Cardiovascular Disease: Living with Congestive Heart Failure - Case Study Example

A Case Study On Cardiovascular Disease: Living With Congestive Heart Failure (Your Name) (Details) I. Introduction Congestive Heart Failure is an ailment faced by many people all over the world. The drive to cure is hoped for by all patients experiencing the pains and tribulations of the disease. Today, the many possibilities for the palliative care of the long term ailment are made probable through various medications and through the latest research hoping to derive a cure for the chronic illness. According to Silvestri (2005), heart failure is described as the inability of the heart to maintain adequate circulation to meet the metabolic needs of the body because of an impaired pumping ability. (pg. 796) Due to the condition, the entire lifestyle of a human being is compromised and is drastically changed. A person with such illness could no longer live with the everyday stress of life. Measures should be taken to alleviate the condition and should strictly be followed in order to end up with a good prognosis. The subject of this case is my patient, Mr. Richard Deo, a 55 year-old man who is suffering from the qualms of Congestive Heart Failure. For five long years, he has endured the tormenting effects of the illness. It captured him, his work, and the things that he normally does everyday. In the hopes of still having a longer life, he has been trying to find ways to alleviate, if not cure, his ailment. Like any other human being, the instinct to linger at a stretched time here on Earth is felt by the ones who are in misery because of a disease. Each of them has hopes of getting well again and of having to continue towards the future with their loved ones. As health care providers, we must do all measures to let them live a comfortable life despite their chronic illness. By all means, we should render utmost care for these patients who are being buffeted by the realities of Congestive Heart Failure. II. Issue The Disease Process Like many other diseases, Congestive Heart Failure is characterized by chronic and irreparable pain. As stated by Black (2003), the patient manifests pain mainly through the lack of oxygen supply delivered to all other parts of the body. (pg. 342) Usually, intolerable pain is felt upon the inhalation process; this is the very reason why breathing and relaxation methods should be taught to the patient. If not, the client would not feel in control of the situation and would panic all the more resulting to too much stress that the weakened body could no longer handle. According to Potter and Perry (2007), the patient, like any other human being, goes through the stages of grieving after having learnt about the disease condition. (pg. 323)At first, the person feels anger and resentment followed by the paths leading to the acceptance of the problem. Also, if the patient can no longer do the activities of daily living, he usually resorts to problems like self image disturbance or ineffective individual coping, as stated by Nanda (2005) (pg411) The outcome therefore is dependent upon the patient's progress and upon his willingness to participate in the activities which would help alleviate the perilous condition. With regards to self care, the patient could still do some activities provided that it's limited and is based upon the energy level. If the symptoms persist or worsen after every purposeful activity, then it would highly be suggested that all stressful activities should be avoided by the patient. Proper explanation of the outcomes should then be further explained to make the ill person comprehend the importance of rest in the disease process. In caring for patients with Congestive Heart Failure, the activities provided for the patient should properly be planned and implemented in order not to exhaust the patient and at the same time would benefit him in many ways. Living With And Dying With Chronic Illness Patients with congestive heart failure suffer too much from the stress that the disease brings. The adaptive mechanism usually varies from person to person; in the case of our patient, he has been living with the disease for already five years now. A lot of changes took place in his life; however, he was able to cope with it through the support that the health team brings. Also, Mr. Richard Deo stated that the best support he got was the one coming from his family. He could not have dealt with the problem if not for the incessant care and support that his family outpours on him. From time to time, the period of stress and anxiety is always felt by the patient, this could never stop on going this way because of the unrelenting symptoms that is experienced by the person. Also, the sick individual may feel hopeless about the condition. But as mentioned, if proper physical and emotional care is rendered, prolonging the life of the ill person is made truly possible. The pain associated with Congestive Heart Failure is developed by the patient through time. This can only be alleviated through the use of certain medications such as Morphine Sulfate. However, the use of such has become very controversial and shall therefore be controlled and monitored from time to time. Also, the patient may divert to other pain relief remedies such as touch and music therapy. Both are proven to be beneficial in closing the gateways of pain. The annual mortality rate ranges from 10% to 50% for those with heart failure, and the rise and fall of these rates only depend on the severity of the ailment. If the condition is diagnosed earlier, the prognosis could turn out to be much better; but unfortunately, if the person is going through the last stages of the disease, then we could hope for nothing except to care more and to make the remaining time of the patient more meaningful. What is important is to make the patient's experience with the disease a more