Mr. P is a 76-year-old male diagnosed with cardiomyopathy and congestive heart failure. Frequently hospitalized, he suffers from 4+ pitting edema, moist crackles throughout lung fields, and labored breathing as well as symptoms of depression. Additionally, the patient struggles with his diet restrictions and polypharmacy. The patient’s wife is saddened by the state of his health and her role as the only caretaker and finds her new duties of managing the medical bills difficult. This paper is concerned with finding the appropriate care approach and treatment plan for the patient, as well as educating the patient and his family on the specifics of his condition and ways to accordingly manage their life.
Approach to Care
Understanding the action of drug therapy and the pathophysiology of cardiomyopathy and CHF, along with other physical and mental conditions presented by the patient, is crucial for selecting an appropriate care approach. The professional should engage in objective monitoring to detect a change in signs and symptoms suggestive of response to treatment. As the patient is a believer, a congregation’s support would help to manage the pair’s depression symptoms that partly stem from lack of social interaction. The patient’s difficulties in maintaining his nutrition regime, detrimental to his condition, are to be addressed as well. Additionally, the RN’s role lies in answering the patient’s health-related questions, such as benefits and risks of surgical intervention, in a prompt and precise manner; effective communication is aimed at improving the patient’s quality of life.
As the patient is elderly, with multiple comorbidities and complex daily dose schedule, the home care treatment plan shall aim at monitoring the patient’s condition with the goal of alleviating the symptoms and avoiding re-hospitalization. As decreased cardiac output results in reduced blood flow to the kidneys, which is then interpreted as a reduction of the total blood volume, thus excessive fluid is retained. To address the severe pitting edema, therefore, the diuretic prescription needs to be revised, bed rest could be recommended in addition to appropriate nutrition management. The patient needs to be tested for cardiogenic pulmonary edema, highly comorbid with cardiomyopathy, as he presents the corresponding pulmonary symptoms. Thus, the RN could detect gallop rhythm and distended neck veins; the physician then adjusts the polypharmacy accordingly. According to Yancy et al. (2013), there is a need to monitor the blood pressure and evaluate the effectiveness of prescribed CHF medication, such as ACE inhibitors and beta-blockers.
Educating the Patient
Daily self-care is crucial to improving the patient’s quality of life. According to Rai, Sharma, Seth, and Pathak (2017), the patient should be educated in “medication adherence, low-salt diet, self-monitoring of symptoms, exercise, regular physician visits” (p. 29). The patient’s anxiety as to difficulties in managing his polypharmacy needs to be addressed by the RN; a pillbox organizer would be of assistance, an electronic version of the financial means, and learning abilities allow. Advance care planning is also recommended, as is CPR training. A qualified volunteer or social worker could provide financial education. A mental health professional could be employed if the financial situation permits; otherwise, a volunteer psychologist could educate the family on relevant mental health issues.
Comprehensible Teaching Plan
Having been informed on his life prognosis and the signs and symptoms of worsening HF, the patient and his wife should be taught to be responsible about his eating habits, as he should drink the appropriate amount of fluids and avoid salty foods while having regular weight check-ups. The patient should be taught to use the pillbox organizer to take his medication as prescribed. His wife’s well-being is to be addressed by joining the support group for relatives of sufferers of chronic illnesses, and Mr. P should regularly talk to a psychologist.
The RN is to address the patient’s medical needs, as well as educate him on drug compliance and aspects of his condition. However, without behavioral changes, life prognosis remains bleak. The patient’s adherence to both treatment and teaching plan should result in improvements in his quality of life.
Rai, M., Sharma, K. K., Seth, S., & Pathak, P. (2017). A randomized controlled trial to assess effectiveness of a nurse-led home-based heart failure management program. Journal of the Practice of Cardiovascular Sciences, 3(1), 28-33. Web.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H.,… & Johnson, M. R. (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology, 62(16), 147-239. Web.