As American Heart Month comes to a close, we want to bring light to a common form of heart disease in the elderly; congestive heart failure. The American Heart Association reports that in the U.S., congestive heart failure (CHF) is the leading cause of hospitalization in people over the age of 65. To improve the effectiveness of care for those with CHF, we not only react and intervene at Mitchell-Hollingsworth when one becomes ill, but we also proactively focus on keeping patients as healthy as possible to prevent unnecessary hospital admissions.
We identify those most at risk for hospitalization and target our efforts to improve outcomes. Risk factors for CHF may include:
A hospital admission (non-elective) during the last 12 months
Admission to the emergency room for cardiovascular symptoms during the last 12 months
Prescriptions for more than nine medications
Diagnosis of diabetes, chronic skin ulcers, pressure ulcers, or COPD
Signs of dyspnea or edema
Non-ambulatory or ambulating only short distances
Assistance with activities of daily living
Nutritional concerns identified on assessment
Individuals identified with three or more of these risk factors can alert the need of a more focused interdisciplinary approach for CHF disease management.
Effective management of CHF requires monitoring and responding to symptoms on a regular basis. Care plans developed with the individual and primary care providers identify when additional assessments and interventions need to be done (lung assessment, administration of oxygen, medications, etc.). Management of CHF requires regular assessments which include:
A review of weight and weight trends
Blood pressure, pulse, respiratory rate
Lung assessment/ breath sounds in all lung fields
Presence of jugular vein distention
Peripheral edema: location and grade
Abdominal assessment that includes measurement of girth and presence of pain/tenderness in upper right quadrant
Oxygen saturation level with activity and at rest
Nail bed color and capillary refill
Presence of dyspnea including paroxysmal nocturnal (note number of pillows, sleeping in recliner, need for elevation of head of bed.)
Review of medication use including PRN
Urine output or voiding pattern changes
Regular exercise and activity are important in CHF management to maintain or increase muscle tone, increase heart function, and improve energy. Therapy staff assists in assessing a current level of function and exercise, identifying goals, and developing exercise and activity plans to meet goals while increasing or maintaining strength and function. In collaboration with the dietician and the individual, a specific diet plan is also developed that includes education and identification of diet and nutritional needs.
Working together with residents, rehab patients, their families, the facility interdisciplinary team, and other care providers will improve the effectiveness of the care and services we provide. Having a plan that demonstrates positive outcomes and satisfaction are also key for ensuring our part in care delivery.