thesis statement and 4 different perspective

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Running head: UNDERSTANDING CONGESTIVE HEART FAILURE
Understanding Congestive Heart Failure
Abstract
1
UNDERSTANDING CONGESTIVE HEART FAILURE
2
Recent statistics show the increasing incidence rate of Congestive Heart Failure and how it
claims more lives if an individual fails to seek medical attention. Unfortunately, these are caused
of lack of education, cultural, economic and ethical issues that can be traced back to history. Put
together, these causes have many effects not only in the patients that have this condition but also
to the country at large. This paper looks at the sources of Congestive Heart Failure, its
pathophysiological side, four different perspectives and its effects and the various ways through
which an individual or relevant institution can tackle this challenge.
Keywords: heart disease, Congestive heart failure, CHF, medical
Understanding Congestive Heart Failure
UNDERSTANDING CONGESTIVE HEART FAILURE
3
Congestive Heart Failure is a stressful and serious condition that requires a lot of daily
management and treatment. Different perspectives need to be considered for managing this kind
of heart condition. Understanding Congestive Heart Failure is essential and critical. It is
unfortunate that CHF incidences are on the rise and are claiming more lives especially if a
patient fails to seek medical attention at the earlier stages. Recent statistics show that “number of
adults living with heart failure in the United States have increased from about 5.7 million (20092012) to about 6.5 million (2011-2014) and about half of people who develop heart failure die
within 5 years of diagnosis” (Mozzafarrian et al., 2016). Congestive heart failure affects people
of all ages in diverse ways and different degrees. “Approximately 550,000 new cases are
diagnosed in the United States each year” (NHI, 2012). Unfortunately, many individuals
particularly elderly are not aware of having the condition not until symptoms appear after heart
deteriorates.
Understanding the anatomy and pathophysiology of the heart is critical in better
understanding how CHF occurs. Aside from that, several cultures have developed myths and
misconceptions about the cause of CHF, and hence have a different understanding of the
condition. Due to declining economy, individuals will also benefit by knowing economic issues
involving congestive heart failure, how it affects our health care system and society, and possible
treatment options that are cost effective. Statistics show that heart failure costs the country an
estimated of $30.7 billion each year which includes the cost of health care services, medications
to treat heart failure, and missed days of work (Roizen, 2012). CHF is a critical condition that
requires high standards of ethical conduct from clinicians and regulation from the medical
bodies. Different laws govern the treatment and monitoring of the CHF condition in the health
care facilities is crucial.
UNDERSTANDING CONGESTIVE HEART FAILURE
4
Scientific Perspective of Inquiry
Congestive heart failure (CHF) is a condition characterized by the heart failure to pump
enough blood to other parts of the body (Acton, 2012). It is unfortunate that CHF incidences are
on the rise and are claiming more lives. However, given the fatality of CHF it is important to
undertake a scientific perspective of inquiry in terms of either anatomic, physiological,
pathological, or epidemiological issues.
The understanding of the anatomy of the heart is critical in better understanding how CHF
occurs. The heart is a critical organ in cardiovascular system that is located at the left side of the
chest, which has muscles responsible for pumping blood throughout the body through the action
of dilation and contraction (Acton, 2012). The malfunctioning of the cardiovascular muscles
through irregular dilation incapacitates them from pumping enough blood to other parts of the
body, thus causing the CHF condition. The physiological issues relating to CHF includes aspects
to do with mechanical functioning of the heart. The respiratory rate and amplitude are important
physiological aspects monitored on a person suspected to be under the attack of CHF (Acton,
2012). Also, the diastolic and systolic pressure will be measured to see if a person is within the
range of high or low blood pressure that may make a person susceptible to CHF. Further, CHF
should be examined from a pathological front. The pathology of heart failure may result from
weakening of the muscle contraction brought about by overloading of the ventricles with blood
through the diastolic process. In the event of CHF, the blood system affected is the atria and
ventricles which will be forced to stretch to hold more blood, and keep it moving, but this will last
for a brief time (Hosenpud & Greenberg, 2013). With time, the blood being pumped through the
aorta to the rest of the body will be reduced, and there will be failure of the arteries to supply
oxygen-rich blood to important organs of the body such as the kidney, and the brain.
