Heart failure is a bitch to live with. You have to always be on top of your fluid intake, restrict how much you drink, carefully obey special diets, RELIGIOUSLY take your meds, monitor your vitals and electrolytes, keep your appointments, track your weight and output, and sometimes genetics STILL wins and you end up in the hospital anyways. Some people are really good at living with it. Others really just don't give a crap about keeping up with their treatment and end up repeatedly being admitted to the hospital and/or dying early.
I've had countless heart failure patients, and for many, the worst part is the fluid restriction. Depending on the severity of their heart failure, they may be restricted to as low as 500 ml per 24-hour period. Some can manage this quite well. Others find it to be absolute torture worse than death. Those patients tend to get very angry when they are denied fluids, and sometimes they will sneak to ice machines to refill their jug. However, there's one patient in particular I remember we had who would do everything he could to get fluids after reaching his limit, including getting water from his own private bathroom sink. And what are we supposed to do then? My first thought was we could assign a "sitter", or a staff member that literally sits with the patient at all times to prevent undesired behavior.
Our unit supervisor had a different thought. I've only ever personally seen this once, but we literally called engineering to come shut off the water supply to that patient's bathroom. The fact he's that sick and struggles so much with it isn't at all funny. But in another sense, it sort of is a little funny how far we are willing to go sometimes. That patient was eventually discharged, and honestly I'm sure he'll be back. But at least we did our part. It's up to him to do his.
Moral of the story: Some patients are their own worst enemy. We may have a lot of control in the hospital, to the point of cutting off water supply, but in the end, the patient has to WANT to be better if treatment is going to succeed once they are discharged. If you're a nurse or doctor, always make sure you support your heart failure patients and encourage them in their efforts to follow the treatment plan. To the extent you can, help ensure they have the resources they need outside the hospital to succeed in continuing their treatment plan.
- Bella, RN
コメント