Mechanism and of Diuretic Resistance in Congestive Heart Failure, Coursework Example

Introduction

Congestive heart failure is a complex condition that requires continuous evaluation and treatment in order to minimize the long-term risks for patients, as quality of life is a significant issue that must also be considered within this patient population. Patients with CHF may experience such symptoms as severe shortness of breath during physical activity or exertion and also at rest, chest pain, edema in the lower legs and feet that causes uncomfortable swelling and difficulties with sitting for extended periods of time, abdominal pain and distention that lead to discomfort, and nausea/vomiting, among other symptoms (MedicineNet.com, 2015). Nurses are likely to observe patients with CHF in the emergency department, medical-surgical units, doctor’s offices, clinics, and in critical care units, depending on the severity of the symptoms and if any other conditions are present at the time of evaluation. In order to receive optimal treatment for this condition, patients should be hospitalized for observation and medication administration when the symptoms are severe and require some form of treatment. In addition, patients should be monitored upon their release in order to continue to evaluate the condition and to determine if the chosen treatment is having the desired impact on patients. In all cases, pharmacological treatments must be carefully addressed and monitored in order to prevent long-term complications and other health concerns that impact quality of life for this group of patients across different age groups.

Analysis

Congestive heart failure typically requires the use of diuretic therapies as a first line of defense in order to promote greater survival with this chronic condition over a longer period of time; however, additional measures must be considered when these drugs no longer perform at the expected level and when there are unforeseen complications that impact patients in different ways (Nag, Murshed, Chakrabortty, & Rahman, 2011). In other words, patients may not fully experience symptom alleviation only with the use of diuretics, thereby requiring additional pharmacologic therapies in order to alleviate symptoms and to improve quality of life (Nag et.al, 2011). These therapies are often used in combination in order to address and to alleviate the symptoms of CHF, but dosages must be carefully monitored on a continuous basis in order to prevent further complications and medication-related risks for patients (Nag et.al, 2011).

Congestive heart failure is typically characterized by a number of levels of dysfunction, including but not limited to left ventricular systolic dysfunction and heart failure that encompasses preserved LV ejection fraction (Lehne, 2012). The most common pharmacological treatment methods for this condition that are used in different combinations include diuretics, beta blockers, renin-angiotensin-aldosterone system inhibitors (RAAS), and digoxin (Lehne, 2012). Specifically, diuretics are prescribed at a controlled level to reduce blood volume, while RAAS inhibitors are prescribed to address cardiac remodeling, such as “ACE inhibitors, ARBs, direct renin inhibitors (DRIs), and aldosterone antagonists” (Lehne, 2012, p. 554). Finally, digoxin is typically prescribed in order to increase contractile force within the myocardium and subsequent cardiac output (Lehne, 2012). Patients are prescribed one or more of these drugs in conjunction with their current symptoms and health status in order to optimize cardiac function as best as possible and to aim to improve quality of life for this group of patients throughout the life span.

Based upon the specific treatments that are commonly prescribed for CHF, the following observations are made regarding a number of different pharmacological therapies: 1) diuretics such as Lasix and Bumex will typically reduce edema in the legs, accompanied by a low sodium diet and fluid restrictions, but it may also cause frequent urination and potentially complicate social situations when this is a recurring problem for patients; 2) ACE inhibitors will improve survival rates and improve overall cardiac performance in conjunction with other types of treatments; 3) Beta blockers support improved cardiac output and left ventricular ejection fraction in patients; 4) Digoxin also supports cardiac output and overall cardiac performance; and 5) Oxygen support will increased breathing function may be used but may also be uncomfortable in some social situations when a portable oxygen tank must be used in all areas of daily living (MedicineNet.com, 2015). Each of these types of pharmacological alternatives must be fully explored in order to demonstrate their potential benefits for patients and in order to ensure that patients receive all possible opportunities to manage the condition as effectively as possible. Each patient case must be examined individually and address the opportunities that are available to effectively treat patients with medications that have been proven successful in the treatment of this condition.

