The Heart Failure Nurse assesses Mina using a number of validated assessment tools (see additional information below). He notes the following observations.
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The Heart Failure Nurse’s observations
Psychological
- Anxiety/depression (very common in heart failure patients).
- Feelings of inability to cope (decline in physical state. no longer able to do things previously able to do.)
- No motivation – can’t be bothered (fatigue and low mood lead to lack of motivation)
Physical
- Noticeable decline (now NHYA IV)
- Shortness of breath (slow down in blood flow out of heart causes blood returning to the heart through the veins to back up, causing fluid congestion. This causes fluid to leak into the pulmonary system.)
- Persistent cough (due to pulmonary congestion)
- Increasing weight (due to fluid retention. In addition to fluid leaking into the tissues, the kidneys are less able to excrete sodium and water, causing further fluid retention.)
- Poor appetite (digestive system receives less oxygenated blood.)
- Cognitive impairment – forgetfulness (less blood to brain and change in electrolyte levels can cause confusion).
- Unable to mobilise as much as used to (due to shortness of breath and fatigue)
- Fatigue (body diverts blood away from less vital organs, such as muscles, in order to try to increase blood supply to vital organs.)
Social
- Social isolation/loneliness (unable to pursue hobbies or attend social events due to own ill health and caring for Joe.)
- Carer – unable to leave house for shopping etc (is full time carer for Joe who cannot be left alone.)
- Financial concerns (couple live on their state old age pensions. Mina worries about fuel bills, in particular.)
- Lack of support (does not presently have any support with caring for Joe. Son visits regularly but is unable to do so on a daily basis.)
