Below is a case of a patient with heart failure. Study the…

Question Below is a case of a patient with heart failure. Study the… Below is a case of a patient with heart failure. Study the situation and make at least three (3) Nursing Care Plans for this patient. The Nursing Care Plans should contain nursing diagnoses that fall under the following categories:1) Actual (Problem-Focused/Priority) Nursing Diagnosis2) Risk Nursing Diagnosis3) Health PromotionCase Presentation:A 54-year old male self-presented to the emergency department with a 4-day history of awareness of irregularities of his heart rhythm. This was not accompanied by any chest pain but he revealed a one- month history of shortness of breath, tiredness and leg swelling. He also reported general malaise and decreased libido. He had recently stopped smoking when the symptoms first started and used to smoke 15 cigarettes a day prior to that for 25 years. He had no prior medical or surgical history other than mild asthma for which he had not been hospitalized previously.On admission, the patient was found to have a narrow complex tachycardia, which reverted to normal sinus rhythm with intravenous verapamil. Initial investigations showed Troponin I of 0.22 (normal <0.04), a BNP of 889 (normal <100), and raised D-dimers of 664. A CT pulmonary angiogram excluded a pulmonary embolus. A transthoracic echocardiogram showed mildly dilated left and right ventricles with global hypokinesia and severe biventricular systolic dysfunction. The left ventricular ejection fraction (LVEF) was calculated, by Simpson's method, to be 15% (normal >55%). The echocardiogram also showed that there was no left ventricular hypertrophy or valve disease of any significance. A full cardiomyopathy biomarker screen was negative for any secondary causes. Coronary angiography revealed only mild atheroma in the proximal left anterior ascending and mid-right coronary arteries. The patient had no further rhythm disturbances on CCU and lost 6.2 kg in weight during his 5- day stay as an inpatient.On transfer from the emergency department to the coronary care unit, the patient said he did not feel anxious because he was in the right place. The diagnosis of dilated cardiomyopathy and biventricular congestive heart failure was given to the patient: “It was those last two words that got my attention. When I was told I was suffering from ‘heart failure’ I was shocked. The heart is one muscle that can’t regenerate itself.” He tried to find leaflets with simple information on heart failure in the ward, but found none. However, “All my questions were answered. The diagnosis was given to me in a clear and straightforward way.”On direct questioning of his appreciation about the management of his condition, he replied: “The first thing to do, the consultant said, is to see how I do on an ACE inhibitor and a beta blocker, along with some other medicines for heart failure. And if those don’t work well enough, there are other things to try such as implanted pacemakers to help the heart work better. The consultant mentioned the possibility of a heart transplant as the last resort; in other words my heart might as well be thrown away…”During the patient’s stay, the “Heart Improvement Team” specialist nurse was assigned to evaluate, inform, and educate him on his condition and emphasize medication adherence, mild salt and fluid restriction, and recognition of signs and symptoms that would indicate progression of the disease. These discussions enabled the patient to become “a strong partner in his treatment plan.” “I feel safe and I have the exact dates of the follow-up appointments with the consultant and the specialist nurse.”The patient had to share his diagnosis with his two teenage children. For him, this was the “most difficult part of the journey,” not being sure of “how much to tell them.” He decided to be truthful and open, tailoring his approach to each child. The diagnosis proved to have long-term effects on his lifestyle choices, such as deciding to work part-time and making the decision to move in with his partner, plan their wedding, and “value each moment.” Health Science Science Nursing Share QuestionEmailCopy link Comments (0)