Case Study and Care Plan: Cardiovascular Disease

Introduction

In the current case study, a 52 year old male patient presents his data to analyze an underlying medical condition. Vital elements, such as medical history, socio-cultural background, habits, family history, and physical examination provide the data required for the medical analysis. Therefore, using the given data, it is possible to suggest treatment and care plan appropriate in the management of the case.

Case Study Evaluation-Cardiovascular Disease

Pathophysiology, Signs and Symptoms, Progression, Diagnostic Testing and Treatment Options

The disease’ main cause is atherosclerosis. The common risk factors of atherosclerosis include hypertension, cigarette smoking, and hypercholesterolemia. For instance, the patient has been smoking cigarettes for many years; thus, he is predisposed to atherosclerosis. The risk factors involve oxidation as well as inflammation of the arterial wall, which form fatty-fibrous wound eventually. Whenever there is inflammation or physical trauma, the lesions rapture results in heart attack or stroke. However, the problem may be resolved through the growth of plaque.

Disease progression is often indicated by C-reactive protein. Cardiac myofilament protein troponin and inflammatory marker CD40 constitute the initial pointers of potential heart attack. Heart failure is commonly caused by coronary atherosclerosis. In both cardiomyopathy and heart failure conditions, disordered calcium signaling experienced by myofilaments. Elevated calcium leads to suppression of heart failure neuro humoral as well as biomechanical processes. For instance, hypertension causes cardiac hypertrophy that predisposes heart failure through apoptosis. Cardiac damage in human leads to cells being lost permanently due to the inability of the heart to regenerate (World Health Organization, 2015).

Common symptoms of cardiovascular disease include chest pain or angina characterized by heaviness, discomfort, pressure, burning, aching, and painful feeling of fullness in the chest area. Indeed, the 52 year old patient has been complaining of both chest pain and angina. Angina can also be felt around the shoulders, neck, arm, throat, jaw, and back. Moreover, cardiovascular disease is characterized by shortness of breath, palpitations, weakness, dizziness, nausea and sweating. Indigestion, choking feeling, vomiting, and anxiety are also symptoms of cardiovascular disease. The patient’s past medical record shows that he had been treated for hypertension as well as high cholesterol; however, he stopped medication based on his own decision.

Electrocardiograph tests are important for patients with heart conditions. The tests record rhythm as well as electrical activity of the heart. Electrodes, which are connected to a machine that records electrical signals of the heartbeat, are put on the chest, arms and legs of the patient. The electrocardiogram exercise test is taken during exercise to identify if symptoms are caused by angina. X-rays can be done to examine the lungs, heart and chest wall. The examination can help to rule out the other conditions that may be accounted for as causing the symptoms.

Echocardiogram is used to generate an image of the heart through sound waves. The test identifies the pumping of the heart, thickness of the heart muscles, movement of the structure the heart valves, and presents a comprehensive picture of the heart. Computerized tomography can also visualize anatomy of the heart. For instance, scans of calcium-score and coronary angiography are some of the computerized tomography tests can help to define the condition.  Coronary angiography helps to determine if coronary arteries are narrowed and the severity of blockages. The test helps to know the pressure inside the heart chambers. Blood tests such as cardiac enzyme test can identify damages to the heart muscles. They also help to monitor the effects of medication. Radionuclide tests assist in noticing the strength of heart pumping and the flow of blood to muscular walls of the heart. Magnetic resonance imaging (MRI) gives a detailed picture of the heart.

Cardiovascular diseases are treated through a number of strategies. Firstly, a patient has to make lifestyle changes. For instance, the patient under study has to quit smoking, which increases the risk for cardiovascular heart disease (CHD). Secondly, he has to adhere to a healthy diet that includes a variety of fruits and vegetables. A healthy diet should have whole grains, lean meats, fat-free dairy products, sea food, soy products, beans, nuts, and peas. The man should avoid foods or drinks that have added sugars. The patient should drink plain water instead of soda. Additionally, the strategy includes limiting solid fats or refined grains, which include trans fatty acids and saturated fats. Refined grains are obtained from whole grains that have been processed, which results in loss of nutrients, for example, dietary fibers. Finally, patient’s alcohol drinking should be moderated because lower amounts reduce the risk of cardiovascular heart disease (World Health Organization, 2015).

