Question

Present a comprehensive overview of case management strategies for the client with heart failure.

Discuss aspects of medications, diet, lifestyle, and activities of daily living that can be addressed by the case manager.

What referral services would be helpful for clients with heart failure. Identify the case management goals.

Answer 1

• Heart failure is a chronic condition in which the heart doesnot pump blood.
• It can occur if the heart cannot pump or fill adequately.
• Case management is the process of coordinating , planning and reviewing yhe case of an individual.
• At home is one of the case management strategy for care of elderly patient with heart failure.
• Othe components are:
  • Regular contacting with the patient by case manager.
  • At home monitoring of symptoms.
  • Patient should take the medication and treatment protocolwhen symptoms arise there should be anticipatory Medicicare planning.
  • Care coordination should be done.
  • Acute and chronic condition should be monitored properly.

The goal of management of heart failure us to relieve yhe symptoms of patients with heart failure and improve the quality of life for their survival.

Medication management :

• ACE inhibitors:
  • Slows the progress of heart failure.
  • Vasodilator
• Angiotensin 2 receptor blocker:
  • Blocks the conversion of angiotensin 1 to angiotensin 2.
  • Decrease blood pressure
  • Improve cardiac output.
• Beta blockers:
  • Decrease the adverse effect from sympathetic nervous system.
• Diuretic:
  • To remove excess extracellular fluid
• Calcium channel blockers:
  • Vasodilator
  • Contraindicated in patient with systolic heart failure.

Diet Management :

• Limiting caffeine -- not more than a cup or two.
• Daily fluid intake
• Healthy diet which includes fruits, vegetables, whole grains, low fat dietary products, skinless poultry and fish, nuts and legumes, and non tropical vegetables oils.
• Saturated fat, trans fat, cholesterol, sodium, red meat , beverages and sweets should be limited.

Life style:

• Quiting smoking ---- as nicotine puff from smoke increase heart rate temporarily.
• Avoid alcohol
• Maintaining weight --- sudden gain or loss may be a sign of developing heart failure
• Decrease stress

Daily activities:

• 30 mins walk for at least 5 days /week, 2 hours and 30 min/week for moderate intensity.

Referral services:

• Clinical
  • Increase diuretic requirements
  • Inability to perform CPET
  • Cachexia, unintentional weight loss.
  • >1heart failure hospitalised in past year.
• Lab
  • eGFR <45ml/min
  • K> 5.2 or < 3.5 mmol
  • Hyponatremia
  • Low albumin
• Imaging
  • Large area of akinesis/ aneurysm.
  • RV dysfunction
  • PA pressure >= 50 mm Hg
  • Difficult to grade aortic stenosis.

Goals

• Large quality should be improved.
• Patient functional capacity and quality of life should be increased.
• Cost reduction
• Satisfaction of patient increases.
• Hospital admission/ readmission decreases

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