The Pathophysiology of the Heart Failure - Case Study Example

I. Pathophysiology: The Pathophysiology of the Heart failure includes the failure of either both sides of the heart or the right or the left side ofthe heart. It may due to the systematic hypertension, aortic serosis. The left ventricular failure may cause the failure of the right ventricle. As a result of it the blood may back up in the circulatory system. The weakness or tiredness of Mr. Herbert may relate to the depletion of blood volume and electrolytes that occurs with vigorous diuretic therapy. This will lead to the decrease in the blood flow to the skeletal tissue and increased effort of the respiration. The Shortness of breathing is a common symptom in the heart failure. The Dyspnea of shortness of breath is caused because the fluids from the pulmonary capillary bed will normally spread in to the surrounding tissue. This consecutively results in the decrease of Oxygen exchange to the blood and the vital capacity of both the lungs. The shortness of breath is worse in exertion. It is a typical problem related to the heart failure The Dyspnea is also cause a feeling of nausea. “Nausea and vomiting are common symptoms of patients with terminal, incurable illnesses and can be distressing” (Perry & Samuel). In Herbert’s case it is caused by the breathlessness. Nausea is one of the problems among palliative care patients and “effective management of these symptoms can make a major contribution to improving quality of life in these patients.” (Nausea and Vomiting in Palliative Care). Care plan for nausea: There are seven steps in developing a nursing care plan for the patients who are suffering from nausea which is one of the symptoms of heart failure. The seven stages for the care plan are assessment, diagnosis, “inference”, planning, “intervention”, rationale and evaluation. (Nursing Care Plan for Nausea and Vomiting). 1. Environmental aspects: When the case of Herbert is referred, he is assessed and diagnosed with nausea in relation to the heart disease and type 2 Diabetes. The planning stage assumes that after one weak of nursing intervention, Herbert would be able to recover from nausea. Intervention stage is very important in this care plan. Hyper active sounds and smell must be avoided from the environment he lives. 2. Nutritional care: A particular food item may create abdominal problems and it is to be avoided. The care taker must know Herbert’s favorite food and the food items he does not like must be avoided. The weight of Herbert must be assessed every day. 3. Medication: It is found that “haloperidol” is very useful in the treatment for nausea and it is widely used to decrease the symptoms of nausea and vomiting. (Perry & Samuel). “Physical therapy” is also suggested for the palliative care. (Nursing Care Plan-Nausea & Vomiting). Rationale stage means controlling the environment in which Herbert lives by way of avoiding high sounds and smells he does not like. It would surely influence Herbert to recover from vomiting tendencies. The last step in the care plan is evaluation. The evaluation must be done in two ways. First one is the evaluation of entire care plan and the second one is the evaluation of improvement of the patient. Care plan for Dyspnea: 1. Medication: The tiredness and shortness in breathing of Mr. Bert is caused by the heart failure. But now Herberts condition has been reclassified as Class 111 Heart Failure. 1. “A review to assess the effectiveness of opioids in these patients found a small but statistically significant positive effect when opioids were administered orally or subcutaneously” (Jennings et al). The morphine is an effective medicine to treat the breathlessness. “Oral morphine 2-2.5 mg prn if opioid naive. This dose can be repeated every 4 hours, although frequent dosing may not be required and may be used in anticipation of exercise” (Breathlessness: Drugs for Symptom Control of Dyspnoea). It is found that the Hawthorn extract can bring effective result in the treatment of chronic heart failure. “The German commission E approved the use of extracts of hawthorn leaf with flower in patients suffering from heart failure graded II according to the New York Heart Association” (Rouling et al, 3). The dyspnea is a common and distressing symptom related with palliative care. “Nebulized furosemide, a common loop diuretic, has been tested as a treatment option for Dyspnia” (Newton et al). 2. Addressing the pain: Morphine can be given to Mr. Bert for the pain relief. “Like other pain relief it provides safe and effective pain treatment” (Palliative Care). 3. Atmosphere alteration: Altering the environment and atmosphere in which patient lives, such as cooling air, making low humidity, availability of fan, calm room and lightweight cloth will help the patient. This will help the patient to cooperate freely with the care plan. For example the presence of family members will increase the effectiveness of care Plan. “Any interventions that can be taught to the family will increase their feeling of wanting to help the individual” (Matzo & Sherman) 4. Reduction of cardiac work load: Physical and emotional rest is an important care plan needed to the Herbert’s case. Maintain always an upright or semi upright posture in bed of in the chair. It will help to the increase of vital capacity and decrease the work load of the heart in relation to the gravitational force. The trunk forward position will also help Mr. Herbert in severe dyspnea condition. This posture can be achieved by “leaning on an over bed table that has been padded with pillows” (JPhipps et al, 421). 