Cardiomyopathy and Congestive Heart Failure
Cardiomyopathy is a disease that affects the heart’s muscular portion and subsequently causes dysfunction of the heart. Congestive heart failure, on the other hand, is a progressive condition whereby the heart is unable to pump blood to the tissues of the body sufficiently. What follows is that the body’s tissues are starved of oxygen and nutrients. Both ailments are serious end term and chronic conditions that require proper care to improve the quality of life of the affected patients. This paper will look at the approach to the care of a patient with a diagnosis of Cardiomyopathy and Congestive Heart Failure (CHF) (Ramani, Uber, & Mehra, 2010). The paper will further recommend a treatment plan for the patient’s symptoms and provide heath education and teaching for the patient and his family.
Mr. P’s Approach to Care
It is important to observe that Mr. P has a life –long diagnosis which that the patient and the healthcare team can best manage with changes in his lifestyle and drugs that will help him avoid acute congestive episodes. Mr. P’s care approach will focus on managing the symptoms that he is presenting with at the time of admission to the hospital. He has presented with a plus four pitting edema, on auscultation, there are moist crackles all over his lung fields. The patient is also experiencing labored breathing (Ramani, Uber, & Mehra, 2010). The caregiver will therefore first seek to treat the symptoms using pharmacologic therapy.
To provide care that is patient-centered, the nurse has to provide biopsychosocial care. In doing this, the nurse will have to address all the problems that the patient has. Mr. P has some social, financial and spiritual issues that need addressing. He has no family and is his only wife is reportedly sad over the worsening state of health of her hubby. She is experiencing financial constraints because the Mr. P used to handle all the bills before e became ill. Furthermore, he is despondent and keeps asking God to take him away from his suffering. All of the above are clear indicators for psychosocial care and counseling for the client and his wife. The caregiver will further seek to give health education and teaching since the customer, and his wife will need that too (Anter, Jessup, & Callans, 2009). The health education and teaching will be geared towards enabling Mr. P to manage his polypharmacy better, control his diet restriction. The caregiver will address spiritual aspect of care.
The treatment plan of Mr. P will be major to do with pharmacologic therapy to relieve the symptoms. If the client’s heart failure has been determined to be due to systolic failure, the caregiver should administer Angiotensin Converting Enzyme Inhibitors (ACE-I) like Enalapril. The ACE-Is will relieve the signs and symptoms of heart failure. ACE-Is will achieve this by promoting vasodilation and diuresis by reducing the amount of afterload and preload. Angiotensin II receptor blockers (ARB) e.g. losartan and vasodilators like hydralazine and isosorbide nitrate should be added to the treatment plan (Cardiovascular Disability, 2010). Mr. P has pitting edema and moist crackles that are palpable all over his lung fields; both of which are clear signs of fluid overload.
Fluid overload is an indicator for a diuretic; the treatment plan should, therefore, incorporate diuretic like spironolactone or furosemide (Lasix). The diuretic will help the body eliminate the excess sodium and water. Finally, the treatment plan should also focus on fluid restriction and diet restrictions. The nurse should ensure Mr. does not consume a lot of liquids. The diet during hospitalization should be free of sodium (Anter, Jessup, & Callans, 2009). The nurses should further vigilantly monitor the fluid input and output charts.
Health teaching and education will be provided through health talks written materials, videos and discharge notes. The client and the wife will be taught because they can hear and can recall the health talks by the nurse. The video will also be used to simplify the health teachings especially those of the Pathophysiology of the condition and how the drug acts. The written materials like charts and notes on drug regimen will be given to the couple upon discharge so they can refer when they forget. The patient will also receive discharge notes on follow-up and danger signs (Davis, 2004). The discharge notes are again helpful because the patient can refer to them while at home. It is important to incorporate all the teaching strategies to enhance recall by the patient and his family.
The nurse will also use brainstorming since Mr. P and his wife have been in this condition for long and are therefore well placed to answer most of the questions.
Teach Mr. P the importance of adherence to treatment regimen, encourage his wife to help him take his drugs without skipping. Show them how to draw a medication dosing timetable so that they avoid forgetting.
Teach Mr. P and his wife the need to prevent high sodium diets. Tell him where sodium goes, water follows and too much water in the body translates to hard work that strains his already weak heart. On the same note encourage fluid restriction.
Teach Mr. P to join social groups for psychological care, or see his pastor or religious leader for spiritual and psychological care. The social groups will also help him and his family with financial groups : (Davis, 2004).
Tell Mr. P to perform light exercises and avoid strenuous ones that can overwork his heart.
Finally teach him and his wife to honor the doctor’s appointments and seek immediate care in case of emergencies.
In a nutshell, this paper has discussed the care to Mr. P a 76-year-old client with a diagnosis of Cardiomyopathy and CHF. The paper has analyzed the approach to care that the caregiver should take given the presenting symptoms. The care has encompassed all aspects of need that the client has. The treatment plan has incorporated pharmacologic therapy plus psychosocial care. Finally, preferred treatment methods like health talks and brainstorming have been given on top of a teaching program for Mr. P and his wife.
Anter, E., Jessup, M., & Callans, D. (2009). Atrial Fibrillation and Heart Failure: Treatment Considerations for a Dual Epidemic. Circulation, 119(18), 2516-2525. http://dx.doi.org/10.1161/circulationaha.108.821306
Cardiovascular Disability. (2010). http://dx.doi.org/10.17226/12940
Davis, L. (2004). Cardiovascular nursing secrets (1st ed.). St. Louis, Mo.: Elsevier Mosby.
Ramani, G., Uber, P., & Mehra, M. (2010). Chronic Heart Failure: Contemporary Diagnosis and Management. Mayo Clinic Proceedings, 85(2), 180-195. http://dx.doi.org/10.4065/mcp.2009.0494