Congestive Heart Failure And Orem’s Theory Free Writing Sample

Incorporating Theory

Agboola, Jethwani, Khateeb, Moore, and Kvedar (2015) found that the Congestive Heart Failure (CHF) could be controlled effectively through outpatient follow-up and patient education. The proposed treatment is in line with the Orem’s theory, which was developed by Dorothea Orem in 1950s (Manzini & Simonetti, 2009). The theory emphasizes patient independence and self-care achieved through quality patient education. According to the theory, nurses may improve the patients’ health outcome through proper education regarding self-care. The patient education programs should be designed in such a way that it allows patients to control their health independently at their homes.

Gellis et al. (2012) observed that the lack of follow-up among the patients with chronic illnesses increased the risk of readmission to hospital. Follow up coupled with self-care may be effective tools for improving the patients’ health against the backdrop of the increasing cases of chronic illnesses such as CHF. One way to contain CHF and prevent readmissions is by empowering the patients to take care of their health and embracing outpatient follow-up. Therefore, the Orem’s theory best fits this analysis since it suggests the empowerment of patients to take care of their health. The selection of the theory to remedy the problem of CHF is informed by the view that the illness may be easily controlled through outpatient follow-up and self-care.

This project seeks to solve the problem of readmissions and poor health outcome for CHF patients. The project is guided by the assumption that knowledge deficiency and lack of follow up are the key causal factors for the recurrent readmissions of patients. The Orem’s theory shall be useful for this project since it promotes patients self-care through education and follow-up.

Review of the Literature

The role of continuous care in reducing readmission for patients with heart failure

Adib-Hajbaghery, Maghaminejad, and Abbasi (2013) adopted a systematic review approach to examine the effectiveness of continuous outpatient services in reducing hospitalizations among CHF patients. The authors obtained 21 articles from reputable databases, such as, Science direct, Pubmed, Iranmedex, SID and Google search engines using the following keywords: readmission, heart failure, continuous care, and follow-up. All the 21 articles were randomized control trials. The results showed that continuous patient monitoring improved the quality of life for the HF patients and prevented readmissions. The results may be applied in the contemporary nursing practice to mitigate emergency hospitalizations and to reduce the cost of health.

Heart failure remote monitoring

Agboola et al. (2015) quantitatively explored the efficacy of outpatient monitoring in reducing hospitalizations and mortality rates. The authors recruited the participants registered in the Connected Cardiac Care Program (CCCP) sponsored by the Massachusetts General Hospital. Besides, the authors recruited a control group from the patients undergoing regular treatment in the same hospital. The hospitalization and mortality rates for the two groups were studied and recorded over a period of 1 year. The authors found that continuous outpatient monitoring improved patient outcome and reduced hospitalization in the short run. The results illuminated the findings from other scholars who had previously found that outpatient monitoring services reduced hospitalization and mortality rates.

Effects of person‐centered and integrated chronic heart failure and palliative home care

Brännström and Boman (2014) used a randomized control trial approach to investigate the effectiveness of the person-centered and integrated palliative advanced home care and heart failure care (PREFER) in improving the patient outcome and reducing hospitalization. The study used a sample population of 72 participants, 36 patients for the treatment group and 36 for the control group. The participants, both from the treatment group and the control group, were assessed at the onset of the study, at 3 months and 6 months. The authors found that patients who received PREFER care had better health outcome than the control group. Therefore, outpatient care services may be a useful tool for improving the patients’ health to mitigate periodical hospitalizations.

Telehealth in adult patients with congestive heart failure in long-term home health care

Cherofsky, Onua, Sawo, Slavin, and Levin (2011) conducted a systematic literature review to investigate the effectiveness of the telehealth interventions on the health outcome for CHF patients. Data validity was guaranteed by exclusively obtaining the articles from reliable medical databases such as CINAHL, MEDLINE, EMBASE and COCHRANE. The listed databases only publish studies, which are reliable and valid. The research team used three randomized controlled trials and two quasi‐experimental studies. The authors found that home-based telehealth reduced chances of emergency hospitalization since it promoted self-care. The findings are important for the nursing practice as nurses are under pressure to cut healthcare cost and improve the health outcomes.

The importance of interactions between patients and healthcare professionals for heart failure self-care

Currie et al. (2014) conducted a systematic review of the literature to investigate the role of frequent interactions between the physician and the HF patients in treatment. The results from the study were valid since the authors systematically selected reliable qualitative based articles from valid health databases. The study reviewed 24 articles that met the inclusion criteria. The authors found that periodic interaction between the physician and the patient improved patient outcome. Additionally, the authors found that such interactions enabled the passage of self-care information from the nurse to the patient hence eliminating hospitalizations. The study is important to the nursing practice since it adds to the existing knowledge regarding minimizing hospitalizations against the backdrop of the heightening campaigns for on-going outpatient services.

