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Related Concept Videos

Heart Failure VII: Nursing Interventions01:30

Heart Failure VII: Nursing Interventions

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The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
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Heart Failure VI: Adjunct Therapies01:22

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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Heart Failure V: Medical Management01:30

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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Mitral Regurgitation IV: Nursing Management01:28

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Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
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Cardiomyopathy VI: Nursing Management01:29

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Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...
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Focusing involves centering a conversation on a message's critical elements or concepts. Focusing is valuable if the talk is vague or patients begin to repeat themselves. Sometimes, when patients are asked about their symptoms, they may go off-topic and try to tell their entire life story. Respectfully, the nurse should bring the conversation back into focus.
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Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
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Improving Communication in Heart Failure Patient Care.

Nathan E Goldstein1, Harriet Mather2, Karen McKendrick2

  • 1Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York.

Journal of the American College of Cardiology
|September 28, 2019
PubMed
Summary
This summary is machine-generated.

Clinician education improved discussions about deactivating implantable cardioverter-defibrillators (ICDs) in heart failure patients nearing end of life. This intervention increased deactivation conversations, especially for those not eligible for advanced therapies.

Keywords:
communicationheart failureimplantable defibrillatorpalliative care

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Area of Science:

  • Cardiology
  • Medical Ethics
  • Palliative Care

Background:

  • Implantable cardioverter-defibrillators (ICDs) prevent sudden cardiac death but may deliver shocks to dying heart failure (HF) patients.
  • Discussing ICD deactivation at end-of-life is crucial to prevent unwanted shocks and align care with patient goals.

Purpose of the Study:

  • To evaluate if a clinician-centered teaching intervention and automatic reminders increase discussions and deactivation of ICDs.
  • To assess the impact on goals of care conversations and advance directive completion.

Main Methods:

  • A 6-center, single-blinded, cluster-randomized controlled trial involving 525 advanced HF patients with ICDs.
  • Intervention group received clinician education and reminders; control group did not.
  • Primary outcomes: ICD deactivation discussions and device deactivation. Secondary outcomes: goals of care conversations and advance directive completion.

Main Results:

  • No overall difference in ICD deactivation discussions or deactivation between groups.
  • However, the intervention significantly increased deactivation discussions in patients not candidates for advanced therapies (25% vs. 11%).
  • Goals of care conversations increased in the intervention group (47% vs. 38%).

Conclusions:

  • The intervention successfully increased conversations about ICD deactivation and goals of care among HF patients.
  • Clinicians adapted communication strategies based on patient illness severity.
  • Further research may be needed to optimize deactivation discussions for all HF patients.