Therapy Treatment Care Plan: Case Profile Analysis

In developing a narrative therapy treatment plan, an example would be to explore and reframe the client's personal narrative to empower them in overcoming challenges and shaping a more resilient and positive future Illnesses, diseases, chronic conditions, all of these inflictions can be contracted or expressed in a variety of people through similar symptoms determined by the individual diagnosis. While each individual condition may express itself in similar ways, the measures taken to establish an effective plan of treatment may vary drastically depending on several biological, chemical and phycological factors. In order to understand a developed plan of treatment in an individual patient, several factors must be analyzed such as: an in dept description of the client to understand their needs and reason for admission, the current pathophysiology of the condition, and the condition management though the use of pharmacological reactions.

Narrative of Client and Activities of Therapy Treatment Plan: Example

Descriptive data was researched and acquired on a hospitalized patient trough a nursing student performing their clinical placement at their local hospital. The patient researched is an older woman that is currently married, is unaffiliated with any religion and is coming from their own home address. The patient reported themselves to the hospital due to symptoms of fatigue and shortness of breath (SOB) that lead to an admitting diagnosis of congestive heart failure (CHF) along with a code status for full resuscitation. The selected patient has an extensive history of previous health problems and diagnoses with the most prevalence being: type 2 diabetes, endometrial cancer, hypertension, metabolic syndrome, renal cell carcinoma and high cholesterol. The previous treatment attempts on the previously stated diagnoses had uncovered an extensive list of allergies that can be detrimental to the patient health such as allergies to: beta blockers, Ativan, calcium channel blockers, gentamicin, clindamycin, nitrofurantoin and several others. This understanding of background information regarding the patient can be detrimental to the creation of a care plan specialized specifically to the patient that attempts to avoid any unwanted reactions or unnecessary stress on the body and mind of the patient. Further research was conducted on the patient’s current plan of care in regard to: their activities of daily living in the hospital involving their nutrition status, hygiene and dressing capabilities, their eliminatory needs and ambulatory necessities that are normally achieved at home through the patient themselves or assistance from their husband . The patient’s nutritional plan of care revolves around a low carb diet with only minimal assistance required to prepare the food for direct consumption as the patient requires time to eat due to their fatigue. The patient’s hygiene and dressing capabilities varies by day depending on their current levels of fatigue and SOB as they may be independent with only set up being necessary or they may need minimal assistance for harder to reach areas. The patient’s eliminatory needs are generally handled independently by the patient with only occasional assistance needed in the form of a bed pan or a urinal due to their symptoms. The patient’s ambulatory necessities are minimal with the patient being able to pull themselves out of bed and make their way to the chair independently. The patient also possesses a four wheeled walker that can be used to ambulate further distances with only supervision required for signs of weakness from the fatigue and SOB. The understanding of the patient’s plan of care in regard to their activities of daily living is important for the comfort and health of the patient in order to fulfill their needs and routines in a semblance of normality that prevents any unnecessary risks of the patient attempting to accomplishes these needs by themselves.