Transitional care interventions to prevent readmissions for people with heart failure

Feltner et al. (2014) conducted a systematic literature review to determine the effectiveness of home-based care in reducing readmissions for patients diagnosed with HF. The authors reviewed a total of 41 articles, all of which covered the topic of HF. Data sources for the study included MEDLINE, Cochrane Library, CINAHL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. The researchers found that frequently home visits reduced readmissions and mortality rates. The findings are significant to the nursing practice since they provide an evidence-based solution to the issue of hospitalization of patients suffering from chronic illnesses.

Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure

Gellis et al. (2012) used a randomized control approach to probe the efficacy of telehealth programs in the reduction of hospitalization among patients with cardiac issues. The study recruited a study population of 102 participants, of which 51 were randomly assigned to the treatment group while the rest were assigned to the control group. The treatment group received the relevant care through a home based telehealth program at 3 months of follow-up. The treatment for the control group and was delayed was availed at 12 months of follow-up. The results indicated that the patients in the treatment group recorded less hospitalization compared to the control group whose members were frequently hospitalized.

Cognitive impairment and self-care in heart failure.

Hajduk et al. (2013) used a mixed method approach (both quantitative and qualitative) to explore the effect of cognitive disorder on self-care practices. The researchers used a sample size of 577 participants, who were all patients hospitalized for HF in five hospitals located in the United States. The study involved both interviews and observations to solicit the relevant data from the participants. The results indicate that HF results in cognitive disorder, which affects the ability of the elderly HF patients to practice self-care leading to recurrent hospitalizations. Patients’ follow-up and regular memory screening, according to the authors, may help improve the patient outcome and prevent intermittent hospitalization.

Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland

Inasmuch as many scholars have found a close connection between outpatient care and reduction of hospitalizations, Vuorinen et al. (2014) hold a differing view as they investigated the effectiveness of telemonitoring in reducing hospitalizations for patients with cardiac conditions. The authors recruited 94 participants, and randomly assigned 47 patients to the treatment group and the other 47 to the control group. The treatment group received home-based care and training through a phone while the control group received standard care from the relevant healthcare facilities. The researchers found that telemonitoring of HF patients neither reduced the number of hospital visits nor improved their health outcomes.

Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews

Kitsiou, Paré, and Jaana (2015) invoked a systematic review approach to examine the effectiveness of home telemonitoring of patients with chronic HF. The relevant articles were obtained using different databases such as MEDLINE, EMBASE, CINAHL, and the Cochrane. The validity of the individual articles was assessed using AMSTAR (assessing the methodological quality of systematic reviews) tool to avoid including invalid results in the current research. The researchers found that telemonitoring of HF patients from home reduced the rate of hospitalization and improved their healthcare outcome. Therefore, nurses need to embrace telemonitoring for patients with chronic illnesses to prevent high hospitalizations and reduce the healthcare costs. The results are congruent with that of previous researchers who found outpatient monitoring to be an effective tool for minimizing hospitalization.

Integrating telecare for chronic disease management in the community

May et al. (2011) conducted a qualitative research to investigate the opportunities and challenges of telecare in the treatment of chronic illnesses. Data collection was done through semi-structured interviews with 60 participants drawn from a cross-section of physicians employing the strategy with their patients. The results showed that telecare minimized hospitalization and improved healthcare for the patients suffering from chronic illnesses. However, the authors identified a few challenges to the use of telecare including the lack of coordination across social and primary care boundaries and the lack of financial or other incentives to include telecare within primary care services coupled with the lack of a sense of continuity with previous service provision and self-care work undertaken by patients.

The impact of self-monitoring in chronic illness on healthcare utilization

McBain, Shipley, and Newman (2015) used a systematic review approach to examine the effectiveness of self-care in improving the quality of life and minimizing hospitalization among patients suffering from chronic illnesses. The literature was searched with the help of the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE, AMED, EBM and HMIC. To guarantee the validity of the data obtained, an article had to be covering a single chronic illness to qualify for inclusion. The researchers found that self-care highly reduced hospitalizations and readmissions. Reduced hospitalization had the effect of reducing the cost of healthcare. The findings match that of the previous researchers who hypothesized a close connection between self-care and improved quality of life.

Discharge planning in chronic conditions: an evidence-based analysis

McMartin (2013) used a randomized control trials approach to investigate the efficacy of post-discharge support in reducing readmissions among the HF patients. Eleven (11) studies were selected based on the inclusion criteria set for the study. The 11 articles compared both normal discharge and individual discharge. The results indicate that patients who received post-discharge support recorded few readmissions compared to the patients who were discharged normally. The results cement the findings by other scholars investigating the topic. Therefore, nurses should ensure that the patients suffering from major chronic illnesses receive the necessary support to avert readmissions.