comfortable one. Although it is never easy to mend a chronic disease, it will surely be possible with all the help of the health care team plus the undying family support. Quality of Life When the disease has finally captured the patient, all we could do is stop it from progressing and maintain the quality of life that the ill person deserves to have. This can only be maintained through relationships formed between health practitioners and the family of the sick individual. Quality of end of life care includes: adequate pain and symptom control, appropriate use of life sustaining treatments, and support for patients and their families. (Health Canada, 2002, pg. 80). Palliative care is rendered when the disease becomes very life-threatening that is usually experienced towards the advanced stages of the disease. Its goals are directed toward the family and most especially the sick individual. If the individual is not properly guided by the people surrounding him, it may result to depression and hopelessness. Such things could lead to noncompliance of the treatment plan, and may also limit his remaining capacities in life. In one way or another, the patient could become dependent to those around him. Such facts could lead to disability of the patient's body functions, thus the quality of life is not met. It is therefore important to have the patient plan his daily activities with you and to always incorporate socialization in those actions. If not, the sense of control over oneself is lost and problems will come to arise all the more. Based on research, the most distressing of all is the pain management. Almost 80% of the ill patients suffer from pain in the disease process. To alleviate this, proper treatment and comfort measures should be instituted. As much as possible, the goal of the team is to maintain a pain-free disease process. However, if total elimination is not possible, then the next step is to redirect the patient to another activity. In rendering care, the whole team must portray their own roles in order to give 100% care to the patient. Culture Language barrier is perhaps one of the most controversial issues in taking care of the sick. Usually, when a practitioner takes care of another race that is not the same as his own, problems tend to arise. However, if dealt with much professionalism, the troubles could just die down in no time. Since culture is different for every nation, the tendency for it to become a major impact in the recovery process is vital. Cultural ties are one aspect of care that we must deal with. At times, patients would resort to another type of cure because they believe in no medicinal treatments. Also, the family of these patients can become a factor in the decision making toward the treatment. It affects greatly because the patients rely on their own belief for decisions. Culture is definitely one thing that we should not pout aside. Another part of cultural which is sensitive is that of the religion. Some individual practices prohibit blood transfusion and some may even refuse the care given. We, as health practitioners, should remember that touch is not always accepted in all cultures. Some may regard touch as disrespectful while others may view at is comfort and compassion. Before rendering care, know first the values of your patient so that you can establish trust right away. In some cultures, they view illness as a punishment for their sins. They believe that it is only right for a person to suffer if he or she has done a lot of mistakes in life. This type of situation can drive to the non-0belief for cure. The family and the patient himself would rather accept the illness as some sort of punishment. Refusal of care given thus follows. Although we can never set aside cultural, it is important and lawful to consider their beliefs. What is right for them may not be proper for us. But then again, it is their own decisions that will be followed. As practitioners, our only main goal is to explain the implications of every step that we make. Ethics In the treatment plan of the sick person, all legalities and ethics must be dealt with the most delicate care. Issues like this are to be tackled with full respect and at the same time with accordance to the law. Everything should be observed at all times to prevent problems with the patient and his family members. One ethical issue commonly talked about in Congestive Heart Failure is the use of Morphine Sulfate. This drug is given to alleviate the pain that the patient feels. However, the respiration effort can be aggravated at the same time. So the practitioner then decides which would do most good to the patient; and when he comes up with that decision, he is sure that he is prolonging the life of the patient. In every disease case, the essential thing to remember is to do the best possible means of saving life and not compromising it. Although it is difficult to do, joined decision making by the health team will be the key to success. In the treatment plan of the ill individual, it is important to consider his rights as a patient. These rights include the power to refuse medication and treatment, and the power leave the hospital premises in his own accord. Whether or not it would be safe for him, the decision still depends on the patient himself. With regards to culture and ethics, the view of a person with a chronic disease usually depends on the person itself. All of them though, goes through the five stages of grieving; but to lead to acceptance is the one question we could never answer. However, as the nurturers to these patients, our role is to guide them and make them feel supported through the course of their disease. Family issues need to be faced as well; the closeness and lack of support from the family are two of the things that we must look into. Encouragement is one good aspect that we must carry with us in order to support the ill patient. The