H eart failure is an epidemic with national and global implications. Compared with the situation in other cardiac diseases, the incidence and prevalence of heart failure continue to increase despite recent advancements in understanding and treatment. Increased survival after myocardial infarction, aging of the population, and increased incidence of diabetes are contributing factors. This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Describe the biopsychosocial holistic model for cardiovascular health 2. Identify 2 neurohormonal pathways and their impact in heart failure 3. Identify nursing implications for heart failure, depression, and anxiety CNE Continuing Nursing EducationCover Depression and anxiety are common comorbid conditions in patients with heart failure. Patients with heart failure and depression have increased mortality. The association of anxiety with increased mortality in patients with heart failure is not established. The purpose of this article is to illustrate the similarities of the underlying pathophysiology of heart failure, depression, and anxiety by using the Biopsychosocial Holistic Model of Cardiovascular Health. Depression and anxiety affect biological processes of cardiovascular function in patients with heart failure by altering neurohormonal function via activation of the hypothalamic-pituitary-adrenal axis, autonomic dysregulation, and activation of cytokine cascades and platelets. Patients with heart failure and depression or anxiety may exhibit a continued cycle of heart failure progression, increased depression, and increased anxiety. Understanding the underlying pathophysiological relationships in patients with heart failure who experience comorbid depression and/or anxiety is critical in order to implement appropriate treatments, educate patients and caregivers, and educate other health professionals. (Critical Care Nurse. 2014;34[2]:14-25)
Utilizing individualized exercise training programs that are inclusive of appropriate resistance training protocols can attenuate the deleterious effects of sarcopenia and enhance quality of life, functional capacity and also diminish its negative effect on independence. Nurses should be educated in how the utilization of proper resistance training (RT) in individuals can be used to ameliorate the effect of sarcopenia, especially considering its relationship to Quality of Life (QoL), functional capacity and independence. In part, this educational process should include how to refer patients to an appropriate healthcare provider trained in assessing sarcopenia and the use of resistance training. However, it is especially important that the provider be an expert on RT that enhances lean muscle, muscular strength, muscular endurance, power, balance and stamina. Therefore, it is vital that nurses have an opportunity to define and recognize how resistance training can be prescribed, ultimately for primary prevention but also as an effective treatment module in enhancing the health outcomes related to QoL, functional capacity and independence.
Sufficient dietary protein intake is vital to maintaining muscle health with aging. Yet protein intake among adults is often inadequate. This study’s main objective was to examine the impact of nutrition education (NE) and a per-meal protein prescription (PRx) with versus without diet coaching on protein intake. A secondary objective examined its effects on muscle health. Participants included 53 women, age 45–64 years. All participants received NE and PRx; those randomized to coached-group received 10-weeks of diet coaching. Assessments included: protein intake at baseline, weeks 4 and 12 and muscle health (muscle mass, grip strength, five-chair rise test, 4 mgait speed test). The Chi-square test examined percentages of participants meeting PRx between groups. Repeated measures analysis of variance assessed within group and intervention effects on protein intake and muscle health parameters. Protein intake (g/kg body weight) increased (p < 0.001): not-coached (n = 28) 0.8 ± 0.2 to 1.2 ± 0.3 and coached (n = 25) 1.0 ± 0.2 to 1.4 ± 0.3 with no significant difference between groups. A greater percentage of coached-group participants met (p = 0.04) breakfast (72%) and met (p < 0.001) three-meal (76%) PRx versus not-coached participants (25% and 53%, respectively). Participants in both groups exhibited significantly (p < 0.001) improved times for the five-chair rise test and 4 mgait speed test. Diet coaching in conjunction with a PRx and NE should be considered to assist individuals in improving protein intake through self-selection of protein-rich foods.
Objective: Sarcopenia is a disease of low skeletal muscle mass and strength that occurs with aging. It is most commonly seen in individuals aged 50 years and over. Nurse practitioners can take a proactive approach to the understanding and screening of this disease in attempts to prolong its onset or to treat the condition before it leads to additional adverse consequences. Methods: A comprehensive review of the literature, including evidence-based literature from peer-reviewed articles, including randomized controlled trials, was conducted.Results: This review of the literature indicated patients can benefit greatly from nurse practitioner's awareness and intervention by screening for sarcopenia as well as offering appropriate education and treatment to their patients. Once a diagnosis is reached, the nurse practitioner can then collaborate with other disciplines such as nutrition, medicine, exercise physiology and/or physical therapy to develop an intervention strategy that can treat or prevent this condition before it leads to decreased independence, early onset disability and decreased quality of life, among other adverse health outcomes. Conclusions: There is a call to action on the part of nurse practitioners in efforts to prevent and/or slow the onset of age-related sarcopenia and its adverse consequences.
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