case study one and two

Congestive Heart Failure

Case Study 2

This case study is about Mr. P, a 76 year old male, hospitalized usually to treat cardiomyopathy and congestive heart failure (CHF). The author describes the approach to care, treatment plan, method to provide education and a teaching plan about the CHF. Congestive heart failure is defined as “the state in which the heart is unable to pump blood at a rate adequate for satisfying the requirements of the tissues with function parameters remaining within normal limits usually accompanied by effort intolerance, fluid retention, and reduced longevity” (Denolin, 1983, p. 445).

Approach to care

· Assessment of patient: Physical examination of the patient (at each visit), with particular attention to assessment of their vital signs, cardiovascular system (including volume status), signs of deterioration and co-morbid conditions.

· Assessment and management of the patient’s cardiovascular risk factors (e.g. hypertension, dyslipidaemia, diabetes, smoking and obesity).

· Assessment of the patient’s nutritional status.

· Assessment of the patient’s potential for adverse effects of medicines

· Regular reassessment of the patient’s biochemistry (including urea and creatinine) and haematology (including haemoglobin) parameters.

· Assessment of the patient’s daily fluid and salt intake from food and drink.

· Ongoing monitoring of the patient’s electrolytes (particularly serum sodium and potassium levels) and renal function.

· Monitor intake and output strictly and take daily weight.

Treatment Plan

CHF is a complex clinical syndrome; therefore, treatment plan includes the focus on the fundamental causes. Appropriate combination of medicines, control over lifestyle with careful monitoring is the basic treatment for CHF.

· An Angiotensin-Converting Enzyme (ACE) inhibitor (captopril, enalapril etc) or an Angiotensin II receptor blocker (ARB) helps to relax the blood vessels and enhance the blood flow.

· Beta-blockers (bisoprolol, carvedilol etc) reduce the blood pressure and stabilize the heart beat rate.

· Diuretics (lasix, bumex etc) remove more sodium and water from the body, which helps in lowering blood pressure. Also, spironolactone and eplerenone called as potassium-sparing diuretics help to retain potassium.

· Other drugs include anticoagulant, statin and digoxin as per doctor’s recommendation.

Besides medication and diet alteration, devices and surgical procedures are available for the treatment of heart failure. An implantable cardiac defibrillator (ICD), coronary artery repair and valve repair or replacement (as appropriate) can be done (Heart.org, 2016).

Education method

Heart failure patients and their family members should acquire the education, problem solving abilities and motivation regarding the treatment plan, medications and effective participation in self-care. “Patient education and post discharge management have demonstrated benefits in patients with chronic heart failure” (Koelling, Johnson, Cody & Aarons). Patient and family are likely to adhere to treatment process and medications if they understand the education they are given. Teach-back and self-management tool are the most effective method to provide education to both patients and families (American Nurse Today, 2012). In this method, patient and family are asked to explain the material just taught. The educator may need to clarify, repeat or modify the content of teaching several times based on how well the learner comprehends and recalls. This method helps to understand the self-management approaches (self-monitoring, medication, diet control, exercise, weight control, and reduction in smoking and alcohol consumption) to assist the patients and their family.

Teaching Plan

Heart failure afflicts an individual but it affects entire families. Family support system is very critical for patient to live with CHF. Therefore family involvement is very important in teaching plan. Teaching plan includes.

· Daily weight monitoring: At the same time every day in lightweight clothing after urinating and before breakfast.

· Medication and its side effects: Take your medications exactly as directed and follow-up the doctor’s appointment. Also, should be well aware of its side effects.

· Physical activity: Exercise help to improve the condition heart muscles, balance the body, relieve the stress and maintain the body weight.

· Diet and Social activities:

1. Sodium intake: Follow a low sodium diet

2. Fluid intake: Avoid drinking excess fluids

3. Alcohol and tobacco consumption: Use of alcohol and tobacco should be avoided as these are associated with the strictly negative effect in CHF patients.

4. Vaccination: Annual immunization against Influenza is recommended.

· Aware of worse symptoms: Contact the doctor if symptoms such as fast and irregular heartbeat, severe crushing chest pain, dizziness, shortness of breath etc are noticed.

CHF is a complex heart disease associated with complex treatment plans. Hence, patient and their family members should be made aware of the disease and the health care providers should implement different method of education and teaching plan for the optimal care of the patients.

References