UNDERSTANDING CONGESTIVE HEART FAILURE
5
CHF can be understood at either the cellular or genetic level. The understanding of heart
failure at cellular level entails making an inquiry on how the attacks affect calcium release and
electrical activity in heart cells. There is a high relationship between asynchronous calcium release
and heart failure that relates to cardiac contractile dysfunction. Pathological issues related to heart
attack normally causes the variability of Ca2+-transient kinetics and membrane depolarization,
that over time makes the myocardial membranes dysfunction, and the cardio muscles to weaken
(Hosenpud & Greenberg, 2013). The abnormalities of the intercellular Ca2+ give forth to
mechanical and electrophysiological dysfunction, which lead to myocardium failure and
Congestive heart failure (CHF) afterwards. More importantly, CHF is a result of interplay of both
the chemical and biological issues. The most important biological issue of CHF is myocardial
dysfunctioning. The tightening of the coronary artery due to myocardial failure presents a
challenge of the heart to properly pump blood throughout the body (Hosenpud & Greenberg,
2013). The myocardial dysfunction makes the heart failure to contract, and hence most blood
accumulates inside it, with less blood being pumped out.
Nutrition has a significant effect on CHF. For instance, when a person eats food reach in
too much fat or salts, his/her
heart will be forced to work harder in eliminating those excess salt and fat molecules from the
body, which may worsen CHF. It is important to monitor the diet one takes to prevent worsening
of CHF because excess intake of fluids and salts make the body hold much fluid, and the heart will
be forced to work harder in order to get rid of the excess fluids from the body (Shils, 2012).
Additionally, uptake of foods rich in fats can worsen CHF, in which the excess fats accumulates
on the coronary artery and reduces its ability to effectively pump blood, and thus likely to worsen
CHF. Nonetheless, early diagnosis of CHF can lead to better outcome on management of the
UNDERSTANDING CONGESTIVE HEART FAILURE
6
disease. One can be made aware of the kind of nutrition to observe such as diet with low salt levels
(Shils, 2012). Also, appropriate exercises coupled with the right diet can be used to slow down the
progression of CHF.
Cultural Perspective of Inquiry
The impact of culture on health disparities is vast. It affects the perception of illness,
death, and health; beliefs about the cause of a disease, approaches to the promotions of health,
and the forms of treatment that a patient might prefer (Ponikowski, et al., 2016). There are
norms, which also influence the understanding of CHF. Some of the norms are taboos. Some
religious or social customs restrict or prohibit particular health practices or forbid any association
with particular sections of the health sector. There are also some of the cultural values including
beliefs, which restrict people from meeting in forums. Such forums help in sensitizing people on
the causes of CHF and possible ways in which individuals can prevent the attack. However,
Western industrialized cultures such as the US observe CHF as a result of a scientific
phenomenon thereby advocate treatments, which use sophisticated technology in the diagnosis
and treatment of the disease.
The Hispanic population in the US is highly affected by CHF since they uphold some of
the practices and believes, which are considered as the major causes of CHF. Smoking is one of
the risk factors for CHF. Hispanic cultural people recognize the importance and benefits
associated with the smoking cessation. They believe that smoking cessation is used in the
treatment of depression. They also believe that a person’s ability to halt smoking is majorly
based on their willpower and not on the use of medical aids. They, therefore, do not uphold the
use of medication in the treatment of diseases such as the heart failure. Other societies also
UNDERSTANDING CONGESTIVE HEART FAILURE
7
believe that CHF is as a result of a supernatural phenomenon and they promote spiritual
interventions, which counter the disfavour of the massive forces.
Management and detection of CHF present significant methodological and cultural
challenges for the researchers and health professionals. Cultural factors influence the acceptance
of help-seeking for CHF. Despite the global prevalence, there is the stigma, which surrounds
heart diseases such as CHF, particularly in the developing countries (Gerber, et al., 2015).