Medicines can treat cardiovascular heart disease. They reduce heart’s workload, relieve symptoms, decrease chances of an attack, lower blood pressure, LDL cholesterol, and prevent blood from clotting. In the case, the patient was given discharge medications that include Tenormin XL 50 mg, QD Glucophage 500 mg, QD Lipitor 10 mg, and BID Baby asa QD. Procedures or surgeries may treat cardiovascular heart diseases, for example, angioplasty is a potential treatment method. Similarly, coronary artery bypass grafting (CABG) is aq surgery procedure, where veins or arteries are removed from other areas of the body, then used to bypass blocked or narrowed coronary arteries. Finally, cardiac rehabilitation is a medical program for improving the health of people with heart problems. The program entails training, education, and counseling.

Differentiating the Disorder from Normal Development

Let-7 plays a significant role in cardiovascular diseases because it switches and regulates the development functions as well as diseases of cardiovascular system (Bao et al., 2013). In cardiovascular diseases, let-7 acts as an essential development gene, stem-cell differentiation, and proliferation of cancer cells. Thus, it has been hypothesized that let-7 is likely to play a critical role in cardiac hypertrophy, heart development, and heart fibrosis. Cardiac hypertrophy manifests in stressed hearts. It is also considered a major factor in the pathogenesis of heart failure. Let-7 participates in normal heart development, while the aberrant form can cause congenital heart disease (Bao et al., 2013).

The Physical and Psychological Demands that the Disorder Places on the Patient and Family

The patient needs to be physically active to lower the risk factors such as LDL cholesterol, excess weight, and high blood pressure. The patient is aware that he is the sole breadwinner for the family; thus, he must remain physically strong to continue providing for the family needs. Physical activity reduces the risk of diabetes while raising HDL cholesterol levels (Haltern et al., 2014). Importantly, HDL cholesterol helps in removing cholesterol from the arteries. Likewise, obesity and overweight are risk factors for CHD; thus, a patient needs to minimize calorie intake and perform physical activities. To prevent CHD, the patient must work towards attaining a body mass index of less than 25 and a waist circumference of less than 35. Moreover, the patient has to consider mild physical activities, such as relaxation therapy or yoga to relieve stress. Furthermore, it is important to note that anxiety and anger are triggers of a heart attack. People resolve to cope with stress through smoking, drinking, or overeating, which are not healthy remedies. Therefore, it is important to have supportive community and family members to share the uncomfortable feelings or concerns with. As a result, the patient can relieve his stress and avoid health complications. Similarly, the condition is causing psychological weariness among the patient’s family members, who are aware that, if the condition worsens, the patient will not be able to provide for the family. The wariness might cause stress for the members.

The Key Concepts that Must Be Shared with the Patient and Family to Achieve Optimal Disorder Management and Outcomes

Firstly, the patient should consider positive lifestyle changes indicated below:

• Quit smoking to minimize the risk of heart attack or coronary heart disease. An individual can quit smoking on his own or may consider joining a support group at the hospital, community or workplace.
• The family should ensure that the patient follows a healthy diet that is rich in fruits, vegetable, whole grains, and fat-free.

Secondly, the patient needs to seek ways to remain physically active to lower the risk factors of CHD, such as excess weight, LDL cholesterol, and high blood pressure.

Thirdly, the patient should maintain a healthy weight to avoid conditions such as overweight and obesity that are considered risk factors for cardiovascular diseases (Jamee & Abed, 2014).

Finally, the patient should consider cardiac rehabilitation.

Key Interdisciplinary Team Personnel Needed and How the Team Will Provide Care to Achieve Optimal Disorder Management and Outcomes

Interdisciplinary team of personnel needed include nurses, doctors, dieticians, exercise specialists, occupational therapists, psychologists, and mental health specialists. They  can help the patient through exercise training, education, and counseling. In exercise training, the patient learns how to conduct safe exercises, strengthen his muscles, and improve stamina. The interdisciplinary team ensures that the exercises are based on the patient’s abilities, needs, as well as interests. Education and counseling ensure the patient understands his/her heart conditions and the ways to lower the risks of future problems. The team helps the patient to learn how to deal with the stress of adjusting to the new lifestyle as well as possible fears about the future.

