Congestive Heart Failure Nurs 480 Family Assessment Visual Report
Katrina Wilson | Benson Baldovi | Chhay Tea | Seong Rhee Kathryn Mae Villamor | Maria Manghiuc | Jessie Chen Nguyen
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What is CHF? - - - - X
Congestive heart failure (CHF) is a condition
where the heart is unable to pump enough blood to meet the body’s needs. CHF causes blood and fluids to back up and accumulate around the lungs and other parts of the body leading to shortness of breath and edema. Symptoms include: ●
Shortness of breath/ difficulty breathing
●
Feeling tired and fatigued
●
Swollen ankles or feet
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Distended neck veins
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Chronic coughing/ wheezing
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The Patient - - - - X
John Pierce is a 56 year old male who was
recently
diagnosed
with
CHF.
He
noticed
an
increase in shortness of breath while working and decided
to
see
his
primary
doctor
when he had
difficulty breathing while lying down.
He lives
in a home with his wife and 2 teenage children
The Family - - - - X
Sherry, 46; Wife Jason, 19; Son Mary, 17; Daughter
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Culture - - - - X Culture refers to the “behaviors and beliefs that characterize a particular group of people, society or nation” (Denham et. al, 2016, p. 143). The Pierce family is a Caucasian, American, Catholic family who lives in a suburban West Coast city. Sherry is a stay-home wife and mother, who prepares the family’s meals, manages the household chores, and takes care of the needs of the family. Mary plays in her high school’s volleyball team and spends after school hours practicing. Jason is in college and works part-time during the night at a restaurant 3-4 times a week. He drops his sister to high school on his way to school, and on his free days he chauffeurs his mother on errands or he goes out with his friends. -Kathryn
Religious Traditions - - - - X
The family attends Church mass every Sunday mornings and spends the rest of the day together doing activities such as watching movies, going to the park or to the beach, and bowling. They also do Sunday brunch with relatives and friends once a month. -Kathryn
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Strength - - - - X Family strengths are the relationship between each family member. Each person can be main biological support for each other such as his wife could be a main supporter in this case. Also spiritual support also could be an important part to have them overcome the current situation. As his condition has led to change in both family dynamic as well as family’s development.Community church or group support also are the great resource for questions and education in term of help with maintain his condition. Emotional support- his wife and children could have him monitor his blood pressures each day, encourage him to adherence with current diet. His wife could involve more in economic resources such as getting a new job to reduce some of his current stressors. JESSE
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Challenges - - - - X The Pierce family was considered a traditional family dynamic with consist of two school age children. The son is at 19 yo that is the age of going off to college and it can’t be closer to the family. The daughter is at 17 and almost time for college as well. Mr John is the primary financial support for this family, so his new found condition- CHF could prevent him for provide both in term of finance as well as the insurance in this case. At this time, His heart condition could be the trigger point to turn his family from Stability to crisis condition. JESSE
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Communication Practices - - - - X
Communication is essential to relaying biomedical
information and helping families with self-care or care management. John, Sherry, Jason, and Mary have good relationships. They talk openly about their daily activities over dinner and solve problems together. John is starting to feel a little depressed and feeling guilty of being ill resulting in having less time with the family. Mary who used to be a cheerful teenager, is now worrying about her father and wanting to spend more time with him and misses the time she spends shopping or bonding with her mother. Jason, due to working many night shifts, has been missing dinner time with the family and is always tired when he gets home leading to a decrease in family communication and time. -​ Kathryn
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Family Systems Theory According to The family System Theory developed by Dr.
Murray Bowen, “individuals cannot be understood in isolation from one another, but rather as a part of their family, as the family is an emotional unit. Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system.” (Entering, n.d.) Concepts: 1. All parts of the system are interconnected ●
JP diagnosis with CHF greatly affects the entire family: Sherry might need to start looking for employment;
Jason- might need to take on more
responsibilities around the house; Mary-might need to become more independent and maybe even take on the caregiver role .
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Family Systems Theory
2. The whole in more than the sum of its parts ● The family might have to change some
of their
traditions and daily routines in order to accommodate for JP condition, and come to the realization that their life as a family has been changed in a permanent way 3. All systems have some form of boundaries aor borders between the system and its environment ● Open boundaries: accepting help and assistance form extended family and church members 4. Systems can be further organized in subsystems ● Husband- wife: JP- Sherry ● Parent-child: JP- Jason; JP- Mary ● Siblings: Jason-Mary
- Maria Manghiuc
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Problems - - - - X
Increased financial strain Due to increased weakness and fatigue JP had to miss a lot of work days, and his doctor is not sure that he can go back to his normal schedule. This place a great financial strain on the family since JP is the sole provider for his family. Increased burden on the family JP’s wife takes care of their children and the household. Now she might need to find employment in order to compensate for the lost income, this mean that Jason and Mary would have to become more independent, take on more household responsibilities, and even become caregivers for their father when their mother is at work. Mary might not be able to keep up with her volleyball schedule and Jason might have to work more hours, and spend less time with his friends.
SHerry would have
to find a way to balance her time between work, children, household and caregiver. - Maria Manghiuc
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Application of Family Theory Evidence-Based Interventions (Seong Rhee) - - - - X
1. Medication - Researches show that taking proper medications is proven to reduce the number of readmission to the hospital because of CHF (Krive et al, 2014). ○ ACE inhibitors dilate blood vessels and decrease sympathetic tone. ○ Hydralazine and nitrates reduce vascular resistance, ○ Digoxin increases the contractility of the left ventricle. 2. Exercises for CHF Increases quality of life and functional improvements (Kim, & Hae-Ra, 2013) ○ Exercise can produce significant and lasting changes in quality of life. 3. Diet ○ ○ ○
- Reduce sodium in the meal (AHA, 2016) Choose plenty of fresh fruits and vegetables. Choose foods that are low in salt. Season with herbs, spices, vinegar and fruit juices.