Utilization of trained volunteers decreases 30-day readmissions for heart failure

Sales et al. (2013) quantitatively investigated the effectiveness of outpatient monitoring in reducing the number of readmissions of the discharged CHF patients over a period of 30 days. Seventy-three (73) participants were recruited for the study and they were divided into two groups namely the treatment and the control group. The treatment group received specialized education for self-care from trained volunteers while the control group received standard care. The researchers found that the outpatient monitoring of CHF patients after discharge reduced the number of readmissions. The findings are consistent with that of other researchers in the field who equally observed better patient outcome and reduced hospitalization for patients undergoing outpatient care after discharge. The results are a wake-up call for nurses to embrace principles of the Orem’s theory and ensure that patients receive the necessary training for self-care.

A supportive-educational intervention for heart failure patients in Iran

Zamanzadeh et al. (2013) qualitatively examined the effectiveness of patient education in mitigating readmissions among HF patients. The authors used a population of 80 participants diagnosed with HF drawn from a cross-section of Iranian hospitals. Data was collected using interviews, which were recorded by the researchers. The results showed that patient education improved the health outcome and mitigated readmissions. The results of the study are significant to nurses and other healthcare providers since it increases their understandings of the outpatient based treatment methods for HFs. The results are consistent with that of other scholars who found patient education and outpatient follow-up as effective tools for enhancing self-care.

References

Adib-Hajbaghery, M., Maghaminejad, F., & Abbasi, A. (2013). The role of continuous care in reducing readmission for patients with heart failure. Journal of Caring Sciences, 2(4), 255-67.

Agboola, S., Jethwani, K., Khateeb, K., Moore, S., & Kvedar, J. (2015). Heart failure remote monitoring: evidence from the retrospective evaluation of a real-world remote monitoring program. Journal of Medical Internet Research, 17(4), 101-09.

Brännström, M., & Boman, K. (2014). Effects of person‐centered and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study. European Journal of Heart Failure, 16(10), 1142-1151.

Cherofsky, N., Onua, E., Sawo, D., Slavin, E., & Levin, R. (2011). Telehealth in adult patients with congestive heart failure in long-term home health care: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 6(12), 1271-1296.

Currie, K., Strachan, P. H., Spaling, M., Harkness, K., Barber, D., & Clark, A. M. (2014). The importance of interactions between patients and healthcare professionals for heart failure self-care: A systematic review of qualitative research into patient perspectives. European Journal of Cardiovascular Nursing, 14(7), 451-511.

Feltner, C., Jones, D., Cené, W., Zheng, J., Sueta, A., Coker-Schwimmer, J.,…Jonas, E. (2014). Transitional care interventions to prevent readmissions for people with heart failure. Annals of Internal Medicine, 2(5), 7-11.

Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012). Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. The Gerontologist, 52(4), 541-552.

Hajduk, M., Lemon, C., McManus, D., Lessard, M., Gurwitz, H., Spencer, A.,…Saczynski, J. (2013). Cognitive impairment and self-care in heart failure. Clinical Epidemiology, 3(2), 407-416

Kitsiou, S., Paré, G., & Jaana, M. (2015). Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews. Journal of Medical Internet Research, 17(3), 63-67.

Manzini, C., & Simonetti, J. (2009). Nursing consultation applied to hypertensive clients: application of Orem’s self-care theory. Latin American Journal of Nursing, 17(1), 113-119.

May, R., Finch, L., Cornford, J., Exley, C., Gately, C., Kirk, S.,…Wilson, R. (2011). Integrating telecare for chronic disease management in the community: what needs to be done? BMC Health Services Research, 11(1), 131-36.

McBain, H., Shipley, M., & Newman, S. (2015). The impact of self-monitoring in chronic illness on healthcare utilization: a systematic review of reviews. BMC health Services Research, 15(1), 1-12.

McMartin, K. (2013). Discharge planning in chronic conditions: an evidence-based analysis. Ontario Health Technology Assessment Series, 13(4), 1-11.

Sales, L., Ashraf, S., Lella, K., Huang, J., Bhumireddy, G., Lefkowitz, L.,…Norenberg, J. (2013). Utilization of trained volunteers decreases 30-day readmissions for heart failure. Journal of Cardiac Failure, 19(12), 842-850.

Vuorinen, L., Leppänen, J., Kaijanranta, H., Kulju, M., Heliö, T., van Gils, M., & Lähteenmäki, J. (2014). Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland: randomized controlled trial. Journal of Medical Internet Research, 16(12), 282.

Zamanzadeh, V., Valizadeh, L., Howard, A., & Jamshidi, F. (2013). A supportive-educational intervention for heart failure patients in Iran: the effect on self-care behaviors. Nursing Research and Practice, 7(6), 52-67.

