Hospice is a comprehensive program of care for terminally ill patients. It provides for and meets the needs of both the patient and their family. For patients of congestive heart failure, it focuses on palliative care, rather than curative care. The main goal is for the patient to have the best possible quality of life and to help the heart failure patient manage the shortness of breath without fear. It also focuses on the spiritual, emotional and supportive needs of the patient and family.
Definition of Illness
Congestive heart failure occurs when the heart no longer functions properly and blood does not flow in and out of the heart the way it should. The heart does not get enough blood or oxygen but it is still trying hard to pump. Heart failure may develop over time or quickly after a heart attack or infection. The usual cause of heart failure is hypertension or diabetes.
Determination/Decision
The decision for hospice care is one between the patient, family and doctor. Congestive heart failure patients still walk, talk and do normal life activities. However, the heart is dying, and if it is decided that the outlook for recovery is poor and there are no more treatment options, hospice can be brought in.
Nursing Care
Hospice nurses focus on palliative care for the heart failure patient by helping the patient breathe as easily as possible. Nurses get oxygen in the home and titrate it for optimal comfort. They also work with the doctor to obtain medications that will keep the patient comfortable. Medications provided may include lorazepam, alprozolam and morphine for ease of breathing as well as nebulizer treatments.
Nurses monitor the weight gain and instruct on a diet low in salt. Salt intake adds more fluid to the body that the heart tries to pump, therefore increasing the shortness of breath in patients with congestive heart failure.
Chaplain
The chaplain will provide spiritual and emotional support for the patient and family. Heart failure patients are often anxious, as are their family members, and the comfort of the chaplain can be important. The chaplain brings a calming presence into the equation of hospice care. The perspective is nondenominational and all faiths are included. Chaplains offer strength that is sometimes missing from the family dynamics when faced with death, and they help pull the family together to improve spiritual and emotional well-being.
Social Workers
Social workers also provide comfort and support for heart failure patients and their family. They are available to counsel and help guide families and patients through the difficult situation. Social workers listen to the needs of the patients and families, and often gather information that is needed for the rest of the team to care for the heart failure patient.
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