Approach to Care Treatment Plan and Patient Education

Case Study Cardiomyopathy and Congestive Heart Failure are two pathophysiologic changes of the heart that cause a major impairment in cardiac output up to a degree that ultimately results in decreased perfusion to vital organs (Smeltzer et al, 2010). These conditions have a chronic duration and therefore cause tremendous stress to the patient, family members, and significant others. In fact, medical interventions of both conditions not only focus on the cardiac pathology itself but on the prevention and maintenance of the remaining functions of other organs such as the liver, kidneys, and the lungs, among others. Apart from the diagnostic procedures, treatment regimen is usually composed of several drugs with different dosages and frequency of intake. In this paper, a case of a patient with Cardiomyopathy and Congestive Heart Failure will be covered including the general approach to care, treatment and teaching plan.Approach to CareMr. P, 76 years old, diagnosed of Cardiomyopathy and Congestive Heart Failure, was brought to hospital for management of acute exacerbations of symptoms. Aside from the peripheral edema, crackles in lung fields, and dyspnea, further evaluation revealed that the patient is having a difficulty complying with the diet restrictions and drug regimen. In this case, approach for the patient should include the stabilization of the condition, patient and care-giver education, and psychosocial support.Treatment PlanPhysiological stabilization is comprised of ventilation assistance, hemodynamic regulation, and energy management (Ignatavicius amp. Workman, 2010). Specifically, ventilation assistance should focus on assessing respiratory rate and rhythm, administration of prescribed supplemental oxygen, proper positioning to promote optimal lung expansion and minimize respiratory efforts, and regular auscultation of breath sounds to discover areas of decreased or absent ventilation and presence of adventitious sounds. Furthermore, hemodynamic regulation should focus on monitoring heart rate and rhythm, peripheral pulses, monitoring intake/ output, urine output, changes in patient weight, and prompt administration of prescribed inotropic medications. Moreover, energy management should focus on monitoring the patient’s cardiopulmonary response to activity and determination of the physical limitations. All these measures form the vital components of patient care to promote functional mobility and prevent aggravation of the condition. Patient Education Needless to say, it is necessary that the patient and his care-giver receive clear information using simple language about the condition to promote compliance with the treatment regimen. Thus, in explaining the disease process, inform him simply that the heart does not pump as effectively as it should (Benbow, 2009). More often than not, the patient’s need for further information should guide the content of the teaching plan instead of overloading the process with information he is not currently interested. Discuss with the patient that shortness of breath happens because of blood backing up in the blood vessels from the lungs and that the heart cannot keep up with the supply. And tell him that the same mechanism happens in the tissues that cause edema or swelling. Since patients with heart conditions are usually prescribed with low- sodium diet to prevent sodium and water retention, problems with compliance usually arise because of the unusually bland food taste. The rationale for adapting such diet restrictions should be reiterated to the patient by pointing out the cardiovascular effect of water retention. If necessary, a dietician may be consulted for alternate food selection. For instance, herbs and lemon may be used to improve the taste of food instead of salt. Aside from the diet, teaching plan for Mr. P should also include the discharge medications, activity level, and weight monitoring. It is essential to identify the specific medications prescribed for the patient to enhance teaching. For example, in explaining the purpose of ACE inhibitors (captopril, enalapril, etc.), beta- blockers (metoprolol, atenolol, etc.), and vasodilators (hydralazine, isosorbide, etc.), use simple phrases like it can open up your blood vessels to reduce your blood pressure. For diuretics (furosemide, hydrochlorothiazide, etc.), tell the patient that it reduces fluid in the body to decrease the work of the heart. For anticoagulants (warfarin, heparin, etc.), tell the patient that it thins the blood to prevent it from clotting. Lastly, for digitalis preparations (digoxin), tell the patient instead that it increases the function of the heart to pump blood (Smeltzer et al, 2010). ReferencesBenbow, DA. (2009). Heart failure: Educating your patient can help prevent readmission. Nursing Management, 40 (9), pp. 5-7. Philadelphia, PA: Lippincott Williams amp. Wilkins.Ignatavicius, DD amp. Workman, ML. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed). St. Louis: Mosby.Smeltzer, SC, Bare, B, Hinkle, JL amp. Cheever, KH. (2010). Brunner and Suddarths textbook of medical-surgical nursing (12th ed). Philadelphia, PA: Lippincott Williams amp. Wilkins.

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