Facilitators and Barriers to Optimal Disorder Management and Outcomes

1. Personal fears about future life may prevent the patient from taking part in the disorder management.
2. Lack of support from family members and friends may hinder active participation in disorder management.
3. Financial constraints can prevent the patient from acquiring the best disorder management options.

Strategies to Overcome the Identified Barriers

1. Caregivers should let family members and friends know the important role that they play in the management of the patient’s condition. Providing unconditional support can help the patient develop a positive perception about recovery.
2. Joining a support group can help the patient to avoid personal fears about the future. In the group, the patient can identify with other individuals, who have similar conditions, and learn the positive attitude about their future lives.

• The patient can join health insurance schemes that are subsidized by the government. Thus, he will be able to acquire better medical attention whenever he needs to manage the condition.

Care Plan Synthesis

Comprehensive and Holistic Recognition and Planning for the Disorder

• The approach should emphasize the critical roles of high blood pressure in the prevention of cardiovascular disease. Socio-cultural determinants of risk factors should be considered in health care practice (Centers for Disease Control and Prevention, 2010).
• The strategy should aim to reap the benefit of shared knowledge through information exchange.
• Cholesterol testing is critical in recognition of the disorder. High cholesterol indicates that an individual is at risk of developing heart disease.
• Blood pressure screening should be done regularly.
• Exercise testing can help to find symptoms such as shortness of breath and chest pain.

How the Patient’s Socio-Cultural Background Can Potentially Impact Optimal Management and Outcomes

The patient seems to come from a poor social background, and is not sure if he can provide for the family from the meager income of $ 50,000 annually. Besides, he cannot afford a comprehensive medical insurance coverage. Therefore, even though the patient may desire to receive optimal management for the case, he may not afford it. His current health insurance only covers for a few medical conditions. Consequently, it can be noted that the patient’s poor socio-cultural background potentially denies him the opportunity to receive optimal management as well as acquire desired outcomes.

Evidence-Based Approach to Address Key Issues in the Case Study

One of the approaches is to emphasize on the intake of heart-healthy foods. For example, intake of fish reduces the risk of cardiovascular disease mainly due to omega-3 fatty acids.

Optimal blood pressure is achieved through the provision of detailed information regarding weight management, healthy eating plan, required physical activity, and sodium reduction. Moreover, community-based programs that target people in low and middle income groups have always provided optimism for policy interventions.

Comprehensive but Tailored Approach to Disorder Management

Caregivers should let the patient know that people can be healed through changing lifestyles and showing compassion. The patient has to learn that cardiovascular disease are manageable through taking medicines, tender loving care, lifestyle change, as well as complementary modalities. The aforementioned strategies create a positive belief in the patient.

The caregiver should encourage the patient to enroll in a rehab program. A comprehensive lifestyle change program can be coordinated by a nurse case manager, who invites individual consultants such as nurse practitioners, physicians, exercise physiologists, registered dieticians, and psychologists. Being a member of such a program, the patient can benefit from yoga, support group communication, meditation, as well as visualization classes.

Additionally, the caregiver should consider providing the patient with guided imagery. Thus, if there is need for surgery, the patient is prepared both emotionally and psychologically. The caregiver should also ensure that there is guided imagery that focuses on the management of pain after surgery.

The caregiver should ensure that the patient receives complimentary therapies such as acupuncture, biofeedback, healing touch, and massage. Likewise, the caregiver should organize for the patient to meet regularly with his nutrition counselors as well as spend time in stress management classes (Centers for Disease Control and Prevention, 2010).

Finally, the caregiver is to recommend a comprehensive program that focuses on the patient’s needs, for example, exercise recommendations, nutraceuticals, and herbal supplements.

Conclusion

The given case has provided an opportunity to review the symptoms of a patient that has a cardiovascular disease. Through the case, working strategies that involve interdisciplinary care providers have been suggested. Likewise, the role of family members in helping a patient cope with or manage the condition cannot be underestimated. In conclusion, it is important for a patient to develop a positive self-evaluation to cope with cardiovascular diseases successfully.

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