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Nursing. Palliative Care for People with Heart Disease

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Palliative care for people with Heart Disease


All over the world, the palliative care literature has become a wealthy literature with regard relieving the mental, spiritual, physical and social anguish in people dying from disseminated heart disease. (Hinton, 1963)

Numerous studies have differently looked into the myriad ways the symptoms of heart failure in its entire stages have an effect on the quality of life. These negative effects imply that compassionate care that embraces good communication, as well as, a holistic approach is imperative, right from when the first diagnosis of heart failure is made known.

As the condition advances, palliative care becomes gradually significant. Ideally, there would be no disparity between palliative and supportive care and presently, this ideal is being considered in the case of heart failure.

The aspects detailed in this paper will be principally detailing on the greater prevalence of nausea and dyspnoea (breathlessness), which are two symptoms in heart failure accounting for the immense depression and anxiety related to the lengthy and irregular course of advancing heart failure.

Previously, then, needs to palliatively address these issues have long been known, but it is only recently that this area of abandoned distress has been acknowledged and addressed.

Origin of palliative care

Palliative care was first introduced in 1960, after families and friends watched their loved ones die painfully from cancer and heart disease, and its effects. (Poole-Wilson, Uretsky, Thygesen, Cleland, Massie, Rydén.2003) As a result, palliative care has mainly centered on cancer and the materialization of autonomous hospices. It is now an acknowledged medical specialty since 1987.

It primarily centers on offering holistic care of families and patients, and covers an extensive range of illnesses, but majorly cancer and heart diseases. According to Murray, Kendall, Boyd, Sheikh, (2005) it is essential to think palliatively with regard to illness trajectories, due to their unpredictability. For instance, a heart patient may advance from a Grade II heart condition to Grade IV in a short time span. Consequently, palliative care is very crucial in such cases, in order to alleviate the possible setbacks that may spring from an advancement of these trajectories, especially in terminal cardiac failure. (Beattie, Murray, Brittle, Catanheira. 1995)

Palliative care necessitates experience in looking after patients with heart failure, in order to establish the subtle change in symptoms and conditions, especially when drugs and blood tests would not be so effective.

The experience of advanced heart failure (Class III)

Dying due to heart failure is a difficult and prolonged process, as it frequently involves fatigue and improbability for both patient and carers. (Murray, Boyd, Kendall, Worth, Benton, Clausen (2002). In the last decade, numerous studies have documented and evaluated the experience of patients diagnosed with heart failure, who were previously ignored. (Anderson H, Ward C, Eardley A et al, 2001)

Notably, the first studies to survey this experience were carried out in detail in the United Kingdom and Australia in 1998-1999. The studies conducted in Auckland, New Zealand revealed that patients diagnosed with heart failure lacked any cohesive awareness of their diagnosis. Consequently, doctors all over the world have insisted on the need for palliative care for such patients. (Hanratty B, Hibbert D, Mair F et al.2002)

Problems and symptoms

Inherently, heart failure is a condition capable of affecting every organ in the body in numerous ways. Additionally, treatments used in alleviating heart failure and its symptoms can also induce other symptoms, such as cough, polyuria and hypotension.

According to Rogers, McCoy AS et al (2002) heart failure symptoms have been evaluated and quantified in copious studies at given phases of the condition. According to Krum, Gilbert (2003) these symptoms include joint pains, chest pains, poor sleep, tiredness, breathlessness and nausea.

Centering on breathlessness and nausea, it is essential to develop a care plan which outlines potential nursing interventions for managing these two symptoms under specialist palliative care. (Gibbs, Khatri, Gibbs. 2006) Essentially, a common feature of all the stages in heart failure is loss of quality of life.

An effective care plan and recommended palliative nursing Interventions for:

a) Breathlessness

* Establish the causes of breathlessness, besides heart failure. For instance, anxiety.

* Pharmacological Management.

i) Administer oramorph in low doses.

ii) Consider using laxatives.

iii) Administer 2.5mg oxynorm liquid hourly, albeit with care, due to its inherent potency.

iv) Administer



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