Developed nations have created initiatives to minimize stigma, which is associated with CHF.
Social stigma toward CHF may prevent the patients from reporting the symptoms, which affect
the statistical accuracy of the disease.
Research shows that some of the people who inhabited the equatorial Africa were
exposed to a genetic predisposition of salt-sensitivity. Their bodies had the tendency of retaining
more sodium. The condition increases the volume of blood, which consequently raises the blood
pressure of the individual concerned. Salt sensitivity is a condition, which is associated with
conserving water. The conserved water is beneficial in a dry and hot climate. The group is also
associated with consumption of meals, which have large contents of sodium. Such meals help
them consume enough water for the adaptation in their selective habitats. Such groups believe
that consumption of sodium is not detrimental to their health but useful since it helps them with
survival in their area. Imparting knowledge on individuals with regard to the treatment of the
disease is thereby difficult since it cannot prevent the spread of the disease at the expense of their
meals.
Asian immigrants are also the largest group of the Americans who are adversely affected
by CHF due to their lifestyle. They have highest levels of obesity due to their dietary restrictions
and their social activities. Exercise is one of the preventive measures against Diabetes, which is
UNDERSTANDING CONGESTIVE HEART FAILURE
8
one of the risk factors of CHF. The Asian immigrants consider a taboo for one to keep exercising
for their own body. They also consume particular diets which result in diabetes. High blood
pressure is one of the causative agents of CHF.
Culture and cultural issues play a significant role in the treatment of a CHF patient. One
of the studies depicted that a particular group of Cambodian individuals with limited formal
education made efforts to agree with therapy but had to revisit their underlying understanding of
the functioning of medication. In the Pacific/Asian Islanders, the patient’s extended family has
an influence on the medication process (Ponikowski, et al., 2016). Older members of the family
make decisions, which are unquestionable. The older members of the society at most times
disagree with the recommendations made by the health professionals, which affects the overall
process of patient medication. All the same, gender biases have never been experienced in the
diagnosis and treatment of CHF.
Some of the cultures such as in Pakistan and India make people reluctant to undergo a
diagnosis and subsequent treatment of severe heart diseases. In the Vietnamese culture, cultural
and mystical beliefs play a big role in the treatment of heart illnesses. Culture has a great impact
on the perception of illnesses and their treatment. The extent to which individuals view
medication depends on their cultural background.
Mathematical/Analytical Perspective of Inquiry
Economic impacts of the congestive heart failure include huge health care costs.
Research revealed that congestive heart failure patient was released at a charge of 10,000 per
discharge, as the mean duration of admission was 6.3 to 7.7 days (O’connell, 2009). Additional
costs imposed on the patient include nursing care, drugs, surgery procedures, costs of regular
hospital check-ups and appointments for discharged patients which could drain family resources
UNDERSTANDING CONGESTIVE HEART FAILURE
9
(Ogah, et al., 2014). Furthermore, the increasing demand for technology, equipment for
treatment and labor costs are burdening to an economy.
Death tolls by the condition disrupt family and social structures. Children are left
orphaned without any guardians to provide for their basic needs like education and health.
Additionally, families are left bankrupt hiking the level of dependency on government aids
which cause the relocation development funds into meeting their needs. Moreover, the
prevalence of the disease in the mid-ages deprive states workers of their most productive years
(Bloom, et al., 2012).
Two reliable approaches to diagnosing congestive heart failure include echocardiogram
tests which utilize sound waves to produce an image of the heart operation (Mayo Clinic, 2017).
It can distinguish between systolic and diastolic conditions. Secondly, blood tests to test for the
presence of NT-proBNP. Statistical facts about congestive heart failure in the United States
include about 5.7 million people in the adult population suffer from heart failure in which one in
nine deaths since the year 2009 is caused by heart conditions and approximately half of the
people diagnosed to have the condition die with the first five years of diagnosis. Moreover,
treating the condition costs about $ 30.7 billion yearly. The amount comprises of the expenses
incurred in health services, drugs for the condition and the number of days absent from work.
