Caring for Patients with Chronic Illness
Caring for Patients with Chronic Illness
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Caring for Patients with Chronic Illness
Topic 1: Caring for Patients with Chronic Illness
In this discussion you will create an age appropriate, evidence based plan of care for a client that might present to a primary care setting with a chronic disease or diseases. Make sure to include in the case study subjective, objective, and assessment data. You will post this information to the Discussion Board. Please provide a list of differential diagnoses, diagnostic exams and create an evidenced based management plan for the client. Be sure to provide a medication list and appropriate dosages. Remember when creating a plan that this patient will have more than one chronic disease and you should create a plan to involve all aspects of care. Comment on peers plan of care in terms of cost effectiveness and evidenced based.
Groups are as follows according to your last name:
A-H: African American female with Congestive Heart Failure, who has had a 20 pound weight gain in the past month. She also has Peripheral Vascular Disease with Venous Insufficiency. This patient has a Grade III murmur and takes anticoagulants
SAMPLE ANSWER
Subjective Data
Chief Complaint: Shortness in breath, fatigue, a “racing” heart, and weight gain
HPI: A 55 year old African American presents to the hospital complaining of shortness of breath, fatigue, a “racing” heart, and weight gain. The patient reports that she has noted breathlessness over the last three months while walking up stairs and in other activities that are strenuous. Two weeks ago she was not capable of completing her routine one-mile walk. The patient further reports that yesterday she became severely breathless while walking from one room to another. Today, she presents with extreme dyspnea.
Medication: The patient is on anticoagulants (warfrain, INR 2.0-3.0).
Allergies: Denies any having any food or drug allergies
Past Medical History: Patient was diagnosed with peripheral vascular disease with venous insufficiency at age 25.
Pat surgical History: Denies any surgery
Sexual/Reproductive History: Patient married and has two children
Personal/social history: Moderate alcohol use. She goes for a jog every morning.
Significant Family History: Patient’s father suffering from hypertension and type II diabetes.
Systemic Review
General: Moderately obese, in acute distress sitting upright, breathless
HEENT: Normoceohalic. Ears, eyes, and throat normal
Neck: Distended neck veins visible
Chest: Scattered rhonchi with productive frothy cough
Heart: Irregular, S3 gallop, grade III murmur
Gastro intestinal: Denies having acid reflux and GI upset
Extremities: Pitting edema, no clubbing, pulse intact
Hematologic: No history of blood transfusion or dyscrasia
Skin: negative for skin lesion, lumps, bruises, discoloration or itching.
Neurologic: Anxious with an impending doom feeling.
Objective Data
Vital signs: BMI 28, BP 130/91, Pulse ox 94%, temperature 37.40C, heart rate 88bpm
Abdomen: no observable or palpable abnormalities
Growth issues: the patient can say his name, speak clearly, respond to three-part commands, and bend his back without falling
Alertness: the patient is oriented, not agitated, but slightly less alert than normal
Musculoskeletal: Denies having any disorders
Diagnostic Tests:
- Chest X-ray: cardiomegally with pulmonary edema
- Echocardiogram: Grade III murmur
- Electrocardiogram: Atrial fibrillation
- Exercise stress test: Exercise intolerance
Assessment
The most likely diagnosis for this patient is congestive heart failure. This is a condition that is characterized with tachycardia, breathlessness, and edema in the extremities all of which are consistent with the patient (McMurray et al., 2012).
Care Plan
Some of the medications that will be recommended for the patient include:
Diuretics: Furosemide 60mg once daily
Beta blockers: Propranolol 100 mg orally twice daily
Angiotensin converting enzyme inhibitors: Enalopril 40mg per day orally (McMurray et al., 2014).
Chromium supplements will also be administered for management of the patient’s weight.
The patient will be advised to monitor her weight and avoid junk foods that may increase her weight. Therefore, she should maintained a balanced diet and restrict herself from taking excess salt. Excessive intake of salt may result in increased blood pressure (Scott & Winters, 2015). She should also regulate drinking of alcohol which may hinder her from achieving positive outcomes. In addition, the patient should continue doing her morning jog which will aid her in managing her weight. She should use at least to pillows at night so that she can sleep comfortably. She should adhere to her medication and report to the physician whenever she is experiencing side effects.
References
McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., … & Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.
McMurray, J. J., Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., … & Zile, M. R. (2014). Angiotensin–neprilysin inhibition versus enalapril in heart failure. New England Journal of Medicine, 371(11), 993-1004.
Scott, M. C., & Winters, M. E. (2015). Congestive heart failure. Emergency medicine clinics of North America, 33(3), 553-562.
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