Medical Negligence In Elderly Population

Introduction

The elderly population constitutes a very important group of people in every society. Ensuring their safety and comfort with regard to health issues is very crucial. It is customary for people to cherish and make every possible effort to ensure the wellbeing of the elderly members in society (McNamee, 2009). Most of them experience many challenges such as poor health and limited mobility brought about by old age. However, there is a certain percentage of this group that is very unfortunate, as they are often treated badly by their caregivers or family members for their selfish interests. Elders have a high vulnerability to physical, verbal, sexual, financial, and emotional abuse (Sage & Kersh, 2006).

Caregivers are often highly criticized for the manner in which they disregard their ethical code of conduct by neglecting the elderly, which worsens their health. According to reports, cases of elderly abuse are very high in various care centers across the United States. The most common challenge that the elderly population encounter is medical negligence in hospitals, at home, or nursing homes.

Statistics released in 2011 by the federal government showed that 3.6 % of the elderly population lived in nursing homes (Shandell & Smith, 2015). In the same year, the state of Florida reported that over 3.3 million people of its population were elderly persons. This meant that the state was prone to having higher cases of medical negligence among the elderly population only behind the state of California, which was reported to have the highest number of elderly people. Medical negligence involves professional wrongdoing that results in injury or damage, as well as failure by nurses to act with prudence characterized by absconding responsibilities and lacking concern (McNamee, 2009).

In addition, it entails a failure by nurses and caregivers to meet the physical and emotional needs of their elderly patients. Some of the practices that qualify as medical negligence towards the elderly include lack of proper medication, food, clothing, hygiene, and safety measures (Sage & Kersh, 2006). There is an urgent need for relevant authorities, especially in Miami to come up with strategies that can effectively address this social challenge.

The problem and the significance of identifying it

The biggest problem with regard to medical negligence in the elderly population is the fact that very few caregivers understand the various needs of this group. In addition, other challenging factors such as lack of effective communication and bad attitude among caregivers or the patients can contribute to this problem (Shandell & Smith, 2015). Studies have established that addressing the issue of negligence would facilitate in echoing the grievances of the elderly population with regard to the provision of health care services (Cooper, Selwood, & Livingston, 2008). One of the common ways in which health care experts neglect the plight of elders is a failure to refer them to specialists.

Legal experts argue that most elders are prone to this problem because their custodial rights are often held and controlled by other people (Sage & Kersh, 2006). This means that for such an elder to receive specialized treatment, the decision is often made by their custodians who can choose to be malicious at times. The inability of the elderly people to make decisions on the kind of treatment options they prefer is a big contributing factor to the high number of medical negligence cases.

A study conducted to establish factors that trigger this kind of behavior among caregivers found out that such decisions are influenced by ill motives such as financial extortion (Shandell & Smith, 2015). In situations where the caregivers are related to an elderly patient and listed as a beneficiary in case they die, chances of medical negligence are often very high. Legal experts that have handled such cases, argue that elderly patients can have their medical needs ignored purposely if there are some underlying benefits connected with their deteriorating health (Reyes, 2016).

The state of treatment accorded to elders in the state of Florida has attracted a lot of concern over the years. The concerns have heightened due to the high number of elderly people, especially in Miami (Reyes, 2016). This means that the number of nursing homes in the city is many, a phenomenon that translates to a high probability of medical negligence cases. In response to this concern, the state government established a department, which solely focuses on addressing the needs of the elderly population. In addition, the Florida state government also set up an elder abuse hotline to necessitate reporting of negligence towards the needs of this important group in the population. Despite the existence of these services, reports indicate that most cases of elderly abuse in nursing homes end up unreported because of factors such as intimidation and lack of awareness (Reyes, 2016).

A survey conducted by the Florida state government in 2012, established that many fraud cases are never reported because the majority of the elders are never realized when they lose their money (Bulman, 2010). The importance of identifying the various cases of medical negligence in the elderly population is that it will help in dealing with the influencing factors, as well as coming up with strategies for dealing with the problem in an effective manner.

Another significant step in identifying the best solutions for dealing with this challenge involves understanding the signs that indicate an elder is being abused (Cooney & Howard, 2006). Some of the notable signs include increased dehydration, unusual injuries, sores, wandering, and falls. Family members of the elderly people in nursing homes also aught to keenly, observe any personality changes such as social withdrawal, unfriendliness, and agitation as they may be indicators of a deeper-lying problem such as depression that could have developed due to negligence (Cooney & Howard, 2006).

Resolution

There is an urgent need for the relevant authorities to come up with effective strategies for addressing the social problem of medical negligence in the elderly population. Although the Florida state government has also put in place a number of mechanisms to help deal with the problem, a lot still needs to be done in order to guarantee the safety and wellbeing of our elders (McNamee, 2009). One of the most effective solutions to this challenge is affirmative action. This approach will ensure equality with regard to elderly people accessing health care services in nursing homes. In most cases of medical negligence towards the elderly population, caregivers tend to be selective when registering the patients in need of crucial services such as specialized treatment (Bulman, 2010). Therefore, this approach will help to bridge this gap, which has compromised the health status of many elders for a long time.

