Working With Mrs Jones and Her Caregivers to Ensure Support

Introduction

This essay seeks to discuss how the voluntary sector can be engaged to provide active support to persons with long term conditions. It is based on a case study of Mrs Jones, a 75-year-old adult with congestive heart failure (CHF). The essay will be organized in sections. The first section provides a brief biography of Mrs Jones and the rationale for choosing her for the case study. The second section will identify and describe CHF, its pathology, and how it is affecting Jones’ well-being. Ultimately, the last section of this essay will analyse how a social worker can work with Jones and his carers to ensure support, independence, and well-being.

A brief Biography of Jones

Jones, whose real name has been concealed for purposes of protecting his identity and confidentiality according to the Nursing and Midwifery code of conduct (NMC, 2015) has Congestive heart failure (CHF). She is a 75-year-old lady who lives with her husband – her main caregiver. Her family lives nearby and is, therefore, able to offer help with her day-to-day activities. Mrs Jones is a housewife who used to regularly attend church and fond of cooking for her family, assisting with events at the church in addition to spending time with her family and caring for their needs. However, over the last one week, she has become increasingly short of breath and her mobility reduced due to fluid accumulating in her legs. 

My rationale for choosing Mrs Jones as my case study is that according to Cowie (2017), the risk of CHF is increasing with age because of an increasing aging population and improved survival rates of heart attacks. Yet, there is an inconsistent provision of care given to such patients. Besides, I chose Mrs Jones because her admission to the hospital presents the best opportunity to learn how to care for people with long term conditions.

The pathology of CHF

According to Amakali (2015), congestive heart failure occurs when the left ventricle is unable to empty blood properly, which leads to pulmonary congestion depending on the degree of heart failure. Patients develop hypoxia which is when there is a poor gaseous exchange in the lungs resulting in low oxygen in the body. This is what Mrs Jones is suffering from.

Mrs Jones long-term condition has affected her independence, she feels fatigued, breathless at the slightest effort, she has peripheral oedema because her heart is not pumping well. Hence her mobility is restricted and has become dependent on her husband and family to partake in everyday activities. Psychologically, based on the evidence by Manneman et al (2018), this has caused moments of isolation and frustration and feelings of helpless because of her condition. Importantly though, Mrs Jones family has developed more interest in caring for her, due to the anxiety and unhappiness for seeing her condition deteriorate. Worryingly, they have also felt exhausted for having taken full responsibility for her in addition to their own daily activities.

Mrs Jones was admitted to the ward with pulmonary oedema, hypoxia, dyspnoea and comorbidities of diabetes with fluctuating blood sugars and obesity. The measurement of her conscious levels using the Glasgow Coma Scale revealed low conscious levels. The Glasgow Coma Scale helps measure the severity of the patient’s medical condition, and out of a scale of 15, Mrs Jones was scoring 12. According to Teasdale et al (2014), this is a moderate severity level.

On physical examination, past medical history, electrocardiogram test, testing for natriuretic peptides in the blood, chest X-ray, performing echo-cardiogram and testing her arterial blood gas for carbon dioxide levels, it was confirmed that she has CHF and started on treatment.

Working with Mrs Jones and her caregivers to ensure support, independence, and optimal well-being

Upon undergoing treatments and showing signs of improvement, I began developing an effective relationship with her to find out her needs, mainly for purposes of developing person-centred care post discharge, prevent readmission in the future and improve her coping strategies (Conroy et al, 2017). Moreover, despite Mrs Jones having adequate caregiver support by her family, she was referred to the heart failure nurse with her consent. The heart failure specialist nurse provided lifestyles modification that Mrs Jones needed to adhere to.

Lifestyle Modifications

The importance of modifying Mrs Jones’ lifestyle in regards to emotions, behaviour or activities is quite clear. According to Mogotlane et al (2013), these lifestyle elements are important to consider because they may increase the heart’s workload and affect Mrs Jones’ health condition. It is therefore monumental for the nurse to advice Mrs Jones’ on the most appropriate modifications needed on her lifestyle and to provide various provisional nursing interventions that are key to enabling a positive health outcome for Mrs Jones.

