Heart Failure Case Study

midpoint Failure Case StudySharon Heather Ferguson-GuyWhen it comes to boldness Failure the best wreak for a brighter forthcoming is to optimise the preventative with handling goals that argon vital for the patients health, well-being and gain a burst calamity of longevity.The benefits of obtaining a compatible music treatment goal for the patient, is so to make out the stress and anxiety for the patient, which in turn foundation minimise hospital admissions.Anyone that has other cardiovascular assays such as diabetes, smoking, excessive inebriant (with young adults with excessive alcohol consumption, they may be susceptible to holiday marrow syndrome which it is likewise cognize as) (Sanders, et al. 2012, p.628) and elevated telephone circuit cholesterol levels.The fol junior-gradeing case poll was given freely from a inhabit on his present health.I have changed his name to protect his confidentiality.Case studyMr Lloyd is a 73 years old widower and has heart stroke in the form of Atrial Fibrillation.He started to set unwrap breathless after riding his bike that he did daily. He said that he also spy excitable flutters in his chest, provided did non trail much notice as he thought it was because he had over exerted on an action at law at his time of life and put it down to the ripening process.He popped to his local world(a) Practitioner with his experiences and was put on a low dose of warfarin. posterior on a couple of weeks he returned and told his General Practitioner that he was not feeling any better and did not feel right. His General Practitioner told him to continue his dosage for another week.Mr Lloyd enjoyed walking if he was not cycling, but, due to the weather he left the bike at home. While on his modal value he slipped on ice and banged his head on the pavement. He was taken to hospital for the rest of the day due to a possible concussion. At the point of leaving he complained he still had a headache. The deb ase was not surprised as he had banged his head and prescribed paroxysm relief and told him what to watch out for with head injuries (They were aware of his music he was on at the time).After a week of pain relief he still did not feel right. His daughter took him to a different hospital. The doctor asked what medicinal drug he was on and told him that he was on still on the warfarin, they took him off it immediately, and replaced with a very low dose of aspirin. They immediately took him for a MRI (magnetic resonance imaging) scan that revealed that he had a haemorrhage on the brain it had been there since the f any.History on that point is not a family history of heart failure.Has not smoke-cured for 50 years.Does not have any previous illnesses.Has never drank alcohol.Has worked outside(a) from home outdoors all of his working life until retirement.Admitted that his diet correctd since his retirement, as with his previous job required him to be away from home quite a lot of the time and so his lifestyle then contained of hotels and bar meals.Has never been a big eater and portions were always small.Signs and symptomsFeeling breathless on light activities, more so when cyclingFeeling weak and more tiredDizzy after excursionPale but not all the time.No sicknessHeart beating too fast, rhythm was irregularNo coughingNot confusionNo weight gain as always activeBP practiceNo depressive feelings or cognitive problemsTests doneAuscultated lungs for changes non were foundBlood test was takenBlood pressure high on his visit, but often fluctuated between normal and highNeck veins checked no distension foundECG that read Atrial FibrillationElectrocardiogram was performed for 24 hoursNo chest roentgen ray was performedPitting oedema was slight at the end of the dayMedication before fallWarfarin was later changed to AspirinSalbutamol inhalerFurosemide (unable to remember dose)Cod liver oil 2 spoonfuls twice a day home remedies(On further reading on drugs. com I was funny regarding his cod liver oil intake and the medication of warfarin he was taking that may move due to it containing vitamin K, this stretchs the effectiveness of the warfarin and flagged an air of caution) (drugs.com)Mr Lloyd still suffered fatigue duty and breathlessness.Medication after fall for 4 monthsAspirinCod liver oil 2 capsules twice a day home remediespravastatin 20mg 1 daily (reduces the braggart(a) cholesterol)Salbutamol when requiredSimvastatin 20mg 1 daily (changed from pravastatin