The second solution to the challenge of medical negligence in the elderly population is awareness creation among the elders with regard to their rights and the channels they can use to air their grievances (Berson, 2010). This will play a crucial role in ensuring that any caregiver that develops a tendency of abusing elders is dealt with, as well as revoking the operating licenses of nursing homes found to be neglecting the needs of elders under their care. Information is power, thus the need to empower the elders with the right and necessary information that will ensure their safety.

The third solution to this challenge is encouraging caregivers in nursing homes to be more vigilant, as well as driving increased performance through capacity building (Reyes, 2016). Research has established that some cases of medical negligence by caregivers are purely out of innocent causes such as lack of information and adequate training with regard to handling the needs of elderly people (Berson, 2010). Therefore, giving the caregivers better training would go a long way in ensuring that the elders get the right services and in the most appropriate manner.

Stopping cases of medical negligence in the elderly population also involves taking aggressive legal action towards caregivers and nursing homes found violating the rights of elderly patients (McNamee, 2009). There is an urgent need to develop better legislation that will provide guidelines for protecting the plights of this group in society. This should happen at the federal, state, and local levels. Therefore, the relevant authorities should ensure they promote effective implementation of various legislation passed to address this challenge.

In addition, the Florida state government should set up a legal department that will solely focus on helping elderly patients with cases involving abuse and negligence by their caregivers. Studies have established that some cases of elder abuse are never addressed because of the high cost of hiring a legal representative (Kessler, 2011).

Therefore, such a move by the state government will be very crucial in addressing this challenge because the elders will have the motivation and courage to come forward in case they are abused. Another approach that can be effective in addressing this challenge is encouraging transparency and accountability on the part of caregivers and nursing homes (Kessler, 2011). Health care experts argue that caregivers have an ethical responsibility of ensuring the safety and general wellbeing of their patients. Therefore, a program for ensuring that they account for action they do and are held responsible in case something bad happens to someone under their care should be put in place (Schiamberg, 2003). This approach will reduce cases of caregivers taking their work for granted or collaborating with other devious people to frustrate elderly people under their care.

Conclusion

Medical negligence in the elderly population is a serious problem that needs to be addressed as soon as possible. Some of the indicators that an elder is being neglected include poor hygiene, malnutrition, poor sanitary conditions, poor clothing, as well as the existence of various occupational hazards such as faulty electrical wires and slippery floors. In addition, medical negligence can also involve healthcare fraud where caregivers collude with other staff to bill for tests not performed on an elderly patient, charge for medication not administered, as well as providing free services in exchange of favors such as medical insurance cover from wealthy elders. There is an urgent need for the relevant authorities to come up with effective strategies geared towards addressing this social challenge.

References

Berson, S.B. (2010). Prosecuting elder abuse cases. National Institute of Justice Journal, 265(3), 10-16. Web.

Bulman, P. (2010). Elder abuse emerges from the shadows of public consciousness. National Institute of Justice Journal, 265(2), 3-9. Web.

Cooney, C., & Howard, R. (2006). Abuse of vulnerable people with dementia: Can we identify those most at risk? International Journal of Geriatric Psychiatry, 21(6), 564-571. Web.

Cooper, C., Selwood, A., & Livingston, G. (2008). The prevalence of elder abuse and neglect: A systematic review. Age and Ageing, 37(2), 151-160. Web.

Kessler, D.P. (2011). Evaluating the medical malpractice system and options for reform. Journal of Economic Perspective, 25(2), 93-110. Web.

McNamee, C.C. (2009). Elder abuse in the United States. National Institute of Justice Journal, 255(4), 34-39. Web.

Reyes, C. (2016). At your defense: Respect and protect your elders. Emergency Medicine News, 38(2), 26-28. Web.

Sage, W.M., & Kersh, R. (2006). Medical Malpractice and the U.S. Health Care System. California: Cambridge University Press. Web.

Schiamberg, L. (2003). An ecological framework for contextual risk factors in elder abuse by adults. Journal of Elder Abuse & Neglect, 11(1), 79-103. Web.

Shandell, R.E., & Smith, P. (2015). The Preparation and Trial of Medical Malpractice Cases. New York: Law Journal Press. Web.

Cardiology: Care Plan Disorder

The disorder and the following elements: pathophysiology, signs/symptoms, progression trajectory, diagnostic testing, and treatment options

Pathophysiology

The primary pathophysiologic mechanisms for the patient’s condition for these signs emanated from a gradual process of atherosclerosis (arterial disease) (Ambrose & Singh, 2015; Sayols-Baixeras, Lluís-Ganella, Lucas, & Elosua, 2014). The arterial condition develops and progresses for several years before any acute outcome can be experienced. The condition is associated with slow inflammation of the inner lining of arteries, and the condition increases with the well determined several risk factors as noted in the patient, including smoking, genetics, diabetes, high cholesterol, obesity, and high blood pressure (Ambrose & Singh, 2015; Sayols-Baixeras et al., 2014).

