preload and afterload through vasodilatation.
Side effects include chest pain, angina, headache,
thrombocytopenia and lowered potassium levels.
It is important to monitor labs, vitals, and daily
weights while receiving this medication.
Heart failure is reported to contribute to every one in nine deaths (AHA, 2018).
Heart
disease remains the leading cause of death in the United States (CDC, 2016).
A community
health assessment was complete for Tri-County area finding an increase in number of patient
diagnosed with heart failure, we are above the national average for mortality rates being one in
every six deaths have been contributed with a diagnosis of heart failure. This shows an
opportunity to better educate our patients on heart failure to achieve early diagnosis with
pharmacological treatment being initiated in the earlier stages of heart failure to optimize overall
quality of health in our community.
Inquiry of evidence-based medical treatment in the state
was reviewed through an acute care hospital setting.
The results of the inquire prove evidence-
based medical treatment for phases a-d of heart failure is the same as the evidence-based medical
treatment guidelines put forth by the AHA 2017 Heart Failure Guidelines (AHA, 2017).
Clinical Guidelines
Clinical practice guidelines are published by a national organization, and focus on medical
practice in the United States.
The intent of clinical practice guidelines is to improve the patient
quality of care and improve health outcome through up to date evidence and data for prevention,
assessment, treatment, and education of disease process.
Several national organizations have
come together to guide clinician in the assessment, diagnosis and treatment of heart failure.
American Heart Association, American College of Cardiology and Heart Failure Society of
America have published Guidelines for management of heart failure.
Pathopharmacological Foundation
9
Assessment:
According to the ACCF/AHA the assessment should be comprehensive and
include an extensive history and physical, this is pivotal in diagnosis of heart failure.
The history
should identify any pre-existing conditions that place patients at higher risk for development of
heart failure, such as hypertension, coronary artery disease, valvular disease, myocarditis and
familial history of heart disease (2013).
History would also include questions about life style
such as smoking, alcohol consumption and activity.
Physical symptoms of heart failure include,
dyspnea with exertion or at night, unusual fatigue, poor appetite, elevated heart rate, report a
rapid weight gain, or signs of congestion.
Upon the physical exam the practitioner should
evaluate vital signs and volume status by a series of weights, jugular vein pressure, presence of
peripheral edema, and orthopnea.
Auscultation of heart and lungs would anticipate hearing a 3
rd
heart tone known as a gallop and or pulmonary rales.
This will aid in the identification of risk to
help guide therapeutic treatment.