also reduces bad cholesterol)Spiro inhaler when required(drugs.com)Mr Lloyd was told to weigh himself every morning as he got out of bed. This was so he could take part in his own progress on any weight gain or weight loss due to the change of medication and possible fluid retentiveness. He noticed the relative frequency during the day and maybe once at night in going to urinate.With the changed medication Mr Lloyd still suffered fatigue and was breathlessness on l ight activities.After a review with a specialist his present medication treatment plan isApixaban 5mg 1 x 2 daily (reduce the risk of stroke clots)Atorvastatin 10mg 1 dailyCod liver oil 2 capsules daily home remedies (not spoonfuls anymore)digoxin 125mcg 1 daily (makes the heart beat stronger and a regular rhythm)Dutasteride 0.5mg 1 daily (used with Tamsulosin, reduce risk of urinary blockage)Omerprazole 20mg 1 daily (acid reflux)Spiro inhaler when requiredTamsulosin hydrochloride 400mcg m/r capsules 1 daily vigor relaxant, ease flow of weewee(drugs.com)This drug therapy is working well and clear from any adverse reactions and nevertheless visits the General Practitioner twice yearly. Blood pressure is stable at 110/75 bpm. His weight has not changed.Mr Lloyd still charts his input and output of fluids. With this, he is able to monitor lizard and report to his this instant General Practitioner any noticeable differences, to which, there is not any.Current statusEven tho ugh Mr Lloyd had to substantiate some frustrating discomfort with tiredness and breathlessness from past medications, these just didnt suit him, (It may have been a perfect combination for some remains else) and the time it had to take to get the correct treatment goals and drug therapy to his own bodys balance, Mr Lloyd is continuing his everyday activities without any problems of breathlessness or tiredness that have hugely lightd. He has decided with himself and with agreement from his General Practitioner that after about 17.00 he ordain start to slow down, and relaxes after food, and will potter in his garden instead of cycling. I have only ever known Mr Lloyd to cycle everywhere and all day. He tells me that he now enjoys seeing a television programme to the end instead of falling asleep half way through. His medication has slowed down his ventricular rate and that he will go for another review later on this year. Mr Lloyd said that he would not mind if the dose was lowered or none at all as he does not like to be reliant on medication.The specialist regenerate after reviewing Mr Lloyd advised him to attend a rehabilitation gym (sponsored by the British Heart Foundation) to monitor his exercise regime and to teach him how to keep fit in a healthy way for his age. They also educated him on a tasteful diet without the worry of blandness. He still goes to the gym, mainly because he has made many friends with similar conditions, and able to swap ideas. Mr Lloyd values the presence of the professional medical mental faculty that are there for any health or heart concerns.Treating congestive heart failure with medicationTo optimise the correct and suitable medication would be to find the patients correct balance. This will take a selection of medication over a period of time in order to reach the best goal of drug therapy. The reason for this is to make less strain on the heart by apply the correct combination of drug and its correct dosage. We must try and ontogenesis the cardiac output so the transmission line can pump more blood every minute. This will in turn improve the pumping action of the heart and reduce the hearts workload. So medication or a medical intervention may be suggested, the severity or damage would be taken into consideration. If there is a valve problem, it may be fixed with a repair or a replacement. If a more invasive form of fixing is needed, surgical implants may be required. This may be a pacemaker. This is a ventricular assist device that contains a pulse generator with one, two or three electrode leads that give off galvanising impulses to and from the heart (British Heart Foundation 2014, p.13)(Cleland 2006, pp.72-44). A more severe case may include a heart transplant which includes a recently deceased donor that is a match for the recipient. There are risks involved like any other surgery, but a heart transplant may be rejected due to rejection, infection or the new heart does not work properly. (Cleland 2006, pp.79-80)We need to take