In this case, the patient has experienced a gradual progression that has led to the slow thickening of the inner layers of the arteries. As such, the lumen becomes narrow. The arterial condition leads to acute myocardial infarction (AMI) and sudden cardiac death (SCD) (Ambrose & Singh, 2015). The condition further causes weaknesses of the vital constituents of arteries and eventually changes the flow in the arteries. Overall, the pathophysiologic for cardiovascular disease involves some high-risk plaques and inflammation among patients.

Sign / Symptoms

Angina (chest pain) is the major symptom of cardiovascular disease. Patients may not be diagnosed with cardiovascular disease until they suffer angina, heart attack, heart failure, or stroke. Besides, shortness of breath and pain in the jaw, neck, back, throat, and upper abdomen are also common symptoms. Patients may also experience numbness, coldness, weakness, or pain in the legs or arms if blood vessels in those sections are constricted.

Progression Trajectory

One must be recognized that cardiovascular disease does not have a linear predictable progress path. The enhanced increment in stenosis severity associated with thrombosis could be used to explain the progression. The rapid progress of the condition could be responsible for multiple acute clinical presentations of acute myocardial infarction and sudden cardiac deaths.

The first phase of the condition marks the onset of the symptoms, disease diagnosis, and the start of treatment. The phase is observed when patients present themselves at the emergency room with life-threatening angina and shortness of breath. Some patients may die during this phase.

In the second phase, the patient requires care of physicians. Stenosis progression is normally observed whether it is clinically related to acute coronary outcomes or not. It is a strong indicator of cardiovascular risk in patients.

Atheromatous plaques related to enhancing coronary artery condition progression usually show clear anatomical or functional impairment noted that is normally classified as unstable or vulnerable. As such, the patient has a high propensity to acute disruption or enhanced thrombogenicity, resulting in a case of serious coronary outcomes. Plagues are now considered as extremely active during the disease progress phases.

In the third phase, the patient experiences increased symptoms related to poor heart function. Treatment is extremely important to restore stability. An implantable device or stent placement may be used to enhance functional aspects of the heart specifically in life-threatening cases.

A few cases of fibrous cap rupturing have been observed, particularly in patients with angina. Other coronary events may follow with serious impacts, leading to further impairment of the heart.

In the fourth phase, the patient experiences further functional impairment characterized by increased symptoms and reduced physical activity irrespective of optimal care. Further, treatment involving cardiac transplants could be an option. It is also imperative to assess the right period for prognosis in the fourth phase. It could be difficult to engage the patient during this period, but enhanced care and interventions are necessary.

The assessment of vulnerable plaques could help in determining the potential risks of coronary events. The outcome can be used for rational management of the patient’s cardiovascular disease. The patient may experience more cases associated with myocardial infarction and ulcerated plaques.

The final phase involves an open review of the care plan and its intended goals. In this case, physicians now focus more on symptom management rather than interventional therapies. The patient will receive supportive and palliative care required. There are possibilities of multi-organ impairment. Physicians will also concentrate on resuscitation status and assessment of cardiac devices. Cardiac devices may be deactivated when the family agrees, triggered device removal is noted, and notable patient discomfort. The final phase is normally characterized by rapid progress and, thus, the treatment plan should be designed in advance. Otherwise, patient care delivery may be disorganized.

Diagnostic testing

Although multiple diagnostic tests are available for the patient, cardiac catheterization, angiography, electrophysiology, chest X-ray, blood and urine tests, and physical examinations are highly recommended (Chin et al., 2012).

According to available evidence, physicians should not conduct diagnostic tests with “resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging” (Chou, 2015, p. 438) for asymptomatic due to false-positive results.

Treatment options

Several treatment options are available for cardiovascular disease. Non-invasive treatment options are generally physical activities, healthy diets, and medication. It is imperative to note that these non-invasive treatment options also include complementary and alternative medicine (CAM) treatment options, which are generally not included in conventional medicine (Rabito & Kaye, 2013). These treatment options can also assist in managing risk factors, including “hypertension, high LDL-cholesterol, smoking, diabetes, overweight and obesity, poor diet, physical inactivity, and excessive alcohol use” (Rabito & Kaye, 2013, p. 1). The patient in this case does not drink. Overall, CAM will assist the patient to control depression, anxiety, stress, and pain.

The disease can also be managed by minimally invasive treatment options, which need catheterization. The physician gains access to the heart via arteries located in the arms or legs to unblock them or insert stent when necessary.

Surgical procedures are also considered for a patient with the condition. In this case, an operational procedure would involve opening the patient’s chest to identify and repair the impaired tissues, arteries, and/or vessels.

