Nursing Assignment.

Case Study 2 Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him. Question Considering Mr. P’s condition and circumstance, write an essay of 500-750 words that includes the following: • Describe your approach to care. • Recommend a treatment plan. • Describe a method for providing both the patient and family with education and explain your rationale. • Provide a teaching plan (avoid using terminology that the patient and family may not understand).

Running head: NURSING ASSIGNMENT
Nursing Assignment
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1Nursing Assignment
Mr. p suffers from CHF caused by cardiomyopathy and followed by 4+ pitting edema. In case of
MR. p he only has his wife, who is also suffering from movement disability and hence cannot take care
of Mr. P properly. In such case, a 24 hour nurse is to be provided to the patient who can take care of
him. His diet should be monitored properly as gaining extra weight can cause further complication in
case of patient suffering from CHF (Shen et al., 2017). As the patient is also suffering from edema,
hence his diet should contain minimal amount of sodium. Massaging also helps in reducing the adverse
effect of edema. Fluid intake should also be restricted. Patient should be encouraged to do breathing
exercise to reduce breathing complications.
The primary complication of the patient is CHF. In the case of patient suffering from CHF,
medication are to be provided regular, lifestyle such as dieting and physical exercise is to be monitored
properly as prescribed by the specialist. The patient should be provided with angiotensin converting
enzyme inhibitor or angiotensin II receptor blocker. It allows the blood vessel to relax and also used in
lowering the blood pressure of the patient. With the aid of ACE inhibitors, heart will be able to pump the
blood more quickly and can provide blood to the rest of the body. He should also be provided with beta
blockers. Beta blockers assists in decreasing the heart rate which provides more time to the heart to get
filled with blood (Ouwerkerk et al., 2017). The patient is also suffering from edema caused due to CHF.
As in patient with CHF, pumping of blood lowers down which leads to accumulation of fluid causing
edema. In order to treat the edema, patient should be provided with diuretics, which helps the
accumulated fluid to again flow back in to blood (Cho et al., 2014). Treatment of CHF also helps in
getting relive from the laboured breathing.
It is important for the patient and the family to know each and every thing about the disease such
as, their risk factor, signs and symptoms and treatment to provide best care to the patient. In case of
Mr.p, he usually skips his medication as he is having problem in managing polypharmacy, which can

2Nursing Assignment
cause further complications (Finkelstein et al., 2016). Hence in such cases, patient and family both are
educated about the importance of medication. They should also be educated regarding the importance of
proper diet, which if not followed properly can cause further health deterioration. As the patient is
despondent, he should be educated that he will recover and there is nothing to worry about. He should
also be provided with strategies to manage the financial issue.
To ensure that the patient are well aware about the treatment and risk factors of the disease,
teaching plan should be formulated. The patient and family are taught that, it is necessary for the patient
to intake diet with low sodium, low fat and low fluid. Importance of each diet should be explained to
them. They should also be explained that the medication is be taken on time as prescribed by the doctor
(Vaillant-Roussel et al., 2014). Function of each and every medication should be explained to them.

3Nursing Assignment
References:
Cho, D. H., Park, S. M., Kim, M. N., Kim, S. A., Lim, H., & Shim, W. J. (2014). Presence of
preoperative diastolic dysfunction predicts postoperative pulmonary edema and cardiovascular
complications in patients undergoing noncardiac surgery. Echocardiography, 31(1), 42-49.
Finkelstein, J., Friedman, C., Hripcsak, G., & Cabrera, M. (2016). Potential utility of precision medicine
for older adults with polypharmacy: a case series study. Pharmacogenomics and personalized
medicine, 9, 31.
Ouwerkerk, W., Voors, A. A., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., ... & Ng, L. L.
(2017). Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in
patients with heart failure: a prospective European study. European heart journal, 38(24), 1883-
1890.
Shen, L., Jhund, P. S., Petrie, M. C., Claggett, B. L., Barlera, S., Cleland, J. G., ... & Latini, R. (2017).
Declining risk of sudden death in heart failure. New England Journal of Medicine, 377(1), 41-51.
Vaillant-Roussel, H., Laporte, C., Pereira, B., Tanguy, G., Cassagnes, J., Ruivard, M., ... & Pouchain, D.
(2014). Patient education in chronic heart failure in primary care (ETIC) and its impact on
patient quality of life: design of a cluster randomised trial. BMC family practice, 15(1), 208.