Case Study; Cardiomyopathy
Congestive heart failure is an end stage condition that often results from complication of other illnesses like hypertension, coronary heart diseases and Cardiomyopathy. There is several ways to manage this condition. This paper will describe the management a CHF case; Mr. P.
Approach to care
In the care of Mr. P, the approach to care depends on identifying the type of Congestive Heart Failure (CHF) he has. The medical management of Mr. P, especially the pharmacologic therapy will depend on about the kind of CHF. One of the goals of treatment is to reduce or eliminate the etiological factors that contribute to the condition (Mahmood & Wang, 2013); this could be excessive alcohol intake or even atrial fibrillation. Secondly, treatment aims at cutting down on the workload of the heart by decreasing the preload and the afterload.
Managing Mr. P will include general sharing education and counseling on the restriction of sodium in his diet, daily checking of his body weight and encouraging regular exercise. Mr. P will also have some prescription medication to take; emphasis put on adherence to the drug regimen (Mahmood & Wang, 2013). The caregiver will hospitalize Mr. P; he may receive oxygen therapy during the admission.
Treatment plan
For his pharmacologic treatment, Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) should be used to relieve the signs and symptoms of congestive heart failure like the plus four pitting edema the client has. The ACE-Is will increase the diuresis and vasodilation by lowering the preload and the afterload. Alternatively, administer an Angiotensin receptor blocker (ARB) if ACE-Is are contraindicated for Mr. P. the other alternative to these is hydralazine or isosorbide dinitrate (Arroll, Doughty, & Andersen, 2010). The care tea should also administer a diuretic like spironolactone due to the fluid overload the client has. Administer digitalis if the symptoms continue.
Furthermore, Mr. P’s treatment plan should also include a nutritional therapy plan. In this, he should be put o a low sodium diet of 2 to 3g per day, avoidance of excessive amounts of fluid consumption is vital as well (Lavie & Ventura, 2013). The need for sodium restriction is to reduce the circulating volume and therefore spare the heart having to pump that amount.
Teaching method
The patient and his wife will first receive education on the congestive heart failure, Etiology, Pathophysiology, symptoms, manifestations and complications through a video presentation. Education will help actualize the condition to the patient. The caregiver will utilize written material containing Mr. P’s nutrition and drug therapy. Mr. P will be allowed to go home with the printed material; this will help him remember the treatment regimen and nutrition therapy (Arroll, Doughty, & Andersen, 2010). Mr. P can refer to the printed material at home in case he forgets something. The patient will also receive discharge instructions on the drug regimen, diet, and exercise. PHR and EMR systems will be used to print the discharge instructions. The discharge instructions are necessary for follow-up appointments with the doctor plus follow-up care.
Teaching plan
- Review the medication regimen with the patient. Ensure the drugs are labeled, offer written instructions to the patients, and teach the patient the adverse drug effects. Remind the patient and the wife to weigh himself daily because of the diuretic he is taking.
- Review of the activity program; teach the patient the importance of exercise. Emphasize that it is important to do light exercise like walking activities daily. Teach the patient to avoid strenuous work to avoid overworking the heart (Lavie & Ventura, 2013).
- Teach the patient the importance of sodium and fluid restriction.
- Explain to Mr. P the danger signs and symptoms that he seeks immediate medical help when he sees. Teach him to honor all the medical appointments and importance of follow-up.
In conclusion, CHF is a debilitating condition that should be properly managed to improve the quality of life of the patient. Mr. P will be managed using pharmacologic means, nutrition therapy and health education as explained above.
References
Arroll, B., Doughty, R., & Andersen, V. (2010). Investigation and management of congestive heart failure. BMJ, 341(jul14 2), c3657-c3657. http://dx.doi.org/10.1136/bmj.c3657
Lavie, C. & Ventura, H. (2013). Analyzing the Weight of Evidence on the Obesity Paradox and Heart Failure-Is There a Limit to the Madness?. Congestive Heart Failure, 19(4), 158-159. http://dx.doi.org/10.1111/chf.12040
Mahmood, S. & Wang, T. (2013). The Epidemiology of Congestive Heart Failure: Contributions from the Framingham Heart Study. Global Heart, 8(1), 77-82. http://dx.doi.org/10.1016/j.gheart.2012.12.006