An emerging treatment option for the cardiovascular disease involves gene therapy. The therapy is necessary for patients who have not benefited from conventional treatment options. Such patients may experience serious cases of angina pectoris even when they are under optimal medical care. Hence, they are no longer managed with coronary artery bypass graft surgery or percutaneous coronary intervention (Wolfram & Donahue, 2013).

The treatment that could soon help such patients is referred to as therapeutic angiogenesis. Physicians administer genes for angiogenic development to enhance additional vessel growth. Some positive preclinical outcomes had shown that gene therapy could be used to overcome limitations of other treatment options. However, multiple failures noted in the gene therapy have reduced its efficacy and possible use. Overall, it is concluded that angiogenesis is an intricate treatment option that relies on the effective timing of several developmental factors noted on receptors to enhance and then maintain new vessel developments (Wolfram & Donahue, 2013).

The disorder from normal development

As opposed to the normal heart development, cardiovascular disorder emanates from improper arrangement or separation of cardiac precursors during growth and by the degeneration of cardiomyocyte activity in adulthood (Dixon, Dick, Rajamohan, Shakesheff, & Denning, 2011). Specifically, it has been observed that the heart has minimal ability to regenerate. Consequently, there is an urgent need to comprehend the genetic processes of cardiomyocyte specification effectively (Dixon et al., 2011).

It has also been observed that the growth abnormalities are associated with abnormal activities or functions of some cells – cardiac myocardial progenitor cells (Degenhardt, Singh, & Epstein, 2013). For instance, normal heart development does not display defects observed in the hypoplastic right ventricle, which generally originate from defective developmental mechanisms specific to the second heart field derivatives (Degenhardt et al., 2013). Also, evidence from normal cardiac growth shows vital factors noted at progressive stages of cardiomyocyte arrangement and lineage restriction.

The physical and psychological demands the disorder places on the patient and family

As the patient indicates, the cardiovascular disease leads to physical inactivity. In most instances, the major drawback of physical inactivity on patients and family are related to financial burdens that could negatively affect the treatment and well-being of the family.

Psychological demands are linked to emotional and social support. Patients who fail to receive psychological demands often suffer depression. Depression is also linked to morbidity and mortality in patients and families, especially if the condition becomes acute. Further, anxiety is also noted in patients, and it could contribute to deaths.

It is acknowledged that depression, anxiety, lack of social support, social isolation, some hostile behaviors, and other chronic conditions are generally regarded as elements of stress. In the case study, a lack of social support is also noted.

Both physical and psychological demands have negative outcomes for cardiovascular disease. These risks may increase as the disease progresses to advanced stages.

The key concepts that must be shared with the patient and family to achieve optimal disorder management and outcomes

The patient and members of his family will have to make critical decisions related to cardiovascular disease and other possible complications to manage health outcomes. The patient and members of his family will learn about cardiovascular disease and engagement with other stakeholders.

They will play a critical role in comprehending possible causes and progression of the disease, health management, engaging inappropriate activities, treatment for acute events, and aspects of managing chronic episodes. The patient and the family must acknowledge these responsibilities and support them for optimal management of the disorder.

In this case, it is highly recommended that the patient and family members should focus on health literacy about cardiovascular disease, shared decision-making, and effective self-management. For enhanced health literacy, decision-making, patient involvement, and education for self-management, the following aspects will be highly important. The patient and family members will require written information to support treatment and decision-making, sources of relevant information, effective communication, decision-making aid for patients, and self-management training.

Key interdisciplinary team personnel needed and how this team will provide care to achieve optimal disorder management and outcomes

The current chronic condition of the patient requires integrated and coordinated interventions to deliver the best outcomes. As such, based on patient-centered cardiovascular disease care, the following interdisciplinary team personnel are required for optimal care.

Biomedical care personnel will perform the following functions. They will conduct assessment and documentation of biomedical factors based on the confirmed diagnosis and further assess the functional capacity of the patient, including physical activity. The personnel will also be responsible for providing tailored medical management, including developing a treatment plan to manage comorbid and related conditions, prescribing medicines, routinely providing preventive care, and developing personalized treatment plans.

Self-care education and support personnel will also be required to assess and document self-management status and advance self-care education and counseling, such as ensuring that the patient understands cause and consequences, activities and medicine to avoid among others. They will also encourage a personalized care action plan to monitor weight, for instance.

Psychosocial care personnel will be responsible for determining the needs of patients. These may include assessment of concurrent depression, social support requirements, and coping strategies among care providers. Care should be developed to meet the unique attributes of the patient, including social and economic status.

The patient will also require nutritionists to manage his poor diets.

Physiotherapists will also be required to assist the patient to perform physical activities because of his current physical weakness.

In the advanced stage, palliative care personnel will assess and document care needs, determine treatment goals, and care with the patient and family members. The patient will also need regular assessment of cardiovascular disease.

