The home nurse and/or home care frequently see the patient in his home situation and therefore have an important role in the follow-up and education of the patient and his environment.
The same role applies to nurses in residential care centres.
In the future, heart failure reference nurses or heart failure educators could play an active role in primary care. Heart failure education training can also be taken over by general practice nurses. An adapted nomenclature will then be necessary, in line with the tasks performed.
Who to follow as a patient with heart failure?
- Known diagnosis of heart failure.
- History of hospitalization for cardiac decompensation (water on the lungs).
- Chronic use of a loop diuretic (furosemide, Lasix 40 mg = bumetanide , Burinex 1 mg per day or more).
The role of home nurses and/or home care is mainly to:
1) Monitoring of parameters and symptoms
Recording these parameters in the heart failure diary (if the patient/caregiver cannot do it themselves) or on a platform. Help patients learn how to work with this diary.
* Weight: the patient should always weigh himself at the same time: in the morning, after going to the toilet, without clothes, before breakfast.
Target weight = weight at which there is no water retention or dehydration. This target weight may change over time. Weight may increase or decrease slowly due to a change in diet, without an increase in dyspnoea or water retention. Diuretics do not always need to be increased or decreased. If in doubt: consult the doctor or the heart failure nurse.
Weighing frequency:
- Every day:
- After a recent admission for cardiac decompensation.
- In case of chronic need for a higher dose of diuretics. Sometimes a patient is given a therapeutic program in which, above a certain weight, a higher daily dose of a loop diuretic or an additional diuretic (e.g., a thiazide diuretic or acetazolamide) should be added for a few days until the weight returns to the target weight and therapy can be reduced to the basic program.
- In case of a concomitant illness (infection, vomiting, diarrhea, etc.).
- 3 times a week: when the condition and the weight are stable and in case of chronic need for only a lower dose of loop diuretic (e.g. furosemide 40 mg daily).
- Once a week: in a stable condition and without the need for daily intake of a diuretic.
2) Follow-up of the medications
- Monitor the effect of recent medication adjustments :
- Increased medications, eg diuretics: weight loss and less shortness of breath? Decreased edema? Hypotension?
- Reduction of medications, e.g. diuretics: decreased dizziness? Better blood pressure? Weight gain? A limited weight gain, up to 1-2 kg, without an increase in symptoms, is not a problem.
- Compliance monitoring: correct medication intake according to the schedule ? If necessary, prepare and/or monitor intake.
- Provide explanations to improve treatment compliance. The medication relieves the weakened heart, allowing it to function better and deteriorate less.
- Encourage the use of diuretics if necessary, even in case of annoying frequent urination. The time of taking can be adapted according to any planned activities (for example, taking in the afternoon after shopping or after visiting the physiotherapist, etc.). Taking in the evening should be avoided to avoid getting up at night to urinate and to avoid falls.
- Monitoring of medication stock (with timely prescription requests and collecting of medication if necessary).
- Monitoring and, if necessary, elimination of medications to be avoided at home (NSAIDs, effervescent tablets, etc.).
3) Lifestyle monitoring
- Salt restriction: do not let the patient put salt on the table, monitor the intake of salty snacks (chips, cookies, etc.), etc. Stricter salt restriction on doctor's prescription.
- Fluid restriction:
- Limit to a maximum of 1.5 to 2 liters per day and drink according to thirst (especially if the patient must take a diuretic daily).
- In hot weather, additional fluid intake is allowed (provided that weight does not increase).
- In cases of severe diarrhoea or vomiting or very hot weather, diuretic intake may need to be reduced or discontinued in consultation with the doctor or heart failure nurse. After improvement, timely restarting or increasing these diuretics should also be discussed.
- Monitoring of food intake. Report if meals are missed or if little food is eaten.
- Encourage a healthy lifestyle:
- No smoking. Assistance from a tobacco specialist if necessary.
- Healthy and balanced diet.
- Exercise daily. Any effort that does not cause chest pain or shortness of breath is allowed. Discuss any physiotherapy or additional aids (walker, etc.) if needed.
- Limit alcohol (not daily, max. 1 drink per day). Alcohol can be toxic to the heart muscle.
4) Support for the patient and their family
- Promoting autonomy:
- Hygiene aid and prevention of pressure sores.
- Applying support stockings.
- Psychosocial support.
- Referral to a home care store: blood pressure monitor, incontinence equipment, etc.
- Referral to additional help (via the GP or other): home care, social services of the health insurance fund, dietician, psychological help, etc.
- Providing the correct documents for a consultation with the GP or cardiologist (heart failure booklet, correct medication list).
5) Optionally, discuss advance care planning in a calm, friendly environment with someone who knows the patient best.
What do the patient and/or family still want if their condition deteriorates in the future? If necessary, do they still want resuscitation, ventilation, admission to intensive care, etc.?