Multidisciplinary Team In the treatment and rehabilitation process, we need to decide on as to who does the main treatment, the therapies, and all other key areas which will be needed by our patient. In planning, we must keep in mind that Congestive Heart Failure needs only palliative and supportive care. The total eradication of the problem may be unfeasible because the illness does not generally go away; the symptoms however, worsen through time. The only good thing left is that the symptoms can be treated although it's not already possible to cure it. Calling for the right cardiologists would be necessary in planning the best possible treatments for the ill person. Nurses are also given the responsibility of bridging between the client and other personnel of the health care team. Occupational and respiratory therapists could be given included in the team too. Medical technologists are responsible for drawing sample bloods that the patient may need in evaluating further the state of his disease. The General Practitioner, being the most important in the team, needs to plan everything and set out realistic goals for the patient. From the medication, to therapies, and even home care, the General Practitioner tells when and how these things will happen. He is therefore the head of every plan and the master of every activity. Without the General Practitioner, all else in the team will not be able to function. Working hand in hand and setting realistic goals for the patient are the best possible ways to not aggravate the patient's condition. If the team works on a great deal of effort, it would truly be possible to lengthen, and still preserve the remaining lives that our patients ought to live. In the case of my patient, Mr. Richard Deo, the whole multi disciplinary team is directed towards alleviating the symptoms in the most comfortable way for him. The plans are given accordingly with much rest periods and with activities that would interest him. Incorporating activities that he would consider a leisurely time would a good thing to do. Self Management When a person is sick, hospitalization is one of the most exhausting issues for them. The patients would rather be confined at the comfort of their homes rather than staying at the hospitals and institutions for long periods of time. In the care though, the importance of the family support is greatly stressed out and needs to be checked by the health team to ensure that the patients receive total care at home even after the admission. Pain control and rehabilitation is one of the areas that we must look into. Patient controlled analgesia would be necessary for the patients who are undergoing severe types of pain. As stated by Mosby (2003), clients have to be in full control over their pain; the need for a PCA is then highly suggested and other ways for pain management shall be looked into. (pg. 451) Medications are available in wide array of choices. The doctor prescribes for the dispersal of these medications; thus, it is controlled and should be checked on with the physician form time to time. Administration should also be done well at home since the drugs are highly restricted and controlled. Some of the most important medications according to Suddarth (2003) are: Morphine Sulfate – prescribed to provide sedation and vasodilation, there is a need to watch out for respiratory depression Diuretics – to reduce the heart preload and enhance the excretion of sodium and water and also reduces the congestion Digitalis – increases ventricular contractility and improves cardiac output Bronchodilators – for bronchospasm and bronchoconstriction Inotropic Medications – enhances contractility and stroke volume Vasodilators – for increased capacity of the systemic venous bed and decrease venous return to the heart (pg. 342-343) According to Lipincott (2003), all the side effects that should be watched out for is provided in his handbook. The guidelines should be met by the patient through the care givers at home and in the hospital. (pg. 167) The resources are easily attainable and accessible since it can be found in hospitals and institutions. Calling over for additional help may also be done so by the responsible care givers. Anytime, one of the health team members can visit you at home if you have any problems. Also, if you do not have your family staying with you, prearranged home visits could be provided for by the hospital that you are in. Congestive Heart Failure is quite manageable if given the proper attention. Support from oneself, the family and other people are greatly needed to guide you in both the treatment plus the recuperating process. Positive outlook is also needed in order to surpass and overcome the bumps along the way. Spiritual guidance may also have a big impact in the way to recovery. As much as possible, the health care providers should meet all the requirements that the ill patient must be given with. If all these will be incorporated, then the rehabilitation process will be much easier to deal with. III. References Websites American Hospice Foundation www.americanhospice.org,index.html www.caregiver.com Books Silvestri, L. (2005, June 15). Comprehensive Review For The NCLEX RN. Elsevier Publication, pg 796. Black, J. (2003, November 18). Medical And Surgical Book. C&E Publishing, pg. 342. Potter and Perry (2007, March 27) Fundamentals of Nursing. Mosby, pg. 323. Nanda (2005-2006, May 23). Nanda Nursing Diagnosis: Definitions and Classifications. Nursecom, Inc, pg. 411. Mosby (2003, May 16) Mosby's Comprehensive Review of Nursing for NCLEX-RN. Mosby, pg. 451. Young, J (2007, March 1). Brunner and Suddarth: Medical Surgical Nursing. Lippincott Williams and Wilkins, pg. 342-342. Karch, A. (2003, April 17). Lippincott's Nursing Drug Guide. Lippincott Williams and Williams, pg. 167. Webster, M. (2002, March 12). Medical Desk Dictionary. Meriam Webster, Incorporated, pg. 309. Read More