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4. Education ○ sign and symptomsRight sided CHF
Left sided CHF
Murmurs Jugular vein distention Edema Weight gain Increase heart rate Acites Fatigue Anxiety, Depression Nausea
Increase heart rate PMI displaced inferior Crakeles Pleural Effusion Changes in mentality Restless, confusion Weakness, fatigue Anxiety, Depression Dyspnea Orthopnea Nocturia Frothy pink sputumn
(Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011) ○ health management- Measure daily weight, obtain vaccination, plan regular daily rest, increase physical activity gradually, avoid extreme heat or cold (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011)
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Developmental Stages ​Chhay Tea Individual Development Stage John Pierce (56)- Generativity vs. Stagnation (adulthood) Sherry (46)- Generativity vs. Stagnation (adulthood) Jason (19)-
Intimacy vs. Isolation (young adult)
Mary (17)- Ego Identity vs. Role confusion (Adolescence)
Generativity vs. Stagnation During middle adulthood (ages 40 to 65 yrs), we establish our careers, settle down within a relationship, begin our own families and develop a sense of being a part of the bigger picture.
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Developmental Stages Generativity vs. Stagnation (Continuation)
We give back to society through raising our children, being productive at work, and becoming involved in community activities and organizations. By failing to achieve these objectives, we become stagnant and feel unproductive. Success in this stage will lead to the virtue of care. (McLeod, 2013)
Intimacy vs. Isolation Occurring in young adulthood (ages 18 to 40 yrs), we begin to share ourselves more intimately with others. We explore relationships leading toward longer term commitments with someone other than a family member. Successful completion of this stage can lead to comfortable relationships and a sense of commitment, safety, and care within a relationship. Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression. Success in this stage will lead to the virtue of love. (McLeod, 2013)
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Developmental Stages Identity vs. Role Confusion During adolescence (age 12 to 18 yrs), the transition from childhood to adulthood is most important. Children are becoming more independent, and begin to look at the future in terms of career, relationships, families, housing, etc. The individual wants to belong to a society and fit in. This is a major stage in development where the child has to learn the roles he will occupy as an adult. It is during this stage that the adolescent will re-examine his identity and try to find out exactly who he or she is. Erikson suggests that two identities are involved: the sexual and the occupational. According to Bee (1992), what should happen at the end of this stage is “a reintegrated sense of self, of what one wants to do or be, and of one’s appropriate sex role”. During this stage the body image of the adolescent changes. Erikson claims that the adolescent may feel uncomfortable about their body for a while until they can adapt and “grow into” the changes. Success in this stage will lead to the virtue of fidelity.
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Developmental Stages Identity vs. Role Confusion (Continuation)
Fidelity involves being able to commit one's self to others on the basis of accepting others, even when there may be ideological differences. During this period, they explore possibilities and begin to form their own identity based upon the outcome of their explorations. Failure to establish a sense of identity within society ("I don’t know what I want to be when I grow up") can lead to role confusion. Role confusion involves the individual not being sure about themselves or their place in society. In response to role confusion or i dentity crisis an adolescent may begin to experiment with different lifestyles (e.g. work, education or political activities). Also pressuring someone into an identity can result in rebellion in the form of establishing a negative identity, and in addition to this feeling of unhappiness. (McLeod, 2013)
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Developmental Stages Family Development Stage Family with adolescenttasks
Situational needs that alter transitions
Loosening family ties Couple relationship Parent-teen communication Maintenance of family morals and ethical standards Promote safe sexual development
Continued dependency may means children never achieve leaving home Family examines how to continue family life with increasing physical growth but ongoing dependence of children High-risk behavior related to sexual activity and drugs
(Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015)
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REFERENCES: - - - - X
American Heart Association (AHA). (2016). Congestive heart failure and congenital defects. Retrieved from http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDef ects/TheImpactofCongenitalHeartDefects/Congestive-Heart-Fai lure-and-Congenital-Defects_UCM_307111_Article.jsp#.WANd5eT rumQ Entering, B. (n.d.). Family systems theory. Retrieved from http://www.genopro.com/genogram/family-systems-theory/. Kaakinen, J.R., Coehlo, D.P., Steele, R., Tabacco, A., & Hanson, S.M.H. (2015). Family health care nursing: Theory, practice, and research. Philadelphia, PA: F.A. Davis Company. Kim, S. M., Hae-Ra, H. (2013, April). Evidence-based strategies to reduce readmission in patients with heart failure. Journal for Nurse Practitioners, 9(4), 224-32. doi:http://dx.doi.org.ezproxy.csusm.edu/10.1016/j.nurpra.20 13.01.006 Krive, J., Shoolin, J. S., & Zink, S. D. (2014). Effectiveness of evidence-based congestive heart failure (CHF) CPOE order sets measures by health outcomes. US National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419927/
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REFERENCES: - - - - X
Lewis, S. M., Heitkemper, M. M., Dirksen, S. R., Bucher, L., & Camera, I. M. (2011). Medical-surgical nursing: Assessment and management of clinical problems. St. Louis: Mosby. McLeod S.(2013). Erik erikson. Retrieved from http://www.simplypsychology.org/Erik-Erikson.html MedlinePlus. (2016). Heart failure. Retrieved from https://medlineplus.gov/heartfailure.html