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Introduction
Chronic heart failure (CHF) is among the leading causes of hospitalization for elderly patients. Approximately 50% of hospital re-admissions are attributed to co-morbidities connected to CHF (Azad & Lemay, 2014). This paper examines the case study of Mr. P, a 76-year-old patient with CHF and cardiomyopathy, and proposes an approach to care, treatment plan, and education plan.
Approach to Care
The major treatment goals are to relieve symptoms and deter disease advancement and hospitalization. There is a need to maintain the patients functional capacity, manage co-morbid disorders, create a suitable home environment, address caregiver issues, and put an emergency response system in place (Azad & Lemay, 2014). The patient should receive a customized disease management strategy to manage the disease and promote medication adherence. Counseling sessions are also necessary for Mr. P to address his despondence and encourage him to continue having the will to live. Mr. Ps wife also needs counseling to encourage her to continue caring for her husband.
Recommended Treatment Plan
Stability for Mr. P can be achieved by ensuring a stable fluid balance, a systolic blood pressure of at least 100 mmHg, and a stable heart rate ranging from 60 to 85 beats per minute. Co-morbid conditions can be managed by ensuring medication adherence. Since the patient has multiple medications, developing a medication schedule will help promote adherence. One strategy of addressing polypharmacy is conducting medication reconciliation to ensure that he takes the minimum number of drugs required to manage the co-morbid conditions (McNeil, Kamal, Kutner, Ritchie, & Abernethy, 2016). A labeled pillbox with specific drugs to be taken at specified times can be helpful in maintaining medication adherence.
Dietary modifications are also necessary for CHF management. Mr. P is reported to have difficulties maintaining his diet restrictions. This problem can be solved by customizing his meals to include his favorite foods while considering diet restrictions for his condition. Mr. P should take regular meals in small quantities. I would advise Mr. P to be physically active by doing low-intensity exercises for at least 5 minutes with gradual increments. Exercise is reported to lower neurohormonal activation, thereby leading to enhanced endothelial function, physiology of skeletal muscle, and professed quality of life (Kitzman et al., 2016). Mr. P appears depressed, as indicated by his despair. I would prescribe a selective serotonin reuptake inhibitor and reduce sympathetic nerve activity using beta-blockers (Azad & Lemay, 2014). The patient suffers from edema, which is linked to congestion and loss of breath. I would induce diuresis to manage fluid retention by administering a loop diuretic such as furosemide (Pellicori, Kaur, & Clark, 2015).
A Method to Provide Education
A palliative care approach is appropriate for CHF patients with advanced disease. I would make use of an end-of-life approach when providing education to improve the patients quality of life and tackle the caregiver challenges. To prevent and relieve suffering, there is a need to identify and treat bodily and physiological symptoms promptly (Kelley & Morrison, 2015). It is also necessary to consider the social and spiritual aspects of care. Overall, a holistic approach to care should be provided. The patients physician needs to instigate end-of-life care discussions, even though all providers caring for the patient should be involved.
Teaching Plan
I would educate the patient and his wife regarding ways of promoting medication adherence, for example, using a customized pillbox and setting alarm reminders. I would encourage the patient to stick to the stipulated diet for his wellbeing. I would also ask him to engage in regular exercise. I would ask Mr. Ps wife to seek help from other family members, for example, their children or close friends. I would also encourage the patients wife to contact the clinic if the patients symptoms worsen or if she needs medical advice while at home.
Conclusion
Multiple co-morbidities among elderly patients complicates the management of CHF. This patient population, alongside their caregivers need adequate support from their healthcare providers to manage the disease effectively. Therefore, providers provide holistic care and improve the quality of life of CHF patients.
References
Azad, N., & Lemay, G. (2014). Management of chronic heart failure in the older population. Journal of Geriatric Cardiology: JGC, 11(4), 329-337.
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755.
Kitzman, D. W., Brubaker, P., Morgan, T., Haykowsky, M., Hundley, G., Kraus, W. E.,& Nicklas, B. J. (2016). Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: A randomized clinical trial. JAMA, 315(1), 36-46.
McNeil, M. J., Kamal, A. H., Kutner, J. S., Ritchie, C. S., & Abernethy, A. P. (2016). The burden of polypharmacy in patients near the end of life. Journal of Pain and Symptom Management, 51(2), 178-183.
Pellicori, P., Kaur, K., & Clark, A. L. (2015). Fluid management in patients with chronic heart failure. Cardiac Failure Review, 1(2), 90.
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