Failure
Congestive heart failure begins when the heart cannot adequately pump blood to vital
organs. This results in fluid backing up into the lungs and the peripheral tissues. The decrease in
blood flow causes a deficit in vital nutrients and oxygen to the body (Ignatavicius, 2006). Many
conditions can lead to heart failure such as high blood pressure, heart attack, congenital heart
defects, valve disease, alcohol abuse, and certain viral infections (Rutledge et al., 2001). Out of
the many causes, the number one cause of heart failure is systemic hypertension.
Hypertension (high blood pressure) is defined as a systolic blood pressure greater than or
equal to 135 mm Hg and or a diastolic blood pressure great than or equal to 85 mm Hg in
individuals who do not have diabetes (Ignatavicius, 2006). The increase in blood pressure causes
the heart muscle to thicken, similar to arm muscles, but the thickening causes the heart to
consume more oxygen. The lack of oxygen causes the body to become hypoxic and it tries to use
other mechanisms to compensate for the decrease. As the left side of the heart begins to fail,
excess fluid builds up in the lungs. Overtime the heart begins to stop beating as forcefully as it
should and symptoms develop. Symptoms can include dyspnea, fatigue, swelling, diuretic related
symptoms, trouble sleeping, difficulty bending over, and cognitive impairment (Rutledge et al.,
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2001). Educating these individuals on the importance of monitoring their blood pressure and
following treatment plans is important for survival of heart muscle.
Health Promotion
Management of Symptoms
Health promotion for a chronic condition such as heart failure is geared towards symptom
reduction and management. According to a study on the effects of chronic illness, selfmanagement of heart failure, there is a 67% decrease in hospital emergency visits and an 87%
reduction in hospitalization rates occurred due to a decrease in daily dietary sodium intake, and
appropriate increase in average daily medication doses (Kennedy-Symonds, 2006). Various
studies have shown that eating a healthy diet low in sodium helps to reduce the symptoms
associated with fluid overload and congestion. When heart failure progresses the reninangiotensin system is activated. This system causes the body to reabsorb sodium through the
kidneys thus increasing the amount of fluid in the body.
Sodium retention and volume overload produce symptoms and physical signs that occur
as a result of the inability to excrete sodium and water. A two liter fluid restriction and a two
gram sodium restriction are common recommendation by physicians. By following these
recommendations, patients decrease the amount of fluid retained by the body. Many people are
also prescribed diuretics (water pills) to help get rid of extra water and sodium. As the diuretics
work, the decrease in extra fluid will reduce the heart's workload. Patients may need to be
instructed on the need to maintain their medications, even if it means using the bathroom in the
middle of the night.
It is important to educate heart failure patients about the need to weigh themselves daily
and report weight increases or decrease to their doctor. If patients experience an increase of more
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than three pounds in two days or a decrease of more than five pounds in three days they need to
see their physician. A log sheet makes it easy to follow the daily progress of heart failure
patients. Informing them that it is important to weight themselves at the same time, every day,
and then to document what their current weight is will help the physician treat their heart failure.
A weight gain of just a few pounds could indicate worsening of their condition.
Implications
Heart disease is the number one cause of death among American’s. For those individuals
who choose to not follow a health promotion plan, they will end up as part of this increasing
statistic. With the increase in individuals living a sedentary life-style and the rise of fast food
consumption, it is no wonder why heart disease is the number one killer.
Those that choose to not treat their heart failure as a chronic condition will only continue
to get worse. Eventually they begin to develop swelling in their extremities and shortness of
breath. The breathing difficulty is due to fluid backing up into their lungs. If left untreated they
become hypoxic and then confused. This ultimately will end in death, but it is unsure as to how
long till the end. These individuals are typically those who choose to not follow a health
promotion plan.
Educating individuals on the need to follow a health promotion plan is imperative to their
survival. If heart failure patients are able to follow a healthy diet and monitor for signs and
symptoms of worsening heart failure, then their life expectancy is in their hands. With use of a
healthy diet, daily weight monitoring, regular doctor’s office visits, exercise, and possible
medications, heart failure patients are able to perform all of their own activities of daily living.
Some even go above and beyond and play sports such as golfing and fishing. With proper care
and treatment, heart failure patients can live normal lives.
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Time For Change
Health promotion is an important component when caring for people with heart failure,
because medical care sometimes is not enough. Beginning in 1979, the Surgeon General's Report
on Health Promotion and Disease Prevention, set broad national goals for improving the health
of all Americans. These reports suggested that major improvements in health could result from
changes in nutrition, physical activity, and personal lifestyle, rather than traditional medical care
(Clark et al., 2006). Now healthcare professionals are integrating health promotion into daily
care.
Health promotion for patients with heart failure should be geared towards counseling
patients on how to initiate or maintain a healthy lifestyle. Healthcare providers should encourage
each patient with heart failure to set realistic goals for healthy lifestyle changes, such as an
increase in safe physical activity, cessation of smoking, and weight reduction if indicated (Clark
et al., 2006). Patients should be given access to resources to help support theses lifestyle
changes.
The purpose of examining heart failure from a nursing perspective is due to the
increasing number of patients admitted to the hospital with this chronic debilitating disease. A
majority of patients with heart failure are admitted because they failed to follow their health
promotion plan. Diet has been found to be the most non adhering recommendation within these
plans. Healthcare workers need to sit down with each patient and set up realistic goals geared
toward that patient. It is easy for doctors or nurses to sit in an office and tell each heart failure
patient what they need to do. The big question is what are they capable of? Many heart failure
patients are on a low, fixed income and can’t afford fresh fruits and vegetables daily. These
individuals may have a hard time adjusting their diet to fit what is needed to stay healthy. They
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might benefit more from a modified diet plan and an addition of different medications. If health
promotion plans are not fitted for each person, then for most it would be considered unrealistic to
even consider.
Individuals with congestive heart failure have a poor prognosis. The disease will never go
away. To stop the progression of the disease, it is important to educate all heart failure patients
on the need to follow proper treatment. For some it could be as simple as a change in life-style,
but for others it might be a need to seek assistance for everyday tasks. The main goal for heart
failure patients is to provide them with as much information and support as needed to maintain
their daily level of function. This can be a difficult disease to have, but with proper treatment the
life expectance can be equal to those without heart failure.
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References
Clark, A., Stuifbergen, A., Gottlieb, N., Voelmeck, W., Darby, D., & Delville, C. (2006). Health
promotion in heart failure -- a paradigm shift. Holistic Nursing Practice, 20(2), 73-79.
Retrieved from EBSCOhost.
Ignatavicius, D., Workman, M. (2006). Medical-Surgical Nursing: Critical thinking for
collaborative care. St. Louis, MO, Elsevier.
Kennedy-Symonds, H. (2006). Managing chronic illnesses. Nursing BC, 38(1), 21-23. Retrieved
from EBSCOhost.
Left Ventricular Assist Device. (2010). Heart Failure Online. Retrieved from
http://www.heartfailure.org/eng_site/whats_new_lvad.asp
Lifestyle Changes for Heart Failure. (2011). American Heart Association. Retrieved from
http://www.heart.org/HEARTORG/Conditions/HeartFailure/PreventionTreatmentofHeart
Failure/Lifestyle-Changes-for-Heart-Failure_UCM_306341_Article.jsp
Rutledge, D., Donaldson, N., & Pravikoff, D. (2001). Patient Education in Disease and Symptom
Management: Congestive Heart Failure. Online Journal of Clinical Innovations, 4(2), 152. Retrieved from EBSCOhost.