Interventions for CHF require nurses to be proactive in recognizing the extent of symptoms and to better understand the role of continuous monitoring in addressing these symptoms and the treatments that are prescribed (Emedicinehealth.com, 2015). In addition, nurses must be able to provide support and promote counseling for patients with CHF who experience difficulties in managing the condition, its symptoms, and its impact on their quality of life (Emedicinehealth.com, 2015). For patients with severe restrictions in their activities of daily living, nurses must be a continuous part of the monitoring process and provide patients with the tools and resources that are available to support improved quality of life whenever possible (Emedicinehealth.com, 2015). Nurses, therefore, must possess the knowledge and experience that is necessary to support patients with CHF at all stages, particularly as they work with these patients and their limitations related to the condition and how it impacts patient wellbeing and quality of life. When survival rates are low, nurses must be part of a collaborative process among their peers and with other clinicians in order to address end-of-life care and treatment at this stage, which may involve the use of hospice care in some cases (Emedicinehealth.com, 2015). Nonetheless, at all stages of the condition, nurses must be available to support patients and to provide them with the necessary information and guidance to improve the life span as best as possible. This will ensure that patients understand the role, impact, and possible side effects of their prescribed medications and how they might have a lasting impact on their overall health while managing the impact of the condition.

The treatment of CHF requires a comprehensive approach that is designed to improve patient outcomes and to sustain an acceptable quality of life for as long as possible, using pharmacological therapies, exercise, nutrition, and other resources as a guide (McMurray et.al, 2012). The costs associated with the care and treatment of patients with CHF is high, with an annual cost of approximately $17 billion; therefore, it is necessary for patients to be treated so as to minimize the number of hospitalizations that are required (McMurray et.al, 2012). This requires a continuous evaluation of patients in order to minimize complications and to address possible challenges as quickly as possible (McMurray et.al, 2012). For patients over the age of 65, CHF is one of the most common reasons why these patients are hospitalized; therefore, this requires a continuous evaluation and a greater focus on patients in order to prevent this need as best as possible (Hall, Levant, & DeFrances, 2012).

Conclusion

Congestive heart failure is a challenging condition that requires ongoing treatment in different forms in order to accomplish the desired objectives in maintaining quality of life for these patients. It is necessary for patients to receive a combination of therapies that will have a lasting impact on their overall health and wellbeing, and this is best accomplished by using a comprehensive approach that will utilize a combination of proven pharmacological treatments, exercise, nutrition, and other therapies in order to improve the lives of this patient population. This combination of resources is necessary to minimize the need for hospitalizations and to be effective in meeting patient needs without the risk of additional complications that could minimize quality of life.

For patients with CHF, it is important to demonstrate that their comprehensive needs ae a critical priority and that pharmacologic treatments must be identified and explored with the knowledge and resources that nurses have in this area. This encourages the development of strategies for nurses to work collaboratively with patients and with other clinicians to explore different types of treatments to improve patient care outcomes. This process is ongoing and requires nurses to strengthen their knowledge of CHF pharmacologic therapies so that patients are able to benefit from these treatments on a continuous basis and also be evaluated accordingly when their needs change. This process supports the improvement of patient care and treatment in an effort to minimize symptoms and any complications that may arise from the use of pharmacologic therapies under specific conditions. This practice is essential to the discovery of new ideas and strategies for nurses to work with patients, communicate any concerns that may arise, and aim to address and to alleviate symptoms as much as possible. Nurses must be apprised and communicate with patients on a regular basis and when they are examined in the emergency department or in another setting when necessary. Therefore, nurses’ knowledge of pharmacologic therapies is essential and requires their full input and understanding of CHF so that patients receive the most accurate information regarding the condition and the complications that may emerge.

References

Emedicinehealth.com (2015). Congestive heart failure. Retrieved from http://www.emedicinehealth.com/congestive_heart_failure/article_em.htm

Hall, M. J., Levant, S., & DeFrances, C. J. (2012). Hospitalization for congestive heart failure: United States, 2000–2010. age, 65(23), 29.

Joynt, K. E., Orav, E. J., & Jha, A. K. (2011). The association between hospital volume and processes, outcomes, and costs of care for congestive heart failure. Annals of internal medicine, 154(2), 94-102.

Lee, J. H., Jarreau, T., Prasad, A., Lavie, C., O’Keefe, J., & Ventura, H. (2011). Nutritional assessment in heart failure patients. Congestive Heart Failure, 17(4), 199-203.

Lehne, R.A. (2012). Pharmacology for Nursing Care, 8^th Edition. Saunders.

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., … & Ben Lamin, H. A. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.

MedicineNet.com (2015). Congestive Heart Failure (CHF) overview. Retrieved from  http://www.medicinenet.com/congestive_heart_failure_chf_overview/page6.htm#what_is_the_treatment_for_congestive_heart_failure

Nag, D. C., Murshed, A. K. M., Chakrabortty, R., & Rahman, M. R. (2012). Mechanism and of diuretic resistance in congestive heart failure.Journal of Dhaka National Medical College & Hospital, 17(1), 44-46.