Heart Failure Case Study

Heart Failure Case StudySharon Heather Ferguson-GuyWhen it comes to Heart Failure the best form for a brighter future is to optimise the noise with treatment goals that are vital for the patients health, well-being and gain a better chance of longevity.The benefits of obtaining a compatible medication treatment goal for the patient, is so to bring d take in the stress and anxiety for the patient, which in turn can minimise hospital admissions.Anyone that has other cardiovascular risks such as diabetes, smoking, unwarranted alcohol (with young adults with excessive alcohol consumption, they may be susceptible to holiday bone marrow syndrome which it is also known as) (Sanders, et al. 2012, p.628) and elevated lineage cholesterol levels.The following case study was precondition freely from a neighbour on his present health.I have changed his name to protect his confidentiality.Case studyMr Lloyd is a 73 years ageing widower and has centerfield failure in the form of Atrial Fibr illation.He started to become breathless after riding his bike that he did daily. He give tongue to that he also noticed excitable flutters in his chest, but did not take much notice as he thought it was because he had over exerted on an activity at his time of life and put it down to the aging process.He popped to his local General practitioner with his experiences and was put on a low dose of Warfarin. After a couple of weeks he returned and told his General Practitioner that he was not tinctureing each 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. bandage on his way 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 assertable concussion. At the point of leaving he complained he still had a headache. The doctor was not surprised as he had banged his head an d prescribed nuisance relief and told him what to watch out for with head injuries (They were aware of his medication 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 medication he was on and told him that he was on still on the warfarin, they took him clear up 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 at that place since the f tout ensemble.HistoryThere is not a family history of purport failure.Has not smoked for 50 years.Does not have every previous illnesses.Has never drank alcohol.Has worked away(p) from home outdoors all of his working life until retirement.Admitted that his diet improved since his retirement, as with his previous job necessary him to be away from home rather a lot of the time and so his lifestyle thus 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 normalNo 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 get word Atrial FibrillationElectrocardiogram was performed for 24 hoursNo chest x-ray was performedPitting oedema was slight at the end of the dayMedication before fallWarfarin was later changed to aspirinSalbutamol inhalerFurosemide (unable to remember dose) lambaste liver oil 2 spoonfuls twice a day home remedies(On further teaching on do drugss.com I was curious regarding his cod liver oil intake and the medication of warfarin he was taking that may interact due to it containing vitamin K, this reduces the lastingness of the warfarin and flagged an air of caution) (drugs.com)Mr Lloyd still suffered tiredness and breathlessness.Medication after fall for 4 monthsAspirinCod liver oil 2 capsules twice a day home remediesPravastatin 20mg 1 daily (reduces the bad 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 swimming retention. He noticed the frequency during the day and possibly once at night in going to urinate.With the changed medication Mr Lloyd still suffered tiredness and was breathlessness on light 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 resolutionage)Omerprazole 20mg 1 daily (acid reflux)Spiro inhaler when requiredTamsulosin hydrochloride 400mcg m/r capsules 1 daily muscle relaxant, ease ladder of urine(drugs.com)This drug therapy is working well and clear from any adverse reactions and that 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 and report to his now General Practitioner any noticeable differences, to which, in that location is not any.Current statusEven though Mr Lloyd had to endure some frustrating discomfort w ith tiredness and breathlessness from past medications, these further didnt suit him, (It may have been a perfect combination for some embody else) and the time it had to take to hurt the sort 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 decreased. He has decided with himself and with agreement from his General Practitioner that after about 17.00 he will 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 go 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 say that he would not mind if the dose was lowered or none at all as he does not like to be dependent on medicatio n.The specialist Doctor after reviewing Mr Lloyd advised him to attend a rehabilitation gym (sponsored by the British Heart Foundation) to monitor his exercise governance 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 staff 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 optimum goal of drug therapy. The reason for this is to make less strain on the heart by using the correct combination of drug and its correct dosage. We must try and accession the cardiac output so the blood can pump more blood eve ry 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, functional implants may be required. This may be a pacemaker. This is a ventricular assisted device that contains a pulse generator with one, two or trio electrode leads that give get rid of electrical 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 transport 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 h eart by decreasing the fluid overload and reduce the blood pressure, so medication to reduce the heart rate and join on vasodilation (widen the blood vessels, by relaxing 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 with child(p) quantities. (Cleland 2006, pp.54-63)(Class notes 2014/15)Another diuretic is a potassium sparing diuretic, it is an aldosterone antagonist ( clotures the sodium retention effects of aldosterone in the kidney). This may cause a reverse problem, the potassium sparing diuretic can cause the body to retain too much potassium, so the patient must be monitored for hyperkalaemia (high potassium). An imbalance 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 stimulate the function of the vasodilation that will rest the heart by slowing it down. The most used medication is called an ACE inhibitors (Angiotensin-converting enzyme) (Cleland 2006, pp.53-56) this will block the enzyme that forms angiotensin II also know n as ARBs (angiotensin receptor blockers) (Cleland 2006, pp.56-57) this causes the vasoconstriction to raise the blood pressure. The ACE 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 rate.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 counseling 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 necktiePrescription Drug Information, Interactions Side 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. United 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 copy was kindly read and checked by The Clinical Manager and three different Clinical Supervisors at Yorkshire Ambulance Service.