the effort off the workload on the heart by decreasing the fluid overload and reduce the blood pressure, so medication to reduce the heart rate and increase vasodilation (widen the blood vessels, by reposeful the smooth muscle cells). Diuretics would be one solution that would help with the fluid overload. This will increase the urine output and so in turn decreases the fluid overload. Different diuretics such as thiazide and loop diuretics that will cause a general loss of sodium and water from the body but also other electrolytes (minerals in the blood). This must be monitored for hypokalaemia (low potassium) because of sodium and water loss, potassium can be lost from the body in large quantities. (Cleland 2006, pp.54-63)(Class notes 2014/15)Another diuretic is a potassium sparing diuretic, it is an aldosterone antagonist (blocks the sodium retention effects of aldosterone in the kidney). This may cause a reverse problem, the potassium spa ring diuretic can cause the body to retain too much potassium, so the patient must be monitored for hyperkalaemia (high potassium). An instability of hypokalaemia or hyperkalaemia in the body will be a risk of the electrical problems in the heart. By using diuretics the patient will be monitored for hypotension (low blood pressure) this is due to the fluid retention and the reduction of blood pressure medication. You must also monitor serum creatinine (waste product in the blood that comes from muscle activity and kidney function indicator). If the levels of this get too high, it will be an indication that the kidneys are having problems. (Class notes 2014/15)(Cleland 2006, pp.59-63)Other medications that will be help congested heart failure is to now focus on the blood vessels, the aim is to bugger off the function of the vasodilation that will rest the heart by slowing it down. The most used medication is called an pass inhibitors (Angiotensin-converting enzyme) (Cleland 2006, pp.53-56) this will block the enzyme that forms angiotensin II also known as ARBs (angiotensin receptor blockers) (Cleland 2006, pp.56-57) this causes the vasoconstriction to raise the blood pressure. The peg inhibitor will interrupt the cycle of angiotensin II, this will then decrease the blood pressure. The increase of vasodilation with the ACE inhibitors and vasodilation will lower the blood pressure and so helps to reduce the workload on the heart. There will be a drop in aldosterone (is a corticosteroid hormone that stimulates absorption of sodium by the kidneys) levels causing a decrease in fluid overload.A medication called ARBS (Angiotensin Receptor Blockers) reduce the activity of the angiotensin II in the blood. You would prescribe this if the patient is not able to tolerate an ACE inhibitor. (Class notes)(Cleland 2006, pp.56)Beta blockers block the binding of norepinephrine (neurotransmitter) to the beta receptors on the heart, this will cause a decrease in the heart rat e.Which in turn will decrease the blood pressure and the workload of the heart. With such an amount of medication, it is advisable to monitor the patient for hypotension.(Class notes 2014/15)(Cleland 2006, pp.57-59)ReferencesBibliographyBritish Heart Foundation (2014) Pacemakers.Chronic heart failure introduction Guidance and guidelines (no date) Available at http//www.nice.org.uk/guidance/cg108/chapter/introduction (Accessed 13 May 2015)Cleland, J. (2006) Understanding heart failure. London Family Doctor Publications in association with the British Medical AssociationPrescription Drug Information, Interactions typeface Effects (no date) Available at http//www.drugs.com (Accessed 14 May 2015)Sanders, M. J., Lewis, L. M., Quick, G. and McKenna, K. D. (2012) Mosbys Paramedic Textbook With DVD. 4th edn. fall in States Elsevier/Mosby JemsCitation(Chronic heart failure introduction Guidance and guidelines, no date)(Prescription Drug Information, Interactions Side Effects, no date )(Sanders et al., 2012, p. 628)(British Heart Foundation, 2014, p. 13)(Cleland, 2006, p. 56)(Cleland, 2006, pp. 57 59)(Cleland, 2006, pp. 57 59)(Cleland, 2006, pp. 56 57)(Cleland, 2006, pp. 53 56)(Cleland, 2006, pp. 59 63)(Cleland, 2006, pp. 54 63)(Cleland, 2006, pp. 79 80)(Cleland, 2006, pp. 72 74)Case study given freely by my neighbour.Font used Calibri light. Size 11. Size 9 for referencesMy draft reduplicate was kindly read and checked by The Clinical Manager and three different Clinical Supervisors at Yorkshire Ambulance Service.