5. Integrated approach: The palliative care of Mr. Bert case can be effective with the integration of various care disciplines such. “Integrated care pathways are utilized as structured multidisciplinary care plans which detail essential steps in caring for patients with specific clinical problems” (John & Roxanne). For example Mr. Bert also suffers stress related problems. This issue can be best deal with the medical social worker and the psychiatric professionals. The integrated approach with the primary health care provider and the care team along with the patient family members can evolve a well planned and complete treatment. The integrated team must include Doctors, nursed social workers, spiritual directors, nutritionists and psychiatrists and counselors. “Besides a physician and nurse, members of various disciplines, such as psychology, social work, nutrition, rehabilitation, pastoral care, pharmacology, speech therapy, and respiratory care, can be efficiently involved in patients care to address these needs” (Strasser et al). The multidisciplinary team is essential to the evaluation process of the prognosis and management of Herbert’s case. 6. Music therapy: Little researches have carried out about the importance of music therapies. Mr. Herbert suffer sever form of frustration during the treatment. This can affect the care plan negatively. This problem can be tackled with the use of music therapies “music therapists assist family and caregivers with coping, communication, and grief/bereavement” (John & Care). 7. Medically assisted nutrition: Mr. Bert always suffers the tiredness. Since he is having less appetite his nutrition is to be monitored properly. A medically monitored nutrition system shoud be added to his care plan “It is common for palliative care patients to have reduced oral intake during their illness. Management of this condition includes discussion with the patient, family and staff involved and may include giving nutrition with medical assistance” (John & Care). 8. Oxygenation: In severe distress Mr. Herbert’s can be assisted with the artificial oxygenation “Oxygen administration by nasal cannula at 4 to 6L/minute may also help to relive dyspnea and make Mr. Herbert more comfortable” (JPhipps et al, 421). Evaluation: The life limiting condition affects the social, mental, physiological and existential condition of Mr. Herbert. He has Frustration due to all these conditions. The better palliative care must ensure that the health needs of Mr. Herbert’s and his family has met completely. Hence it is very important to have an evaluation of the effectiveness of the multidisciplinary team in the palliative care. The evaluation of the two care plan can be carried out using the ad-hoc. Questionnaire is developed in 5.1 scales where the objective answers start from not satisfied at all to very satisfied. It is formulized in a way that the family members can also participated in the satisfaction assessment program. Top of Form “1. I received a call from the Symptom Control and Palliative Care Center nurse prior to my appointment with an accurate explanation of what items to bring to my appointment, as well as an estimate of how long the appointment would last. 2. I had adequate time with each member of the team to explain my symptoms/concerns. 3. Each member of the team was patient and caring. 4. The physician adequately reviewed my symptoms and the treatment plan with me and my family. 5. The written treatment recommendations I received were useful to me and my family. 6. I have followed the recommendations made as prescribed. 7. Overall, I felt I was helped” (Strasser et al). Works Cited Breathlessness: Drugs for Symptom Control of Dyspnoea. Patient UK. Web. 3 Aug. 2010. . Jennings, Anne Louise, et al. Opioids for the Palliation of Breathlessness in Terminal Illness. The Cochrane Library. 2010. . John, Bradt & Care, Dileo. Music Theory for End-of Life Care. The Cochrane Collaboration Cochrane Reviews. 2010. Web. 28 Jul. 2010. . John, Webster & Roxanne, Chan. End-of-Life Care Pathways for Improving Outcomes in Caring for the Dying. The Cochrane Collaboration Cochrane Reviews. 2010. Web. 28 Jul. 2010. . JPhipps, Wilma, et al. Shafer’s Medical Nursing–Seventh Edition. BI Publication PVT LTD. 1980. Print. Matzo, Marianne & Sherman, Deborah Witt. Palliative Care Nursing: Quality Care to the End of Life. Springer Publishing Company. 2006. Print. Module 1- Principle of Palliative Care. PCC4U. Web. 28 Jul. 2010. . Nausea and Vomiting in Palliative Care. EMIS. 2010. Web. 28 Jul. 2010. . Newton, Phillip, et al. Nebulized Furosemide for the Management of Dyspnea: Does the Evidence Support its Use. Journal of Pain and Symptom Management. 2008. Web. 3 Aug. 2010. . Nursing Care Plan for Nausea and Vomiting. Scribd. 2009. Web. 28 Jul. 2010. . Nursing Care Plan-Nausea & Vomiting. Nursingcrib.Com. 2010. Web. 28 Jul. 2010. . Palliative Care. National Institute of Nursing Research. 2009. Web. 28 Jul. 2010. . Perry, Perkins & Samuel, Dorman. Haloperidol for the Treatment of Nausea and Vomiting in Palliative Care Patients. The Cochrane Collaboration Cochrane Reviews. Web. 28 Jul. 2010. . Rouling, Gou, et al. Hawthorn extract for treating chronic hear failure (review). Wiley Interscience. Web. 3 Aug. 2010. . Strasser, Florian, et al. Impact of a Half-day Multidisciplinary Symptom Control and Palliative Care Outpatient Clinic in a Comprehensive Cancer Center on Recommendations, Symptom Intensity, and Patient Satisfaction: A Retrospective Descriptive Study. Journal of Pain and Symptom Management. Web. 3 Aug. 2010. . Read More