Pathophysiology of Congestive Heart Failure

On admission to the hospital, the patient was diagnosed as having CHF. The condition known as CHF occurs when damage or weakness begins to affect the heart, inhibiting the necessary strength to pump blood around the body. This inhibition of strength it the heart allows for the possibility of fluid build up due to blood backing up from the lungs to the heart from lack of muscle relaxation that can increase during activity or stressful events. The congestion caused by the back up of blood may lead to exhaustion, SOB and edema accumulating in the ankles, legs, arms, hands or torso of the patient. CHF has several possible underlying factors that may have initiated the condition with the two main underlying factors being damage or weakness to heart from: a myocardial infraction or long periods of hypertension. CHF can manifest itself through multiple symptoms with varying degrees of seriousness such as: SOB, edema to the peripheries and occasionally to the core, increased levels of fatigue with activities or at rest, increased urination that mostly occurs at night, along with pain, discomfort or pressure in the chest or heart. As the heart is considered one of the most vital organs that supports the function of several others, severe cases of CHF can lead to the shutdown of other organs such as the kidneys, lungs, peripheral nervous system and in extreme cases lead to complete organ failure due to lack of oxygenated blood leading to necrosis. Several tests can be performed to detect CHF before reaching end stage symptoms appear as long as patient visit a health care provider as the symptoms arise. These test can include an electrocardiogram test to assess the size, rhythm and strength of the heart as it pumps blood, a chest x-ray to examine for any fluid build up in the lungs and a complete blood count to assess for any bleeding, electrolyte loss and renal function. Once diagnosed with CHF, the main treatment is primarily pharmacological with medications such as diuretics, beta blockers and ace inhibiters to decrease fluid volume, increasing cardiac output and decreasing systemic resistance. The patient, once admitted and assessed by the student nurse, showed several signs and symptoms that would suggest that CHF was present. The symptoms assessed involved an irregular heart rate where occasional beats would not be heard, swelling with pitting to the lower peripherals, primarily around the ankles that suggest a build up of fluids, increased fatigue with increased rest periods and SOB with little activity such as getting out of bed. Other signs that would suggest a problem were observed in the blood results with nearly triple the normal values of creatine and blood urea nitrogen, suggesting reduced blood flow to the kidneys, and low levels of hemoglobin, hematocrit and mean platelet volume, suggesting decreased volume percentage of red blood cells in the blood and decreased oxygen transport through the blood. The treatment measures selected by their physician involved the use of beta blockers to decrease the force and rate of the heart which would lower the pressure of the blood in the arteries as it leaves the heart, immunosuppressants to lower the bodies reaction to the beta blockers due to the patient’s allergies to the medication, diuretics to decrease fluid volume and build up to prevent increases in the edema and manage blood pressure levels and a combination of bronchodilators and selective beta-adrenergic receptor agonists to help ease the flow of oxygen through the airways and into the lungs. This treatment plan proved ineffective to the patient as evidenced by the observations on a weekly basis until requiring a transfer for further treatment measures. When dealing with this patient, the nursing student noted that several considerations and interventions were needed such as the patient requiring breaks between activities and rest from their normal activities of daily living due to their fatigue and SOB. Short and direct activities were needed to decrease the patient’s level of fatigue compared to long and slow activities, with moments of independence such as allowing them to perform peri care and eat at a slower rate to prevent exhaustion.

Pharmacological Plan of Care and Drug Profiles

The patient over their lifetime, has acquired multiple conditions that required multiple pharmacological treatment methods that have carried over to the patient’s current treatment plan for CHF. The previously ordered medications that the patient has been using include: apixaban used to prevent serious blood clots from atrial fibrillation, atorvastatin and ezetimibe used to manage high lipid levels, insulin aspart and insulin glargine used for management of diabetes, levofloxacin to prevent the growth of bacteria in the patient’s wounds, mometasone for psoriasis, pantoprazole for management of gastro esophageal reflux disease, and tolterodine for an overactive bladder. The understanding and recognition of current prescribed medications from previous diagnoses that the patient is using is vital for the creation of a pharmacological care plan to prevent any chemical reactions between medications and to avoid overdoses. Occasionally while creating a pharmacological plan of care, certain medications are needed for mild conditions or as secondary medications that are unrelated to the patient’s diagnoses such as: allopurinol for kidney stones, acetylcysteine for management of acetaminophen poisoning and prednisone to suppress the patient’s immune system These medications can be considered some of the most important as they can prevent further symptoms from developing or assisting with the function of the primary medications to improve the chances of recovery. Finally, the primary drugs associated with a pharmacological plan of care are those that work to manage or treat the condition that the patient was admitted with such as: bisoprolol, furosemide and nitroglycerin to manage high blood pressure, and guaifenesin, ipratropium and salbutamol for management of the patient’s airways and breathing. A further in dept analyzation of the patient’s pharmacological plan of care can be explored through the prevalence of the five most significant medications in the patient’s plan of care.

Prednisone, otherwise known as Winpred, is one of the most important drugs present in the patient’s pharmacological plan of care, not as a primary medication used to manage the diagnosis, rather as a secondary medication that allows for the proper effects of bisoprolol due to its immunosuppressant effects. Prednisone falls under the class of corticosteroids for its primary anti-inflammatory effects. The prescribed drug was being administered daily in the morning through an oral tablet dose of 30mg. Prednisone was indicated for the patient to suppress the body’s natural immune response as the patient has an allergy to beta blockers, one of the most effective drug classifications for the management of CHF. Prednisone works by binding to cytoplasmic receptors and inhibiting DNA synthesis to decrease the replication rate of white blood cells in the body to decrease the immunological and inflammatory response. As no drug is perfect, certain side effects did express themselves such as: dry skin that could be found on the feet where the gout would display, increased bruising as seen by the bruising present from injections, and slow wound healing as seen by the healing rate of the wounds on the patient’s legs. For nursing considerations, it is important when administering the medication to assess for any peripheral edema that develops or congestion in the lungs that may require a diuretic to resolve.

