Running head: CASE STUDY 2 1 3 CASE STUDY 2 Congestive Heart Failure Case Study 2 This case study is about Mr. P, a 76 year old male, hospitalized usually to treat cardiomyopathy and congestive heart failure (CHF). The author describes the approach to care, treatment plan, method to provide education and a teaching plan about the CHF. Congestive heart failure is defined as “the state in which the heart is unable to pump blood at a rate adequate for satisfying the requirements of the tissues with function parameters remaining within normal limits usually accompanied by effort intolerance, fluid retention, and reduced longevity” (Denolin, 1983, p. 445). Approach to care · Assessment of patient: Physical examination of the patient (at each visit), with particular attention to assessment of their vital signs, cardiovascular system (including volume status), signs of deterioration and co-morbid conditions. · Assessment and management of the patient’s cardiovascular risk factors (e.g. hypertension, dyslipidaemia, diabetes, smoking and obesity). · Assessment of the patient’s nutritional status. · Assessment of the patient’s potential for adverse effects of medicines · Regular reassessment of the patient’s biochemistry (including urea and creatinine) and haematology (including haemoglobin) parameters. · Assessment of the patient’s daily fluid and salt intake from food and drink. · Ongoing monitoring of the patient’s electrolytes (particularly serum sodium and potassium levels) and renal function. · Monitor intake and output strictly and take daily weight. Treatment Plan CHF is a complex clinical syndrome; therefore, treatment plan includes the focus on the fundamental causes. Appropriate combination of medicines, control over lifestyle with careful monitoring is the basic treatment for CHF. · An Angiotensin-Converting Enzyme (ACE) inhibitor (captopril, enalapril etc) or an Angiotensin II receptor blocker (ARB) helps to relax the blood vessels and enhance the blood flow. · Beta-blockers (bisoprolol, carvedilol etc) reduce the blood pressure and stabilize the heart beat rate. · Diuretics (lasix, bumex etc) remove more sodium and water from the body, which helps in lowering blood pressure. Also, spironolactone and eplerenone called as potassium-sparing diuretics help to retain potassium. · Other drugs include anticoagulant, statin and digoxin as per doctor’s recommendation. Besides medication and diet alteration, devices and surgical procedures are available for the treatment of heart failure. An implantable cardiac defibrillator (ICD), coronary artery repair and valve repair or replacement (as appropriate) can be done (Heart.org, 2016). Education method Heart failure patients and their family members should acquire the education, problem solving abilities and motivation regarding the treatment plan, medications and effective participation in self-care. “Patient education and post discharge management have demonstrated be ...

1. Running head: CASE STUDY 2
1
3
CASE STUDY 2
Congestive Heart Failure
Case Study 2
This case study is about Mr. P, a 76 year old male, hospitalized
usually to treat cardiomyopathy and congestive heart failure
(CHF). The author describes the approach to care, treatment
plan, method to provide education and a teaching plan about the
CHF. Congestive heart failure is defined as “the state in which
the heart is unable to pump blood at a rate adequate for
satisfying the requirements of the tissues with function
parameters remaining within normal limits usually accompanied
by effort intolerance, fluid retention, and reduced longevity”
(Denolin, 1983, p. 445).
Approach to care
· Assessment of patient: Physical examination of the patient (at
each visit), with particular attention to assessment of their vital
signs, cardiovascular system (including volume status), signs of
deterioration and co-morbid conditions.
· Assessment and management of the patient’s cardiovascular
risk factors (e.g. hypertension, dyslipidaemia, diabetes, smoking
and obesity).
· Assessment of the patient’s nutritional status.

