Adult Patients with Fluid Overloaded Diagnosed with Congestive Heart Failure
Introduction
Assessment, volume regulation and management remain as fundamental aspects among patients diagnosed with heart failure. Fluid congestion remains as the initial challenge among patients suffering from chronic heart failure. The features of heart failure show a syndrome described through the renal retention of water and sodium that result in interstitial and intravascular fluid volume redistribution and expansion (Davies, Leslie & Morgan, 2015). The condition associates itself with extended in-patient stays, increased in-hospital and post-discharge mortality and morbidity. The nursing intervention involves actions and actual treatments carried out by a nurse to assist a patient in achieving created care plan goals. A nurse utilizes knowledge, critical-thinking skills and experience to decide on suitable interventions. The essay seeks to form a PICOT question on the interventions on adults with fluid overload resulting in congestive heart failure.
Clinical Question
Fluid overload entails a medical condition where the body has much fluid in the blood. Excess fluids in the form of water and salt accumulate in the body resulting in gaining of weight. Such fluids mostly occur among patients critically ill, and it is always a result of vital care intervention. Fluid overload among severely ill patients remains independently related to increased mortality and morbidity (Kwiatkowski, Goldstein, Cooper, Nelson, Morales & Krawczeski, 2017). Fluid overload involves the expansion of the extracellular fluid volume that takes place in kidney failure, heart failure, cirrhosis, and nephritic syndrome. Increased retention of renal sodium results in increased content of sodium in the body hence brings about varying levels of overloaded volume. Treatment of fluid overload involves removal of the fluids through diuretics and mechanical removal of excess fluids through paracentesis and dialysis. The focus of the work is to ensure the recovery of such patients with excess fluids through various intervention approaches. The intervention seeks to prevent health consequences associated with fluid overload like congestive heart failure.
The significance of interventions on adults with fluid overload is that it might affect multiple organ systems. Congestive Heart Failure forms one of the leading causes of fluid overload among ten patients per 1,000 patients aged 65 years and above. Among these patients, almost 90% of them demonstrate symptoms of fluid overload (Lee, Jeng & Huang, 2015). The USA witnesses approximately 1 million hospitalizations yearly for chronic congestive heart failure. Such patients stay in the hospital for five days. Moreover, studies indicate 50% of the discharged patients of HF experience re-hospitalization within six months of discharge. Approximately 50% of the patients discharged from the hospital of HF experience, either weight loss or gain. The cost of heart failure treatment cost the USA nearly $31 billion annually, and it keeps on increasing over time (Zoccali, Moissl, Chazot, Mallamaci, Tripepi, Arkossy & Stuard, 2017). The PICOT question for the nursing intervention on adults patients with fluid overload includes: in adult patients with fluid overload diagnosed with congestive heart failure (P), how to document patient weight gain (I), compared to no documenting patient weight gain (C), compliance of this intervention increased after educating nurses on patient outcomes (O), during a patient hospital stay (T).
Level of Evidence
The work focuses on asking interventions questions targeting adult patients with fluid overload because of congestive heart failure. The intervention asks questions, records information on weight gain of the patients, and compares the nursing outcome when not recording such data. Available evidence shows that nurses learning about patient outcomes concerning fluid overload increased compliance with the set innervations. A qualitative study of the available information on fluid overload among patients with congestive heart failure would best answer the questions. Qualitative data, like the information on the number of hospitalization annually in the USA, helps in answering such questions (Andersson, Salickiene & Rosengren, 2016). Additionally, information of patients re-hospitalized because of fluid overload with congestive heart failure serves as evidence that could help in answering these questions. Qualitative evidence gives an in-depth comprehension of the means individuals understand, act and manage situations in a certain setting.
Search Strategy
Searching strategy involved the utilization of organized key terms based on the topic under study and questions. The strategy also involved the search for possible terms with similar meaning, phrases, truncated variations of search terms and subject headings. The strategy involved the utilization of thesaurus to establish synonyms in various search engines like Google Scholar, Google+ and many others. Moreover, the strategy involved scanning the outcomes for alternative phrases and words. Consequently, the strategy involved examining various relevant articles and abstracts for keywords and alternative words, subheading and phrases on the topic until the acquisition of the two articles took place. The search strategy help in narrowing down to the two articles chosen that would help in the next research work.
Conclusion
Adults aged sixty-five years and above witness increased incidences of fluid overload with congestive heart failure. The USA experiences huge numbers of hospitalization of such patients annually costing the country vast amounts of money. The teaching of nurses patient outcomes of fluid overload demonstrated increased compliance with the goals of the set intervention to ensure the mitigation of such patient outcomes. A qualitative study of the available evidence would help in answering the questions. The utilization of an effective search strategy described helped in settling in the articles chosen and assembling the available information in this document.
References
Andersson, E., Salickiene, Z., & Rosengren, K. (2016). To be involved—A qualitative study of nurses’ experiences of caring for dying patients. Nurse education today, 38, 144-149.
Davies, H., Leslie, G., & Morgan, D. (2015). Effectiveness of daily fluid balance charting in comparison to the measurement of body weight when used in guiding fluid therapy for critically ill adult patients: a systematic review protocol. JBI database of systematic reviews and implementation reports, 13(3), 111-123.
Kwiatkowski, D. M., Goldstein, S. L., Cooper, D. S., Nelson, D. P., Morales, D. L., & Krawczeski, C. D. (2017). Peritoneal dialysis vs furosemide for prevention of fluid overload in infants after cardiac surgery: a randomized clinical trial. JAMA paediatrics, 171(4), 357-364.
Lee, Y. W., Jeng, Y. J. & Huang, L. H. (2015). Development and testing of a scale to assess fluid overload symptoms. Applied Nursing Research, 28(2), 206-209.
Zoccali, C., Moissl, U., Chazot, C., Mallamaci, F., Tripepi, G., Arkossy, O., … & Stuard, S. (2017). Chronic fluid overload and mortality in ESRD. Journal of the American Society of Nephrology, 28(8), 2491-2497.