Case Study 2: The Approach Should Include A Combination Of N ✓ Solved

Case Study 2the Approach Should Include A Combination Of Nutritional T

The approach should include a combination of nutritional therapy as well as medication and other treatments. The home-based care program consisted of weekly home visits by a physician and a nurse. During visit, they have to assess the condition of patient, review of medications and made any necessary changes. Along with that, the needed laboratory tests were examined and the intravenous diuretics were administered. The patient compliance with the dosage regimen should also be determined on the basis of pill count which is followed by assessment of patient’s physical status.

Since, the patients had poor knowledge about the regimen or poor compliance he must need the additional intervention. Moreover, the information derived from the home visit must be provided to the patient’s primary physicians. During initial visit, the nurse must educate and counsel the patients on the management and on behavioral techniques to enhance the compliance. It must be followed by telephone calls every week for 6 weeks with continued counseling so that he must be adhered to the diet and drug regimen plan as well as the self-monitoring of symptoms (Grady, et al., 2000). The treatment plan should include the airway management as it is the critical first step.

It is required since the elderly with heart failure can promptly fatigue and may require the emergent intubation. The diuretics such as Furosemide should be used to decrease the venous congestion however, the use must be regulated as in the elderly, there is age-related decline in the renal function as well as the decreased circulating volume (Emergency Physicians Monthly). For pulmonary edema, the morphine and IV nitrates should be used. Moreover, the symptoms caused by fluid retention may be treated with diuretic followed by the weight monitoring. Additional treatments include the use of ACE inhibitor according to the tolerability, β-blockers, digoxin or spironolactone.

The angiotensin antagonists are also used in patients in whom ACE inhibition is contraindicated (Gillespie, 2005). The education and counseling of heart failure patient are the essential part of patient care. It may reduce the re-admission of these patients along with cost of care. The education can be provided through mailing the personalized educational materials in which main emphasis was done on self-care and the recommended health behaviors were promoted (Serxner, Miyaji, & Jeffords, 1998). The wife can be educated about the risk of contracting the disease.

Along with that, the history of the wife should also be assessed to determine her risk of contracting the disease due to hypertension. Moreover, the overviews of associated symptoms, activity and exercise, dietary recommendations, and medications are taught to patient and his wife. The written materials and videotapes can also be used as the additional resource for patient education (Quaglietti, Atwood, Ackerman, & Froelicher, 2000). The teaching plan may involve the following steps: · Understanding the symptoms of heart failure is the primary topic to begin the teaching as many patients do not understand the term “heart failureâ€. It must be explained clarifying the expected symptoms of heart failure and worsening failure. · Watching a video regarding cardiomyopathy and heart failure in which the patient and his wife can watch the effects of the disease. · Counseling related to dietary habits and recommendations as well as the activity and exercise. · Patients should be taught the name and purpose of drugs used, their dosage, frequency, and the side effects if any.

Moreover, a written medication schedule should be given to him to reduce the adverse affect of polypharmacy on his daily life, compliance, and drug interactions (Francis, 1998). The main objective of education and counseling are to assist the patients to comply with the drug regimen, to maintain the clinical stability and function, and thereby improve the quality of life. These objectives can only be achieved if the patient and family are having knowledge about every aspect related to the condition and treatment and take active participation in the plan of care (Regan, 1990).

Sample Paper For Above instruction

Chronic heart failure (CHF) among the elderly is a complex condition requiring an integrated approach to management that encompasses medication, lifestyle modifications, patient education, and family involvement. For patients like Mr. P, whose condition is exacerbated by poor compliance and inadequate understanding of his regimen, a comprehensive, patient-centered care plan is essential to improve outcomes and quality of life. This essay explores the treatment approach, patient education methods, and a structured teaching plan tailored to Mr. P’s circumstances, emphasizing the importance of multidisciplinary intervention.

The foundation of Mr. P’s care involves a multidisciplinary team that includes physicians, nurses, dietitians, and social workers. Regular home visits by healthcare professionals are crucial, allowing for continuous assessment of his clinical status and reinforcement of therapeutic goals. During these visits, thorough review of medication adherence through pill counts, assessment of physical signs like edema and lung crackles, and review of laboratory results are performed. These assessments guide medication adjustments, such as optimizing diuretic therapy with Furosemide, which must be carefully regulated in the elderly due to age-related decline in renal function (Emergency Physicians Monthly). Moreover, interventions like morphine and nitrates address pulmonary edema, while ACE inhibitors, β-blockers, and spironolactone are incorporated according to tolerability, aiming to reduce cardiac workload and manage fluid overload (Gillespie, 2005).

Equally important is the education and counseling of Mr. P and his wife. Effective patient education reduces hospital readmissions and enhances health outcomes by empowering patients to manage their condition proactively. The initial education session should include explanations of heart failure symptoms, emphasizing understanding of signs like edema, shortness of breath, and fatigue. Visual aids, such as videos illustrating the pathophysiology of cardiomyopathy and heart failure, can improve comprehension (Quaglietti et al., 2000). Personalized educational materials should be provided, covering medication purposes, dosing schedules, potential side effects, and the importance of lifestyle modifications such as salt restriction, fluid management, and activity planning. Family members, especially spouses, should be actively involved in these discussions to foster a supportive environment and recognize early warning signs (Serxner, Miyaji, & Jeffords, 1998).

The teaching plan should follow a phased approach: starting with understanding the disease process, progressing to practical aspects like medication management and symptom monitoring, and ending with motivational strategies to promote adherence. Patients should be taught to record their weight daily, recognize worsening symptoms, and maintain fluid and dietary restrictions. Use of written schedules, reminder notes, and videotaped instructions supports retention of key concepts. Additionally, scheduled follow-up calls serve as reinforcement, addressing questions and providing encouragement to sustain behavioral changes (Francis, 1998). Addressing emotional and psychological aspects, such as Mr. P’s feelings of despair and his wife’s overwhelmed state, is vital. Counseling services or support groups may be recommended to address mental health needs and promote resilience (Regan, 1990).

In conclusion, caring for elderly CHF patients like Mr. P requires an integrated approach that combines clinical management with robust patient and family education. Regular home visits, personalized teaching plans, and ongoing counseling are instrumental in improving adherence, reducing hospitalizations, and enhancing overall quality of life. Recognizing the unique needs of each patient ensures that interventions are both effective and sustainable, ultimately fostering better health outcomes and a higher sense of well-being.

References

• Gillespie, N. D. (2005). The diagnosis and management of chronic heart failure in the older patient. British Medical Bulletin, 49-62.
• Grady, K. L., Dracup, K., Kennedy, G., Moser, D. K., Piano, M., Stevenson, L. W., et al. (2000). Team management of patients with heart failure. Circulation, 102.
• Emergency Physicians Monthly. Geriatrics: Managing Congestive Heart Failure. Retrieved from [source]
• Serxner, S., Miyaji, M., & Jeffords, J. (1998). Congestive heart failure disease management: a patient education intervention. Congestive Heart Failure, 4, 23–28.
• Quaglietti, S. E., Atwood, J. E., Ackerman, L., & Froelicher, V. (2000). Management of the patient with congestive heart failure using outpatient, home, and palliative care. Progress in Cardiovascular Diseases, 43(3).
• Francis, G. (1998). Approach to the patient with severe heart failure. In E. Rose & L. Stevenson (Eds.), Management of End-Stage Heart Disease (pp. 39–52). Lippincott-Raven.
• Regan, T. J. (1990). Alcohol and the cardiovascular system. JAMA, 264, 377–381.