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NURS 480 Visual Presentation, Group 15
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Transcript of NURS 480 Visual Presentation, Group 15
Chronic
Family
Congestive
Heart
Failure
Created By:
CSU, San Marcos
NURS 480
Dr. Phinney
Rachelle Mendoza-Galapin (Team Leader)
Cammie Huynh
Daniel O’Kelly
Kevin Blas
Michelle Lin-Park
Guadalupe Ornelas
Vena Valdez
DESCRIPTION OF CONDITION:
● New York Heart Association (NYHA) classification of
Congestive Heart Failure (CHF), Class II for the past 3 years
● Class II: Displays slight limitation of physical activity
that can lead to fatigue, dyspnea, palpitations (Lewis et
al., 2014)
● CHF: Impair cardiac pumping/filling that result in volume
overload. It decreases in contraction, stroke volume, and
cardiac output of the heart (Lewis et al., 2014).
COMPLICATING FACTORS, CHRONICITY, & COMORBIDITIES:
● Dyslipidemia
● Hypertension
● Angina
● One stent to the left anterior descending artery inserted
2015
● Hypothyroidism
CASE SELECTION: 69 year old Chinese-American woman named A.B.
ALLERGIES: No Known Food or Drug
Allergies
MEDICATIONS:
● Lipitor 20 mg daily
● Aspirin 100mg daily
● Coreg 3.125 mg twice a day
● lisinopril 10 mg daily
● Lasix 10 mg daily.
Explanation of NYHA Classifications
Class Symptoms
I No physical limitation to activity. No fatgue
or dyspnea.
II Slight limitation to physical activity.
Regular physical activity causes fatigue,
palpitation, dyspnea.
III Increased limitation during physical
activity. Activity less than regular actions
induces fatigue, palpitation, dyspnea.
IV Cannot participate in any physical activity.
Experiences symptoms of heart failure at
rest. Any physical activity can cause
discomfort.
Class Objective Assessment
A No objective symptoms of cardiovascular disease
presented. No physical limitation.
B Minimal objective symptoms of cardiovascular
disease noted. Slight limitations during regular
activity observed. No symptoms at rest.
C Moderate symptoms of cardiovascular disease noted.
Both regular and physical activities can cause
moderate symptoms. No symptoms at rest.
D Severe cardiovascular disease symptoms observed.
Highly limiting symptoms are noted during rest and
physical activity.
DESCRIPTION OF A..B.’s CONDITION
● Performs IADLs & ADLs without restriction
● Is a homeowner, divorced, lives independently, & is retired but used to own a pet store in
which she ran for the past 30 years
● Enjoys preparing healthy meals at home, shops regularly at the farmer’s market for organic
fresh produces & drinks one to two cups a coffee/day
● Denies alcohol or tobacco use
● Religious affiliation is identified as Catholic, but only attends masses on certain
holidays & occasions
● Maintains close friendships with family & small circle of friends, & attends their social
events
CARE-RELATED ISSUES
● Concerns over her health and is afraid of getting cancer and debilitating illnesses.
● Expresses worry over her son, F.B.’s personal difficulties
TREATMENT COMPLIANCE
● Compliance with the medical regimen prescribed. Sees a cardiologist three
times/year & makes appointments as needed for her cardiovascular medical
complexities
● Has a primary physician she visits once a year & receives prophylactic care &
follow-up based on her needs
● Keeps regularly scheduled appointments with her dentist and optometrist
● Has Medicare part C and D & private health insurance
● Is proactive about her health & seeks information related to her diagnoses
DESCRIPTION OF FAMILY, DEVELOPMENTAL STAGE & FUNCTIONS
MOTHER
● A.B. lives with 90-year old mother K.B. who has controlled hypertension, but otherwise healthy &
independent
● Has two small dogs and three cats & walks her dogs four to five times/week for 20 minutes for exercise
CHILDREN
F.B.
● 30 year-old son who is single & graduated college with a Baccalaureate of Science degree in Criminal
Justice, and works as a legal assistant
● Currently going through personal difficulties & is not able to provide A.B. with emotional or financial
support
● A.B. communicates with him on a regular basis at least two to three times a week & visits once a month
L.B.
● 41-year old daughter who is married & lives three hours away in Ventura County
● A.B. closest to her out of all her children providing her the emotional support that
she needs with visits once every two months & contact with her through the telephone
four times/week
● Employed as Registered Nurse, A.B seeks her professional advice in regards to all her
medical/health-related matters
● Has one son who currently attends college & lives at home with his significant other
M.B.
● 35-year old, middle daughter who lives one-hour away in Orange County
● Currently uninvolved in family affairs and has not spoken to A.B. in about three years
● Marital status is single, works part-time at local convenience store & is a full-time student pursuing her
doctorate in education
RELATIONSHIPS AMONG FAMILY MEMBERS
● All her children are in direct communication with each other through phone calls, texts & visits keeping
each other updated on family events.