Facilitators and barriers to optimal disorder management and outcomes

Health awareness and comprehension of specific consequences of not adhering to treatment plans and cases of deteriorating conditions are imperative facilitators to effective care (Siabani, Leeder, & Davidson, 2013).

Patients and families that lack knowledge of the cardiovascular disease, particularly on diets, physical activities, risk factors, and misconceptions about cardiovascular disease are critical barriers. Moreover, failures to understand symptoms and outcomes also limit management and outcomes.

Social practices may undermine healthy practices. For instance, non-adherence, failure to ask for help, and poor diets will negatively impact care outcomes. Conversely, supportive social factors will enhance the quality of care.

Supportive environments, including the family, care providers, and neighbors will assist the patient to realize optimal care outcomes.

Strategies to overcome the identified barriers

These barriers can be overcome by enhanced patient education. The patient must understand cause and consequence relationships, the importance of adherence to recommended diets, physical activities, social support, and avoidance of risk factors.

Care providers will also enhance their relationship with the patient and family members through effective communication.

Care Plan for Cardiology Clinical Case

  • A comprehensive and holistic recognition and planning for the disorder

The objective of the care plan is to improve the quality, safety, and patient experience.

Continuous assessment of the patient condition

  • Administering effective treatment for cardiovascular disease

Several drugs are available, but physicians must opt for the most effective one based on the condition of the patient. These medications include ace inhibitors, antiarrhythmic drugs, antiplatelet drugs, beta-blockers, aspirin, thrombolytic therapy, and diuretics, and warfarin among others.

Surgeries

  • The patient may require additional surgery if the stent is no longer effective.

Physical and psychosocial health support

Physicians and nurses should visit the patient and assess their condition and feelings about status. They should determine the best education options and exercise approaches. Moreover, the patient may need telephone support and sustained follow-ups. He should also be introduced to other groups of people with the same cardiovascular condition to avert his social isolation. A community-based support center would be effective for the patient after his discharge from the hospital to assist in monitoring progress, adherence to medication and diet plans, as well as risk factors, control plans.

The patient should bring his wife along, specifically during patient education on cardiovascular disease, self-management, and related outcomes.

The patient should go for further assessment to determine his physical and psychosocial health requirements a few weeks after the discharge. Moreover, he should also attend patient education on related risk factors, such as obesity, type 2 diabetes, gene factors, and high blood pressure. The patient’s GP should be regularly updated on outcomes.

The patient will also receive the necessary physical support conducted by a physiotherapist from the community support center. The patient will be encouraged to have specific exercise regimens that can be conducted at home.

Physicians will also receive home visits and review of progress to determine outcomes and make appropriate medication therapy. The patient must focus on regular assessments with the care providers and with cardiologists to ensure a continuous management plan for the cardiovascular condition.

The patient should be managed through effective communication to ensure optimal management of the cardiovascular condition and care outcomes.

Socio-cultural background

The socio-cultural background could negatively affect treatment and related outcomes. Specifically, the plan is designed to enhance patient adherence to treatment. The physician will have to conduct a realistic evaluation of the patient’s knowledge and comprehension of the treatment and exercise regimen and their beliefs about the condition. This approach would ensure that the care plan is designed to provide optimal care for the patient. For instance, he must rest adequately rather than strive to provide for his sick wife while still in poor health.

Care providers will allow patients to narrate their experiences to enhance communication. Consequently, information about the patient’s attitude, beliefs, cultural practices, isolation, social support, depression, anxiety, and emotional issues will be effectively addressed.

Lifestyle and health behaviors

These will generally address risk factors observed in the patient. These will include “hypertension, high LDL-cholesterol, smoking, diabetes, overweight and obesity, poor diet, and physical inactivity” (Rabito & Kaye, 2013, p. 1).

  • The patient currently smokes, and smoking is a major risk factor for cardiovascular disease. The patient must reduce cigarette smoking and ultimately stop.
  • The poor diet can lead to obesity (in this case, the patient has android obesity) and, therefore, the patient must focus on healthy diets and regular physical activities. The patient must now focus on foods rich in nutrients, specifically fruits, and vegetables.
  • Regular physical activity is known to aid in reducing the risks of cardiovascular disease. The patient must be taught the importance of being active throughout his life. Past physical activities cannot sustain his current health needs. He should at least consider 30 minutes of physical exercise for five or more days every week.
  • The patient does not drink or abuse drugs. However, the current depression and stress could result in drug and alcohol abuse. Hence, patient education must also account for such risk factors.

This care plan is based on the notion that no single intervention approach can enhance treatment and patient adherence. As such, successful outcomes will largely depend on designing and implementing unique attributes of the patient, cardiovascular conditions, and effective treatment regimens.

References

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Wolfram, J. A., & Donahue, J. K. (2013). Gene Therapy to Treat Cardiovascular Disease. Journal of the American Heart Association, 2, e000119. Web.