Congestive Heart Failure (CHF), while not the most prevalent of conditions, can nonetheless feel like an uphill battle. But even so, a patient’s time in hospice can be made just a little more comforting, pleasant, or at ease by keeping compassion, patience, and attention, as well as a few key tips.
To begin, one of the most important measures you want to take is pain/fatigue management. This step requires healthy and consistent communication with the patient’s healthcare team. A patient with CHF will often experience chest pain and fatigue. Managing these symptoms into accommodating comfort includes leniency and relaxation. Pain will likely require medication, but of course, in careful amounts. Allow the patient short, frequent naps and lots of soothing relaxation time to combat lethargy and be able to feel closer to ease. Additionally, it can be helpful to afford a few lifestyle changes to limit tiredness, such as an adjusted heart-friendly diet and occasional exercise. Try improving the quality of sleep by using soft background noises or pillows/mattresses that better cater to the patient’s comfort. Being well-rested is a great way to feel more energized!
Next, you can implement symptom management. Think of it as a broader address than the previous tip. Besides chest pain and fatigue, patients will also commonly experience shortness of breath, coughing, dizziness, loss of appetite, bloating, and swelling. These should be monitored closely and addressed promptly, especially symptoms such as shortness of breath, heart rate, weight, swelling, blood pressure, confusion, and appetite. Again, be sure to have good, open communication with the healthcare responders assigned to the patient. For many CHF patients, there are generally several medications to be taken. Unfortunately, not all of these will cover all the symptoms attached to CHF. It’s important to keep in mind that the same condition can look different from patient to patient, so not everyone will always display the same symptoms. Moreover, it helps to address symptoms at their roots. Mild exercise can help lift spirits as well as keep fatigue at bay. Of course, be prudent that the patient is not over-exerting themselves, as that can do more harm than good. Ensure oxygen levels never drop too low. Keeping the patient well-rested and high-spirited is a good response to fatigue, and similarly, occasional workouts can help with dizziness and swelling, if managed well. CHF patients would also benefit from cleaning up lifestyle by quitting smoking and drinking, and additionally being routine with vaccinations and check-ups. A part of symptom management for declining CHF patients quickly becomes nutritional management. As mentioned above, some measures have to be taken to treat underlying causes, such as diet. Reducing salt and sometimes fluids from the patient’s diet can be super helpful. The later into their CHF progression a patient reaches, the more likely it is to observe loss of appetite as a symptom. In such cases, it helps to prepare simple, small portions that are easy to swallow and have them eat a little at a time. And especially important is hydration! While frequent urination is common in CHF patients and can be frustrating or disruptive, it is important not to cut out water intake. It may help to have small frequent sips or keep ice chips for the patient to chew and swallow occasionally.
Part of the above managements and also its own management is medication management. Even for terminal patients in hospice, medication management is crucial. Keep track of all medication intake, their doses, time taken, and any immediate effects or concerns. Staying organized is super important. It can help to keep a diary or a medication storage that keeps everything straight. Discuss with the patient’s caretakers what the patient might need changed or what has already been done. A strong communication between the patient and healthcare providers ensures clear and careful treatment!
Beyond medication management, there is also emotional management. For a CHF patient, as with any other terminal patient, it might be daunting to contend with a prognosis or exhausting to undergo the symptoms of the disease. A small boost in morale can go a long way. It is important to keep the patient feeling included in relevant events of their loved ones and to exchange meaningful conversations or gifts or time. Don’t let this be a lonesome period for them! You can be emotionally supportive by being a good listener and showing you are present for the patient. Be mindful of any concerns or desires the patient might communicate. Let them know they are heard. Spend meaningful time with them and create enjoyable memories. It can be easy to fall into depressive episodes or desolation, so it is of high import to maintain positive experiences ever so often that help lift spirits all around. These memories are even better when they radiate past the patient to also include their family and loved ones. A strong sense of community and family make a person feel less alone in a difficult time, and the support will never be for nothing. For the family themselves, it can be difficult not to focus on losing their loved one soon, and they themselves need emotional tending to. As such, it enriches everyone emotionally to spend quality time together in the patient’s later stages. For the family and loved ones, it might help to find support groups and resources to help manage their loss and grief. Let there be free and open communication and bonding between family and patient, so everyone has an easier time dealing with the impending death. Loved ones often have wishes or regrets to get off their chest at these times, so it is important to develop a safe and loving environment for that.
Attached to emotional management is spiritual management. This is where a patient’s personal beliefs are accounted for. Because CHF patients are looking at a short time left to live, they will often have desires or wishes regarding how they hope their time to pass. It is important to respect a patient’s religious or spiritual beliefs and make sure that any rituals and rites are fulfilled. It is sometimes even helpful to have a clergy member or such figure present while a patient navigates this period of time and contends with the clock on their life. Both spiritual and emotional management involve end-of-life planning for the patient, so always remember to keep an open ear to their requests so they can be fulfilled and the patient assured.
Another important aspect to keep family in the loop for, beyond emotional management, is for discussing vital aspects of care. People close to the patient commonly have preferences and concerns regarding the patient’s treatment, and when permissible, can direct some proceedings of the caretaking. Be sure to remain mindful of who is privy to what information and who is allowed to make medical decisions for the patient, of course. Other than that, loved ones can help in making the duration of a patient’s time one that is most pleasing to the patient, as someone who knows them well.
Comfort management is another approach to helping a CHF patient through their terminal years. Because so many symptoms of CHF are uncomfortable, you’ll find that combatting those aspects of the patient’s experience will help their outlook and situation significantly. Monitor and adjust the ambience of their living spaces, keep them feeling safe and secure, and ensure that furniture, temperature, and lighting are to their comfort. When the patient has trouble breathing, you can help them find a comfortable sitting/resting position and encourage them to manage their symptoms by pulling in long, slow, deep breaths. Provide access to creature comforts such as in entertainment and hobbies, as these familiarities and enjoyments can help both physically and emotionally for the patient. Having something fun and reliable to do helps keep a patient’s mind off of pains and sadness, and interactive pastimes can be useful in fostering bonding moments with loved ones, as in emotional management.
And lastly, be sensitive. A CHF patient will be going through a very difficult part of their life and it will understandably be very difficult for them. A loving heart and considerate mind go a long way. It is important to allow a dying patient their dignity and respect. Having empathy is a key trait in caretaking, so always be mindful of the patient’s wants and needs. Remember, people can have the same diagnosis and still have different experiences! Validate what the patient is going through and let them know they are supported through and through.
With these management skills in mind and a well-wishing heart, you can make a CHF patient’s hospice care a better experience for them. At Lenity Light Hospice of Texas, we hope the best for hospice patients, and you can always contact us for more information or assistance.