Particularly, considering Mrs Jones’ case, I was keen to ensure that she lived in a caring environment where she performs a less physical activity or any other activities that may demand high oxygen volumes due to over-reactivity (Mogotlane et al, 2013). Besides, as recommended by Vaughan et al (2013), I ensured that Mrs Jones was always in a peaceful environment; with low noise pollution to prevent chances of her getting emotional unrest. Equally, the air in her surrounding environment was kept free of pollution to prevent respiratory stress, a phenomenon that could complicate her already eminent hypoxia.

Ideally, I advised Mrs Jones’ carers to avoid smoking anywhere around her because passive or active smoking could lead to respiratory stress (Paul, 2008). Moreover, I advised her against alcohol consumption or consumption of any alcoholic substance because this could add toxins to already retained metabolic waste; leading to an increase in the risk of metabolic acidosis (Stromberg, 2005).

Diet Modification

I was also keen to modify Mrs Jones’ diet considering that diet plays an important role in maintaining the health and well-being of patients with CHF. The reason why Mrs Jones’ diet had to be modified is because her heart failure conditions required her to take foods with low salt and fat content (Maric et al, 2009). Consequently, Mrs Jones’ needed to feed on low fat and salt food both at the hospital and while at home post-discharge.

Ideally, salty food would lead to high fluid retention within the heart cavity, contributing additional load to the already ailing heart – while on the other hand; food with more fat content would increase her risk of developing ischemic heart diseases (Cellar et al, 2003). Therefore, I advised Mrs. Jone’s family caregivers to ensure that her food contained minimum salt and fat content.

Another diet modification that I was keen to initiate was softer food for Mrs Jones. According to Riley et al (2012), softer food is necessary for patients with CHF because it minimizes the energy and effort needed for mechanical digestion of food. Basically, according to Radhakrishnan & Jacelon (2012), mechanical digestion of food requires more energy, a phenomenon not good for Mrs Jones because of her already compromised body metabolism. Hence, I advised that Mrs Jones should generally be given small servings of food to minimize her energy requirements for digestion.

Medication

Whereas medications for heart failure are prescribed by the physician, my role as a nurse is to ensure that these medications are administered according to the exact prescriptions while acknowledging the side effects and therapeutic requirements of these medications (Stromberg, 2005). Against this background, I evaluated the side effects of the heart failure medications prescribed for Mrs Jones and advised the following:

First, I counselled Mrs Jones to enable her to accept her heart condition because according to Mogotlane et al (2013), accepting her heart condition could help her make the necessary adaptations that would contribute to her health and well-being. Besides counselling, I provided Mrs Jones with some education on self-care, focusing on follow-up treatment, diet, lifestyle modifications, and self-monitoring. This was especially important because The NHS’ (House of Care, 2013) strategy places the people living with long-term health conditions, like Congestive Heart Failure, at the centre of the system to be supported by health and social care professionals. With this model, patients are able to influence their care provision that is specific to their individual needs. 

Nonetheless, in regards to self-monitoring, I informed Mrs. Jones that because of her CHF condition, she might encounter low systemic output, hypoxia and slow circulation, leading to symptoms such as short breath, dizziness, coldness, and weakness (Mogotlane et al, 2013). Hence, she needed to observe these symptoms and respond appropriately (i.e. rest during a short breath, or wear warm clothes during coldness). I also advised her, together with her family caregivers, to report any case of a persistent or worsening symptom.

Concluding Remarks

In conclusion, this essay has highlighted the dynamics of heart failure and how it affects Mrs Jones health, independence well-being and quality of life and that of her husband. By addressing the patients, social, environmental, medical and psychological aspects Mrs Jones can have a positive quality of life. The multi-disciplinary heart failure teams are vital for patients as they can treat and assist patients to navigate the healthcare system in an effective manner. Nonetheless, caring for Mrs Jones has helped me develop skills, understand the long- term condition and I am more confident in supporting patients with similar conditions better.

References

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