Various statistical methodologies are applied to study the prevalence and impact of the
congestive heart condition. However, the best technique must be a qualitative study of the causeeffect relationship of the disease. Such research should explore the causative agents, measure the
prevalence and provide data coded in charts and graphs for easy interpretation. Qualitative
studies are factual therefore the statistical figures generated from research are reliable as they
portray the real state of the disease.
UNDERSTANDING CONGESTIVE HEART FAILURE
10
Home based care is one of the treatment options that are cost-effective in treating CHF.
Home base care after a patient leaves the hospital proves to accelerate the speed of recovery. The
care includes reminder to take prescribed medication, sensitization to recognize early signs of the
condition, practicing a healthy diet routine and exercising. Cumulatively, these practices will
reduce the risk of readmission in the hospitals. Another cost-effective treatment option is to
provide a clinical practice guideline for the evaluating systolic heart diseases patients. By doing
so, the US Department of Health and Human Services will ensure caregivers are restricted to
malpractices like the amount of time they put a patient unnecessarily in the hospital. Maximize
on out-patient treatments as well as provide a price ceiling on the charges levied on the patients
(Parmley, 2009).
Ethical Perspective of Inquiry
Clinical care for congestive heart failure requires the application of knowledge and
understands the law. Management of CHF involves the application of the multinational
approach. It incorporates lifestyle medications, use of surgical devices and medical devices.
Non-pharmacological measures improve the prognosis and symptoms of the conditions. The
laws of the CHF require moderate physical activity when the patient’s symptoms are moderate or
mild (Achelrod, 2014). The law requires the treatment of the condition by the use of BiPAP and
CPAP if sleep apnea exists. The laws also require the reduction of weight through proper and
controlled dietary and physical activities. The condition also requires proper formulation of fluid
restriction because excessive consumption of sodium worsens heart failure. The laws also require
effective professionalism and expertise from the clinical officers. According to the available
laws, payment of the treatment laws must depend on the public laws of the country. It requires
the treatment process to provide a high level of confidentiality of the patient. This boosts the
UNDERSTANDING CONGESTIVE HEART FAILURE
11
confidence of the patients. Ethical obstacles affect how the medical community addresses the
various issues associated with the CHF conditions. Ethical issues require the medical community
to focus on the laws. Some situations require emergency and immediate decision making by the
practitioners. The ethical issues lower the decision-making process among the stakeholders of
the medical community (Hjelm et al., 2014). This affects the flexibility and effectiveness of the
treatment process of the CHF.
Ethical theories enable the understanding of the issue. They provide theoretical aspects of
the condition facilitating the regulation and maintenance of the condition. The theories assist in
the formulation of the appropriate measures and procedures for treating the condition (Achelrod,
2014). They also assist the clinicians to develop an appropriate understanding of the condition
and to formulate an effective relationship with patients. This boosts the rehabilitation process.
Congestive Heart failure also results from depression and stress. Money, power, and control
matters are some of the issues leading to stress experienced by the patients. The treatment of the
CHF also requires a high amount of money (Alosco et al., 20113). Money and power enable the
assessment of better and quality treatment processes.
End-stage treatment of the CHF involves the continuation of the medical therapy
guidelines and cardiac transplantation. Patients approaching the end of their respective life
forego therapies and consider some procedures burdensome (Vecchio et al., 2015). The ethical
issues of maintaining the quality of life and end life care in patients with CHF include support
and education of the patients and respective families. The clinicians provide guidance and
counseling to encourage the families and to provide support to the patients.
The ethical issues prevention and solution occurs by guaranteeing adequate
understanding between the patients and the clinical officers. Providing updated statistics and data
UNDERSTANDING CONGESTIVE HEART FAILURE
12
about the patient’s help in understanding their conditions (Hjelm et al., 2014). It also facilitates
the referral of the patients. Providing hospice and palliative care also solves and prevents the
ethical issues experienced.
Conclusions

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