Case Study: Cardiomyopathy and Congestive Heart Failure

In this particular case study, Mr. P is suffering from cardiomyopathy and congestive heart failure. Cardiomyopathy is a particular type of disease of the muscles of the heart that in essence makes the heart weaker and often not able to pump blood throughout the body or maintain a proper electrical rhythm, while congestive heart failure occurs when the functioning of the heart is inadequate to deliver blood to the rest of the body due to a particular types of disease (Madara and Pomarico-Denino, 2007). With Mr. P, it would seem reasonable that his cardiomyopathy caused his congestive heart failure, which is why he is exhibiting the symptoms that he is exhibiting. In addition to these two diseases, Mr. P also has 4+pitting edema, which typically related to the heart as well.

Specifically, the most common forms of edema are those that involve the heart, the kidneys, and the liver and this disease is by and large the result of the body retaining too much salt and water. The water then leaks into various spaces within the bodily tissue and edema begins to appear (Madara and Pomarico-Denino, 2007). In treating Mr. P, first there would have to be an educational process with him and his wife about his conditions. Mr. P and his wife would need to know the particulars about his edema, his cardiomyopathy and his congestive heart failure as it appears as though the treatments that have been prescribed for him thus far have been unsuccessful. The teaching plan would be brochures and informational packets regarding the conditions that essentially spell it out to both Mr. P and his wife in laymen’s terms without the medical jargon to confuse them.

As soon as Mr. P and his wife have been educated on the three different conditions that he has, then there would need to be a treatment of the conditions, individually, but also at the same time meaning education of treatment of the edema would be first, then the cardiomyopathy and then the congestive heart disease. "Treatment of edema consists of reversing the underlying disorder, restricting dietary salt to minimize fluid retention and employing diuretic therapy. This approach highlights the need to establish a diagnosis and to use nonpharmacologic approaches rather than resulting in immediate use of diuretics" (O'Brien et al., 2005). Not all patients necessarily need drug treatment, but it may be wise for Mr. P to undergo both given the severity of his moist crackles and labored breathing. There may be options in terms of Mr. P's insurance that these dosing regimens could be done in spurts and/or increments given that their bills are piling up. 

Quaglietti et al. (2000) noted that congestive heart failure is often treated with a myriad of items. Irrespective of the research that has allowed for therapies to be found, the disease is still quite debilitating. Early planning of therapy to prevent readmission for CHF includes "social support systems, patient education concerning lowering his high cholesterol diet, medication, and exercise, and close medical follow-ups" (pg. 261). Therefore, Mr. P and his wife will need to be thoroughly supported while Mr. P begins his lifestyle changes. Emphasis will be placed on getting Mr. P to understand that he has to want to live in order to get better given he has become despondent due to his many illnesses. One particular recommendation that has been tried is juicing, specifically pomegranate juice. "Pomegranate fruit has been rated to contain the highest antioxidant capacity in its juice. The potential health benefits of pomegranate juice consumption make it crucial to understand. [Much of its potency] is in its polyphenols" (Basu and Penugoda, 2008) I would inform Mr. P's wife to begin juicing for him and getting him to drink pomegranates especially which is a good treatment for both CHF and cardiomyopathy in addition to the medications that Mr. P is currently taking.

There is the rationale that lends itself to Mr. P coming on board with the recommended treatment of juicing in addition to his current medication for the CHF and cardiomyopathy and also undergoing extensive drug and diuretic treatment for his pitting edema. Patients more or less need to understand how nurses and medical professionals can assist them and the goal of educating Mr. P and his wife will do just that. 

References

Basu, A., & Penugonda, K. (2008). Pomegranate juice: a heart-healthy fruit juice.Nutrition Reviews, 67(1), 49-56.

Madara, B., & Pomarico-Denino, V. (2007). Pathophysiology. Burlington, MA: Jones & Bartlett Learning.

O'Brien, J. G., Chennubhotla, S. A., & Chennubhotla, R. V. (2005, June 1). Treatment of Edema. 71(11), 2111-2117. Retrieved from http://www.aafp.org/afp/2005/0601/p2111.html

Quaglietti, S. E., Atwood, J. E., Ackerman, L., & Froelicher, V. (2000, November). Management of the Patient With Congestive Heart Failure Using Outpatient, Home, and Palliative Care. Progress in Cardiovascular Diseases, 43(3), 259-274.