Chronic

Family

Congestive

Heart

Failure

Created By:

CSU, San Marcos

NURS 480

Dr. Phinney

Rachelle Mendoza-Galapin (Team Leader)

Cammie Huynh

Daniel O’Kelly

Kevin Blas

Michelle Lin-Park

Guadalupe Ornelas

Vena Valdez

DESCRIPTION OF CONDITION:

● New York Heart Association (NYHA) classification of

Congestive Heart Failure (CHF), Class II for the past 3 years

● Class II: Displays slight limitation of physical activity

that can lead to fatigue, dyspnea, palpitations (Lewis et

al., 2014)

● CHF: Impair cardiac pumping/filling that result in volume

overload. It decreases in contraction, stroke volume, and

cardiac output of the heart (Lewis et al., 2014).

COMPLICATING FACTORS, CHRONICITY, & COMORBIDITIES:

● Dyslipidemia

● Hypertension

● Angina

● One stent to the left anterior descending artery inserted

2015

● Hypothyroidism

CASE SELECTION: 69 year old Chinese-American woman named A.B.

ALLERGIES: No Known Food or Drug

Allergies

MEDICATIONS:

● Lipitor 20 mg daily

● Aspirin 100mg daily

● Coreg 3.125 mg twice a day

● lisinopril 10 mg daily

● Lasix 10 mg daily.

Explanation of NYHA Classifications

Class Symptoms

I No physical limitation to activity. No fatgue

or dyspnea.

II Slight limitation to physical activity.

Regular physical activity causes fatigue,

palpitation, dyspnea.

III Increased limitation during physical

activity. Activity less than regular actions

induces fatigue, palpitation, dyspnea.

IV Cannot participate in any physical activity.

Experiences symptoms of heart failure at

rest. Any physical activity can cause

discomfort.

Class Objective Assessment

A No objective symptoms of cardiovascular disease

presented. No physical limitation.

B Minimal objective symptoms of cardiovascular

disease noted. Slight limitations during regular

activity observed. No symptoms at rest.

C Moderate symptoms of cardiovascular disease noted.

Both regular and physical activities can cause

moderate symptoms. No symptoms at rest.

D Severe cardiovascular disease symptoms observed.

Highly limiting symptoms are noted during rest and

physical activity.

DESCRIPTION OF A..B.’s CONDITION

● Performs IADLs & ADLs without restriction

● Is a homeowner, divorced, lives independently, & is retired but used to own a pet store in

which she ran for the past 30 years

● Enjoys preparing healthy meals at home, shops regularly at the farmer’s market for organic

fresh produces & drinks one to two cups a coffee/day

● Denies alcohol or tobacco use

● Religious affiliation is identified as Catholic, but only attends masses on certain

holidays & occasions

● Maintains close friendships with family & small circle of friends, & attends their social

events

CARE-RELATED ISSUES

● Concerns over her health and is afraid of getting cancer and debilitating illnesses.

● Expresses worry over her son, F.B.’s personal difficulties

TREATMENT COMPLIANCE

● Compliance with the medical regimen prescribed. Sees a cardiologist three

times/year & makes appointments as needed for her cardiovascular medical

complexities

● Has a primary physician she visits once a year & receives prophylactic care &

follow-up based on her needs

● Keeps regularly scheduled appointments with her dentist and optometrist

● Has Medicare part C and D & private health insurance

● Is proactive about her health & seeks information related to her diagnoses

DESCRIPTION OF FAMILY, DEVELOPMENTAL STAGE & FUNCTIONS

MOTHER

● A.B. lives with 90-year old mother K.B. who has controlled hypertension, but otherwise healthy &

independent

● Has two small dogs and three cats & walks her dogs four to five times/week for 20 minutes for exercise

CHILDREN

F.B.

● 30 year-old son who is single & graduated college with a Baccalaureate of Science degree in Criminal

Justice, and works as a legal assistant

● Currently going through personal difficulties & is not able to provide A.B. with emotional or financial

support

● A.B. communicates with him on a regular basis at least two to three times a week & visits once a month

L.B.

● 41-year old daughter who is married & lives three hours away in Ventura County

● A.B. closest to her out of all her children providing her the emotional support that

she needs with visits once every two months & contact with her through the telephone

four times/week

● Employed as Registered Nurse, A.B seeks her professional advice in regards to all her

medical/health-related matters

● Has one son who currently attends college & lives at home with his significant other

M.B.

● 35-year old, middle daughter who lives one-hour away in Orange County

● Currently uninvolved in family affairs and has not spoken to A.B. in about three years

● Marital status is single, works part-time at local convenience store & is a full-time student pursuing her

doctorate in education

RELATIONSHIPS AMONG FAMILY MEMBERS

● All her children are in direct communication with each other through phone calls, texts & visits keeping

each other updated on family events.

● Mrs. A.B is compliant with her medical treatment. She sees a cardiologist three times a year and makes

appointments as needed. She has a primary physician she visits once a year and as needed. She keeps

regularly scheduled appointments with her dentist and optometrist. She has Medicare part C and D, health

insurance. She attends all appointments by herself. She seeks to learn information about her illness and

maintains optimal health.

● Mrs. A.B at times expresses concerns over her health and is afraid of getting cancer and debilitating

illnesses. She expresses anxiety over her son’s F.B, personal difficulties.

CULTURAL & RELIGIOUS TRADITIONS

CHALLENGES

● Estranged from youngest daughter for 3 years

● Son unavailable for emotional and financial support due to

personal difficulties.

COMMUNICATION PRACTICES

● Eldest daughter and son communicate directly with patient.

● Youngest daughter receives information from siblings; no

contact with patient.

APPLICATION OF FAMILY NURSING THEORY:

CHRONIC CARE MODEL

PROBLEMS● Anxiety related to fear of debilitating

disease

● Estranged from her daughter M.B. for years of

no contact.

● Caregiver burden, 90 yr old mother and 30 yr

old son live at home.

● Stress over adult son’s personal difficulties

EVIDENCE-BASED INTERVENTIONS (PART I OF II)

● Diuretics to decrease volume overload

● ACE inhibitors to reduce preload

● Digoxin to increase myocardial contractility

● Insertion of left ventricular assist device in later stages

● Beta Blockers for patients with left ventricular dysfunction

● Stent/Angioplasty considered when cause of CHF is CAD

● Lifestyle changes (i.e. reduce sodium intake, weight loss, stress

reduction)

● Encourage family to continue practicing open communication

style by sharing thoughts and expressing feelings to adapt and

normalize the chronicity of illness

●

●

EVIDENCE-BASED INTERVENTIONS (PART II OF II)

● Listen to the family story

● Reflect on the family’s needs and concerns

● Collaborate by offering ideas to assist with sharing of

responsibilities within the family

● Coordinate care to ensure gaps and duplication of care are avoided

● Identify competing needs or plans within family tasks to reduce

risks of treatment errors and poor outcomes

● Help to integrate the new family health routines

● Allocate essential resources to address needs

● Collaborate in setting attainable goals to achieve effective

outcomes

EFFECT ON FAMILY

● Caregiver burden is a prominent outcome for family members.

● Social support from family and friends are strongly associated

with decrease readmissions & increase medication compliance.

● Research indicates family has overall positive impact on family

regarding family health maintenance and health promotion

behaviors (Dunbar et al 2009).

● Living alone and social isolation with CHF is linked with

increased mortality and morbidity (Dunbar et al 2009).

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