● Mrs. A.B is compliant with her medical treatment. She sees a cardiologist three times a year and makes
appointments as needed. She has a primary physician she visits once a year and as needed. She keeps
regularly scheduled appointments with her dentist and optometrist. She has Medicare part C and D, health
insurance. She attends all appointments by herself. She seeks to learn information about her illness and
maintains optimal health.
● Mrs. A.B at times expresses concerns over her health and is afraid of getting cancer and debilitating
illnesses. She expresses anxiety over her son’s F.B, personal difficulties.
CULTURAL & RELIGIOUS TRADITIONS
CHALLENGES
● Estranged from youngest daughter for 3 years
● Son unavailable for emotional and financial support due to
personal difficulties.
COMMUNICATION PRACTICES
● Eldest daughter and son communicate directly with patient.
● Youngest daughter receives information from siblings; no
contact with patient.
APPLICATION OF FAMILY NURSING THEORY:
CHRONIC CARE MODEL
PROBLEMS● Anxiety related to fear of debilitating
disease
● Estranged from her daughter M.B. for years of
no contact.
● Caregiver burden, 90 yr old mother and 30 yr
old son live at home.
● Stress over adult son’s personal difficulties
EVIDENCE-BASED INTERVENTIONS (PART I OF II)
● Diuretics to decrease volume overload
● ACE inhibitors to reduce preload
● Digoxin to increase myocardial contractility
● Insertion of left ventricular assist device in later stages
● Beta Blockers for patients with left ventricular dysfunction
● Stent/Angioplasty considered when cause of CHF is CAD
● Lifestyle changes (i.e. reduce sodium intake, weight loss, stress
reduction)
● Encourage family to continue practicing open communication
style by sharing thoughts and expressing feelings to adapt and
normalize the chronicity of illness
●
●
EVIDENCE-BASED INTERVENTIONS (PART II OF II)
● Listen to the family story
● Reflect on the family’s needs and concerns
● Collaborate by offering ideas to assist with sharing of
responsibilities within the family
● Coordinate care to ensure gaps and duplication of care are avoided
● Identify competing needs or plans within family tasks to reduce
risks of treatment errors and poor outcomes
● Help to integrate the new family health routines
● Allocate essential resources to address needs
● Collaborate in setting attainable goals to achieve effective
outcomes
EFFECT ON FAMILY
● Caregiver burden is a prominent outcome for family members.
● Social support from family and friends are strongly associated
with decrease readmissions & increase medication compliance.
● Research indicates family has overall positive impact on family
regarding family health maintenance and health promotion
behaviors (Dunbar et al 2009).
● Living alone and social isolation with CHF is linked with
increased mortality and morbidity (Dunbar et al 2009).
Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2016). Family-focused nursing care. Philadelphia, PA: F.A. Davis Company.
Dunbar, S., Clark, P., Quinn, C., Gary, R., & Kaslow, N.(2009).Family influences on heart failure self -care and outcomes.Journal of
Cardiovascular Nursing, 23(3).
Heart.org.(2015) Classes of Heart Failure. Retrieved April 19, 2016 from ww.heart.
org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp
Kee, J., Hayes, E., & McCuistion, L. 2015). Pharmacology: A patient centered approach (8th ed.). St. Louis, MO: Elsevier & Saunders.
Lewis, S.M., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems (9th ed.). St. Louis: Mosby.
[Thats All Folks Online Image]. Retrieved April 13, 2016 from http://2.bp.blogspot.com/_7OeU3GAGUBI/S9DZdiChuoI/AAAAAAAAACE/-
CJ6H_oL2Ck/s1600/thats%252Ball%252Bfolks.jpg
[Untitled heaven and hell sign online image]. Retrieved April 13, 2016 from https://images4.alphacoders.com/712/71264.jpg
[Untitled Waving Nurse Illustration]. Retrieved April 13, 2016 from http://images.clipartpanda.com/nurse-clipart-nurse9.png
[Untitled heart attack illustration]. Retrieved April 5, 2016 from http://images.easyfreeclipart.com/871/showing-20-pics-for-
heart-attack-cartoon-871595.jpg
[Untitled wooden valentine heart online image]. Retrieved April 19, 2016 from http://www.skipprichard.com/wp-
content/uploads/2014/10/bigstock-Red-Heart-On-Wooden-Background-56485448.jpg
References
References (con’t)
[Untitled Understand HF online image]. Retrieved April 19, 2016 from http://www.heart.org/idc/groups/heart-
public/@wcm/@hcm/documents/image/~extract/UCM_477289~1~staticrendition/large.png
Zhu, L., Ho, S. C., & Sit, J. H. (2012). The experiences of Chinese patients with coronary heart disease.Journal of Clinical Nursing, 21
(3/4),476-484. doi:10.1111/j.1365-2702.2011.03909.