Clinical Reasoning Cycle for Heart Failure Patient

The presentation is based on a case study regarding Mr. Tomasi Joni, a 56 year old male of Fijian background. The presentation will include a clinical reasoning cycle that will identify the health risks of the patient from the case study. This presentation will also cover SMART goals for the patient and both pharmacological and non-pharmacological interventions for reducing health risks.

Introduction
■ The presentation is based on a case study regarding Mr. Tomasi Joni, a
56 year old male of Fijian background.
■ The presentation will include a clinical reasoning cycle that will
identify the health risks of the patient from the case study.
■ This presentation will also cover SMART goals for the patient and both
pharmacological and non-pharmacological interventions for reducing
health risks.
Name of the Student
Name of the University

Consider the pt, collect cues and
information
■ Mr. Joni has been identified to suffer from the complication of heart failure
■ It is anticipated that an estimated 300,000 Australians suffer from chronic heart
failure(AIHW, 2019)
■ Roughly 30,000 new cases of heart failure are diagnosed every year (AIHW, 2019)
■ The patient’s previous history of hypertension (142/96mmHg) and acute myocardial
infarction (AMI) increases his risks of suffering from the complication since flow of
blood to the cardiac muscle gets abruptly cut off, thereby leading to tissue damage
■ His obs also indicate that he demonstrates signs of hypertension, dyspnea,
hypercholesteromia, obesity, and hypothermia
■ He is under medication for angina and hypertension (metoprolol), gout and kidney
stones (allopurinol), and pain management (aspirin)

Process information and identify
issue
■ Heart failure is generally caused due to events
that decrease the efficiency of the cardiac
muscles, through overloading or damage.
■ Previous history of AMI that resulted in
starvation of the cardiac muscles and their
subsequent death and hypertension that lead
to an increase in the force of contraction that is
required for pumping blood increased risk of
heart failure (Asgar, Mack & Stone, 2015).
■ Clinical manifestations include shortness of
breath, weakness, fatigue, edema, reduced
capability to exercise, persistent cough,
irregular heartbeat, nausea, and chest pain.
Figure 1- Mitral valve anatomy
Source- (Asgar, Mack & Stone,
2015)

Identify issue (patho) – continued
■ The patient who is at a risk of heart failure, demonstrates a decreased
force of contraction in his heart
■ This can be accredited to overloading of the heart ventricles
■ In healthy heart, an increase in filling of ventricle causes amplification
of the contraction force, and increases cardiac output (Ter Maaten et
al., 2015)
■ In heart failure, the ventricle remains loaded with blood to an extent
that reduces efficacy of cardiac muscle contraction
■ This occurs due to decreased capability to form cross-link between
myosin and actin filaments in over-stretched muscles

Establish goals
■ To restore the balance
between oxygen supply
and demand within 30
hours
■ To reduce prevent heart
failure within 24 hours
Figure 3- Treatment plan
Source- (Skelly et al., 2016)

Take action
■ Pharmacological interventions- Administration of nitroglycerine and
angiotensin converting enzyme inhibitors (ACE inhibitors).
■ Nitroglycerine exets both peripheral hemodynamic and direct
coronary impacts that will help in vasodilation of the coronary arteries
and systemic veins (Maruhashi et al., 2016)
■ ACE inhibitors will help in controlling elevated blood pressure and also
prevent heart failure by dilating blood vessels (Romero, Orias & Weir,
2015)

Take action - continued
■ Non-pharmacological interventions- Recommending dietary modifications
and performing aerobic exercise
■ Daily consumption of Mediterranean diet that includes whole grains,
fruits, vegetables, and healthy fat will reduce risks for adverse cardiac
events, in comparison to low-fat diet (Rosato et al., 2019)
■ Aerobic exercise will enhance cardiovascular fitness and increase
capability of using oxygen (Drenowatz et al., 2015)

Take action – continued
■ Provide convenience and play the role of an active listener to
understand his apprehensions and health related concerns
■ Helping him lean what heart failure is, its pervasiveness, and the
common signs and symptoms
■ Providing clear information about the medical condition
■ Development of actionable plans that can be followed post discharge
from the hospital
■ Encouraging smoking cessation and adherence to proper dietary
modification

Conclusion
■ The primary health risk identified from the case study was heart
failure
■ The two goals were to maintain equilibrium between oxygen demand
and supply and reduce heart failure incident
■ Reduction in blood pressure, and no reports of heart failure or CAD
would help in evaluating success of the interventions
■ The clinical reasoning cycle helped in increasing my awareness on
CAD, AMI, and the associated risks for cardiac dysfunctioning.
■ It also increase understanding on the mechanism of action of different
pharmacological management techniques.

References
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