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Models of Care in Heart Failure
Transcript of Models of Care in Heart Failure
"H D 5" Aggabao, Joseph
Saba, Theodor THANK YOU FOR LISTENING! INTRODUCTION Model 1: Elevated Risk of CHF or with Asymptomatic early disease Model 2: People with stable symptomatic CHF Model 3: People with acute exacerbation of CHF Model 4: People with end-stage CHF Objectives:
- Prevent development of CHF in people at elevated risk
- Prevent deterioration of CHF in people with asymptomatic early disease
- Preserve the cardiac function of people with asymptomatic early disease Key Elements of the Model:
- Prevention is based on early detection and intervention
- Patient's willingness to take control of health
- Patient Empowerment Service Delivery Settings
Metropolitan and Urban vs Rural and Remote Service Providers:
- General Practitioner
- Community Nurse
- Aboriginal Health Worker
- Health Staff involved in primary prevention Objectives:
- Ensure that CHF patients receive appropriate pharmacological and non-pharmacological treatment , including appropriate referral to a specialist cardiology and allied health services and to community-based health services.
- Ensure that CHF patients receive information and education that enables them and or their carers to monitor and manage their disease.
- Accurately and promptly diagnose CHF, determine its cause, its precipitating and exacerbating factors and assess its severity. Key Elements:
- Prompt and comprehensive communication between hospital staff and community-based health services if the patient is admitted to the hospital.
- Access to specialist medical expertise for pharmacological management. SERVICE DELIVERY SETTINGS
- Services in metropolitan and urban settings
- Services in rural settings SERVICE PROVIDERS
- General practitioners
- Community and hospital based nurses.
- Hospital pharmacist.
- Psychologists SERVICES In hospital setting Out of hospital setting In hospital setting:
- When you find a patient with acute exacerbation of CHF
- Accurate and prompt detection
- Appropriately responding Accurate and Prompt Detection
- Check patient's status (head to toe)
- Give Oxygen (2-4L)
- Perform an ECG and check vital signs
- Ask questions! (e.g. location of pain, severity, feeling) Out of hospital setting:
- Accessing to the services within a 45 minutes
- Seeing initially by a doctor
- Presenting to hospital ED involving Ambulance
- Transferring to a metropolitan hospital including Ambulance or Aero-medical team Palliative care for patients with end stage failure
- Its objective is to maximize the quality of life.
- provide psychosocial support to the patient, the family and other carers. Key Points:
- Effective Symptom control:
- Dyspnoea, Uraemia,Lower limb oedema, Cardiac cacchexia,
- Other symptoms like pain, nausea, constipation and depression of mood
- Providing education
- Access to appropriate palliative care services.
- Provide Referral to community support services
- Recognize the quality of Life Advance care directive
- Negotiation of end-of-life issues with the patient and their carer.
- Its aim is to optimise planning to avoid futile treatments, investigation and distress for patients and their families at the end of life.
- Routine inclusion of care planning and agreed treatment goals - Unavailability or shortage of medical specialist and allied health services.
- Specialist referral particularly for more complicated cases.
- Telephone based education programs
- Increasing role for practised registered nurses working with specialist/GP in
providing CHF education.
- Lack of nurse’s knowledge about assessing and giving proper education. Coordination in terms of the management programs compared to usual care for CHF to;
- Improve quality of life
- Adherence of fluid and dietary restrictions
- Medication regimens
- Reduce the likelihood of readmission
- Registered nurse
- Multidisciplinary coordination
- Ongoing participation of patient, family, GP and other health professionals - Effective ongoing patient education
- Establishing and fostering communication between hospitals and community based health care providers, patients and carers
- Continuity of Care Areas in which there have been significant new developments include:
- Use of B-type natriuretic peptide(BNP) or N-Terminal porBNP plasma level measurement in guiding treatment of CHF
- New pharmacological approaches to the treatment of systolic heart failure
- Drugs to avoid or use with caution in CHF
- Treatment of cardiac arrhythmias in patients with CHF
- Multidisciplinary care and post-discharge management programs Between-visit home telemonitoring for high risk patients
> In addition to other programs, the telemonitoring component in the early 1999 after nurses realized that telephone-based weight checks were time consuming.
> Information provided in September 2012 indicates that this program now also provides video telehealth for patients in rural communities. References:
Bennett, M.H., Lehm, J.P. & Jepson, N. 2011, ‘Hyperbaric oxygen therapy for acute coronary syndrome’, Cochrane Database of Systematic Reviews, vol. 8, no. 4818, pp. 4-17.
Burls, A., Bayliss, S., Emparanza, J.I. & Quinn, T. 2009, ‘Oxygen therapy for acute myocardial infarction’, Cochrane Database of Systematic Reviews, vol. 6, no. 7160, pp. 2-9.
Krum, H., Jelinek, M., Stewart, S., Sindone, A. & Atherton, J. 2011, ‘2011 Update to National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand Guidelines for the prevention, detection and management of chronic heart failure in Australia, 2006’, The Medical Journal of Australia, vol. 194, no.8, pp. 405-409.
National Heart Foundation of Australia 2010, Multidisciplinary care for people with chronic heart failure. Principles and recommendations for best practice, Australia, viewed 16 October 2012, < https://www.heartfoundation.org.au/SiteCollectionDocuments/Multidisciplinary-care-for-people-with-CHF.pdf>.
NSW Health 2003, NSW Clinical Service Framework for Heart Failure A practice guide for the prevention, diagnosis and management of Heart Failure in NSW, vol. 2, NSW Health, Sydney, viewed 20 September 2012, <http://www.health.nsw.gov.au/pubs/2003/pdf/heartfailure_2.pdf>.
Porth, C. 2005, Pathophysiology: Concepts of Altered Health States, Lippincott Williams & Wilkins, Philadelphia, PA, p. 604.
Seeley, R. et al. 2005, Essentials of Anatomy and Physiology, 5th edn, McGraw-Hill, New York, NY, p. 324. CONCLUSION Appropriate Response
- Preparing initial resuscitation
- Providing timely management
- Providing prompt emergency treatment aimed at optimising cardiac function
- Providing relief from symptoms
- Preventing damage to other organs Services in rural settings
– Medical practitioners in rural towns should have the capacity to:
- make a diagnosis of acute CHF
- carry out resuscitation if necessary
- take initial steps to stabilise the patient’s condition
- assess and treat immediate underlying causes of an acute episode
- make arrangements for the patient with acute CHF to be transported to a centre for definitive management.