Education for a patient with CHF

[Joe1984]

I feel like I'm kind of going out on a limb on this one but I thought I would at least ask and see what you guys think...

You have a patient with CHF who admits to drinking 10-15 beers / day and completely refuses to decrease their intake or change their diet. They state "I have made it this far, why should I stop now". Is it inappropriate to discuss another type of alcohol in place of beer. i.e. have 10 shots of vodka vs. drinking 10 beers? I know in the overall picture neither is good for this patient, especially when discussing alcohol intake and CHF, but at least by drinking liquor it would significantly reduce their fluid intake especially if the patient also refuses to change their already high Na+ diet... Just trying to think outside the box a little bit :-/ With the patient refusing to stop drinking, I was thinking the would possibly be the only positive in an otherwise negative situation.

1 beer = 12oz = 360ml * 10 = 3,600 ml / day of beer

1 shot = 1oz = 30ml *10 = 300 ml / day

So this alone would reduce the patient intake 3300ml/day.

Am I crazy for thinking this?? Thanks for your input.

[tarotale]

uh.. assuming the 10 shots instead of 10 beers is a careplan for a patient while in hospital, that's pretty much impossible b/c doctors and nurses will not allow that to occur. if however they decide to not give a damn and keep drinking even with the debilitating disability such as CHF or diabetes outside the hospital, then they are doing it on their own risk. patients have right to refuse treatment or refuse life style changes (1 of 5 nursing ethics, autonomy remember?). as far as the 10 shot vs 10 beer thing, i can assure you that if it were to be asked in a test, the "advise patient to replace 10 beer with 10 shots" is definitely going to be a wrong answer, and all your professors will simultaneously agree that such action is unethical, unprofessional, and goes against "do no harm". but like i said, if they refuse to change lifestyle and keep adding gasoline to the fire, well hell, i wouldn't feel sympathy. as far as teaching, teach patient to monitor daily weights, monitor signs of edema, crackles, JVD, angina, etc etc. hope it helped

[Katie71275]

Umm, Im not a drinker, so Im not really familiar with alcohol content, but although it is less volume wise, isn't say "10 shots of vodka" a higher alcohol content than the beers? Which would be more toxic to the liver.

I think all you can do is educate the patient. An alcholic is one that is VERY hard to change. They have to WANT to change and a measley nursing student isn't going to be the difference more than likely(not meaning that meanly!, but its them and their drinking that is important to them).

[anonymousstudent]

Yes, that is crazy. Moving to liquor is a further step toward alcoholism. The end doesn't justify the means. Replacing one bad habit in a patient with an equally bad habit at face value and a much worse one in the grander scheme of things is NOT helpful.

Nice try though, that was way out of the box.

You can't fix everybody. You can't make them comply. HF is a hard one because it's not always easy for patients to see that they are sick. I don't see them refusing your recommendations, no matter how logical and valid, as any different than refusing any other medical intervention. They have the right to do so. Make sure you cover all of your bases with referrals to AA and mental health, as well as dietary supplementation recommendations for alcoholics.