The Management of Cardiomyopathy and CHF

Ms. A. is suffering from hypochromic, microcytic anemia (Siegenthaler & Aeschlimann, 2007). Normally, the body of such a patient cannot meet the demand for iron because of dietary deficiency, chronic blood loss, or defective absorption (Nayak, 2008). This type of anemia is characterized by absent or low levels of iron, low concentration of serum iron, elevated transferrin (capacity to bind iron), low transferrin saturation, and low hematocrit or simply hemoglobin concentration.

Rationale

Parameters Levels/Lab values
Hemoglobin 8g/dl
Hematocrit 32%
Erythrocyte Count 3.1×10/mm
Reticulocyte count 1.5%
Red blood smear showed microcytic and hypochromic cells

Symptoms

Shortness of breath Worse during menses
Low levels of energy and enthusiasm Light-headed
The temperature of 98 degrees F An elevated heart rate and respiratory rate
Low blood pressure, stiffness in joints Menorrhagia and dysmenorrheal

More information has been used to show the differences between hypochromic microcytic anemia and other types of anemia. Red cell indices, for instance, give information regarding the red cell hemoglobin concentration (MCHC) and the average red cell volume (MCV). MCV is used to differentiate between hypochromic, microcytic anemia from normocytic anemia (Nayak, 2008). Estimating hemoglobin in each red blood cell is important, particularly when determining the total number or level of blood hemoglobin (Siegenthaler & Aeschlimann, 2007). In other words, the number of red blood cells and hemoglobin levels are important for the diagnosis of hypochromic microcytic anemia.

Test: Reticulocyte Count

Normally, this test is used to estimate the level of reticulocytes in the blood. Generally, reticulocytes are immature red blood cells. Normal Values are approximately 1 percent of normal red blood cell counts (50,000) as indicated in the table above. However, the range of 0.5-1.5 percent is used because the results usually vary (Nayak, 2008).

Test: Red Blood Cell Count

This is usually done to estimate the number of red blood cells per cubic mm of blood. As it has been established, normal Values for males fall within a range of 4.5- 6.0 million/ cubic mm blood and for females within a range of 4.0 – 5.5 million/ cubic mm blood.

Test: Hematocrit

This test, the hematocrit test, is used to measure the percentage of RBCs in a particular volume of blood. For instance, it has been established that a hematocrit of 40 percent indicates that a 100-milliliter blood sample contains exactly 40 milliliters of blood cells (Siegenthaler & Aeschlimann, 2007). For persons who are normal, their values fall within a range of 37 to 47 percent for females and 40 to 50 percent for men.

Test: Total Hemoglobin

The total hemoglobin test is used to determine the amount or content of hemoglobin in the whole blood. As it has been established, normal Values for men fall within a range of 12-17 grams/100ml ad for females within a range of 11-15 grams/100ml (Nayak, 2008). Since all these values are outside the normal range, Ms. A. is suffering from the hypochromic microcytic anemia.

Cardiomyopathy and Congenital Heart Failure

Congestive heart failure (CHF) simply means, the heart cannot function properly ( Abraham & Baliga, 2009). At times, due to low pressure, blood may pump back into the arteries and lungs. Cardiomyopathy, on the other hand, is a weakened heart. Cardiomyopathy and CHF are closely related but not linked.

Patient-centered care approach

My approach to care will be a continuum of strong medical management, together with implantable devices. In an advanced situation, the patient will be assessed for heart transplantation and ventricular assist devices ( Shaddy, 2011). The most important thing is that this approach will be cautiously integrated with patient education in order to empower the patient, enhance outcomes and eventually reduce hospitalizations that are currently being witnessed. Importantly, the approach will also offer the patient with the disease novel therapeutics at all stages.

The Treatment

There are various types of Cardiomyopathy including:

  • Dilated Cardiomyopathy. In this case, the left ventricle is enlarged, making it hard for the heart to function efficiently (Siegenthaler & Aeschlimann, 2007).
  • Hypertrophic Cardiomyopathy. In this case, the heart muscles are highly thickened affecting the ability of the heart to pump blood.
  • Restrictive Cardiomyopathy. In this case, the heart is highly rigid meaning that its pumping ability is weak therefore, the heartbeat cannot fill will blood.

Essentially, the treatment approach of cardiomyopathy is similar to that of chronic heart failure. The recommended treatments include medicines, surgery, lifestyle changes, and an Implantable rhythm control device to correct abnormal heartbeats.

Healthy Diet and Physical Activity

Physical activity and a healthy diet are important in human life. A healthy diet comprises a variety of vegetables, fruits, and grains. The larger portion of grains should be obtained from whole-grain products ( Shaddy, 2011). In addition, the patient should take foods that do not have a high content of fat or cholesterol. Most importantly, the patient should stick and observe the diet strictly as advised by the nutritionist.

Medication

In general, the main elements of medical therapy are afterload reduction, preload reduction, airway support, and diuresis. In this patient, since he has severe refractory pulmonary edema, the best medication would be the use of bimodal positive airway pressure or continuous positive airway pressure as they have the ability to avert intubation (Siegenthaler & Aeschlimann, 2007).

The method of Education

The best method of offering education to this patient and the family is group visits. This method involves the patient, his family, and the people who have the same or similar chronic diseases. This method allows physicians to deliver self-management instruction and extensive patient education ( Shaddy, 2011). In addition, group visits will offer the sick person an opportunity to actually interact with people who are suffering from illnesses and maybe learn from one another.

Teaching Plan

Since the patient is just one, the teaching plan will be very simple, but learner-specific.

Parameters
Overview: An Overview about the topic at hand:
management aspects of CHF and Cardiomyopathy
goal(s): The outcome: want my patient to attain: Know how to manage the condition alone
objectives: The more specific information or facts that the patient will obtain from the lessons knowing will help achieve the goals set.
content: The content will address and cover all the set objectives.
procedures and materials: how the objectives will be attained: stories,
Demonstrations, handouts, audio-visuals, experiments.
evaluation: Determining whether the goals were met. This will be done through a short post-test, a return demonstration, a short question as well a return answer session with the patient in order to verify his level of understanding.

References

Abraham, W., & Baliga, R. (2009). Cardiac resynchronization therapy in heart failure (8th ed.). Philadelphia, Pa.: Lippincott Williams & Wilkins.

Nayak, P. (2008). MCQs in pediatrics with explanatory answers (7th ed.). New Delhi: India: Jaypee Brothers Medical Pub.,.

Shaddy, R. (2011). Heart failure in congenital heart disease: from fetus to adult. London: United Kingdom: Springer.

Siegenthaler, W., & Aeschlimann, A. (2007). Differential diagnosis in internal medicine from symptom to diagnosis; 323 tables (6th ed.). Stuttgart, NY: Thieme.

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