Bisoprolol, otherwise known as Zebeta, is the most important drug for the treatment of CHF in the patient’s pharmacological plan of care for its decreasing effects on the rare of heart contractions. Bisoprolol falls under the class of selective adrenoreceptor beta blocking agent for its effect in managing high blood pressure. The prescribed drug was being administered daily through an oral tablet of 2.5mg. Bisoprolol was indicated for the patient to allow the heart to relax while replenishing the amount of blood entering. Bisoprolol works by blocking the stimulation of adrenergic receptors in the cardiac muscles to slow the conduction of the atrioventricular node. Side effects from bisoprolol expressed themselves as increased tiredness as the patient needed periods to rest through the day, and a slower heart rate as seen during the patient head to toe assessment. For nursing considerations, it is important to slowly decrease the amount being administered instead of simply discontinuing as severe adverse effects may occur.

Furosemide, otherwise known as Lasix, can be invaluable in the management of the diagnosis as the drug can be used to lowers blood pressure and flush out any excessive fluid in the body. Furosemide falls under the class of drugs known as a non-potassium sparring diuretic for its hypertension management effects through the loss of fluids. The prescribed drug was being administered twice a day through an oral tablet of 40mg. Furosemide was indicated for the patient to help manage blood pressure and excrete any excess fluids that may build up and travel to the interstitial tissues causing an increase in edema. Furosemide works by blocking the absorption of sodium, chlorine and water in the kidneys. Side effects from furosemide expressed themselves as constipation in the patient as seen by the lack of a bowel movement over a three-day period. For nursing considerations, it is important to monitor the patient’s blood pressure before administration to prevent the risk of hypotension.

Ipratropium, also known as Atrovent, is an important drug present in the patient’s pharmacological plan of care as the drug helps to relieve the conjoining side effects that CHF has on the lungs. Ipratropium falls under the drug classification of bronchodilator for its effects on the lungs to ease breathing. The prescribed drug was administered four times a day through the use of a nebulizer to create a mist out of the 500mcg of fluid. Ipratropium was indicated for the patient to help relieve muscle contraction around the opening of the trachea to help ease their breathing. Ipratropium works by blocking the effects of acetylcholine on the muscles around the airway to relieve wheezing and SOB. Side effects from Ipratropium expressed themselves as a cough as seen by the need for guaifenesin, and a dry mouth as seen by the patient’s need for liquids. For nursing considerations, it is important to monitor the patient’s lung sounds for the possibility of increased distress from infectivity.

Salbutamol, also known as Albuterol, is an important drug that works most effectively when paired with ipratropium to assist in the ease of respirations. Salbutamol falls under the drug class of selective beta-adrenergic receptor agonist to relax the smooth muscles in the lungs and airways. The prescribed drug was administered four times a day with the ipratropium trough the use of a nebulized to create a mist out of the 2.5mg present in the liquid. Salbutamol was indicated for the patient to assist with the management of respirations due to the secondary effects of CHF. The drug works by decreasing the contractions of the smooth muscles around the lungs and airway to increase the ease of respirations. Side effects from salbutamol expressed themselves as a loss of appetite as seen by the fair nutritional consumption, and sweating as seen by the excess sweat present on the patient’s body. For nursing considerations, it is important to monitor the patient’s respiratory condition and airflow to avoid oxygen toxicity.

Conclusion

The development of a treatment plan specifically tailored to a patient was explored through the analyzation and assessment of an older woman admitted to the hospital with congestive heart failure. This patient that is normally independent, now required the support of her husband and the nurses at the hospital to fulfill several of her normal activities of daily living. The diagnosis of the patient’s condition was performed through the use of a complete blood count test which suggested a decrease in hemoglobin carrying oxygen through their body and an increase in creatine and blood urea nitrogen which suggested a decrease in kidney functions. Several symptoms were also observed which lead to the diagnosis such as shortness of breath, fatigue and edema to the lower peripheries. This diagnosis combined with the patient’s personal symptoms lead to a specific care plan create for the patient involving beta blockers and diuretics to decrease the stress on the patient’s heart, an immunosuppressant to reduce the bodies rejection of the beta blocker, along with a combination of a bronchodilator and a selective beta-adrenergic receptor agonist to ease the airways. This treatment plan proved ineffective for the patient requiring alterations to be made with services not available at the hospital they were located at leading to the development of another treatment plan specifically tailored to this patient.