2. · Assessment of the patient’s potential for adverse effects of
medicines
· Regular reassessment of the patient’s biochemistry (including
urea and creatinine) and haematology (including haemoglobin)
parameters.
· Assessment of the patient’s daily fluid and salt intake from
food and drink.
· Ongoing monitoring of the patient’s electrolytes (particularly
serum sodium and potassium levels) and renal function.
· Monitor intake and output strictly and take daily weight.
Treatment Plan
CHF is a complex clinical syndrome; therefore, treatment plan
includes the focus on the fundamental causes. Appropriate
combination of medicines, control over lifestyle with careful
monitoring is the basic treatment for CHF.
· An Angiotensin-Converting Enzyme (ACE) inhibitor
(captopril, enalapril etc) or an Angiotensin II receptor blocker
(ARB) helps to relax the blood vessels and enhance the blood
flow.
· Beta-blockers (bisoprolol, carvedilol etc) reduce the blood
pressure and stabilize the heart beat rate.
· Diuretics (lasix, bumex etc) remove more sodium and water
from the body, which helps in lowering blood pressure. Also,
spironolactone and eplerenone called as potassium-sparing
diuretics help to retain potassium.
· Other drugs include anticoagulant, statin and digoxin as per
doctor’s recommendation.
Besides medication and diet alteration, devices and surgical
procedures are available for the treatment of heart failure. An
implantable cardiac defibrillator (ICD), coronary artery repair
and valve repair or replacement (as appropriate) can be done
(Heart.org, 2016).
Education method
Heart failure patients and their family members should acquire
the education, problem solving abilities and motivation

3. regarding the treatment plan, medications and effective
participation in self-care. “Patient education and post discharge
management have demonstrated benefits in patients with
chronic heart failure” (Koelling, Johnson, Cody & Aarons).
Patient and family are likely to adhere to treatment process and
medications if they understand the education they are given.
Teach-back and self-management tool are the most effective
method to provide education to both patients and families
(American Nurse Today, 2012). In this method, patient and
family are asked to explain the material just taught. The
educator may need to clarify, repeat or modify the content of
teaching several times based on how well the learner
comprehends and recalls. This method helps to understand the
self-management approaches (self-monitoring, medication, diet
control, exercise, weight control, and reduction in smoking and
alcohol consumption) to assist the patients and their family.
Teaching Plan
Heart failure afflicts an individual but it affects entire families.
Family support system is very critical
for patient to live with CHF. Therefore family involvement is
very important in teaching plan. Teaching plan
includes.
· Daily weight monitoring: At the same time every day in
lightweight clothing after urinating and before breakfast.
· Medication and its side effects: Take your medications exactly
as directed and follow-up the doctor’s appointment. Also,
should be well aware of its side effects.
· Physical activity: Exercise help to improve the condition heart
muscles, balance the body, relieve the stress and maintain the
body weight.
· Diet and Social activities:
1. Sodium intake: Follow a low sodium diet
2. Fluid intake: Avoid drinking excess fluids
3. Alcohol and tobacco consumption: Use of alcohol and
tobacco should be avoided as these are associated with the
strictly negative effect in CHF patients.

4. 4. Vaccination: Annual immunization against Influenza is
recommended.
· Aware of worse symptoms: Contact the doctor if symptoms
such as fast and irregular heartbeat, severe crushing chest pain,
dizziness, shortness of breath etc are noticed.
CHF is a complex heart disease associated with complex
treatment plans. Hence, patient and their family members should
be made aware of the disease and the health care providers
should implement different method of education and teaching
plan for the optimal care of the patients.
References
Denolin H, Kuhn H, Krayenbuehl HP, et al. (1983). The
definition of heart failure. Eur Heart J (1983)4:445–8.
Retrieved from
http://aje.oxfordjournals.org/lookup/ijlink?linkType=PDF&jour
nalCode=ehj&resid=4/7/445
Heart.org,. (2016). Treatment Options for Heart Failure.
Retrieved 27 January 2016, from

5. http://www.heart.org/HEARTORG/Conditions/HeartFailure/Trea
tmentOptionsForHeartFailure/Treatment-Options-for-Heart-
Failure_UCM_002048_Article.jsp
Target:HF, (n.d.). Taking the failure out of heart failure.
Retrieved 28 January 2016, from
https://www.heart.org/idc/groups/heartpublic/@private/@wcm/
@hcm/@gwtg/documents/downloadable/ucm_428949.pdf
Dinh, H., Clark, R., Bonner, A., & Hines, S. (2013). The
effectiveness of health education using the teach-back method
on adherence and self-management in chronic disease: a
systematic review protocol. The JBI Database of Systematic
Reviews and Implementation Reports, 11(10), 30-41. Retrieved
from
http://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/
article/view/900/1634
Koelling, T., Johnson, M., Cody, R., & Aaronson, K. (2005).
Discharge Education Improves Clinical Outcomes in Patients
With Chronic Heart Failure. ACC Current Journal Review,
14(5), 25-26. http://dx.doi.org/10.1016/j.accreview.2005.04.003
Using teach-back for patient education and self-management -
American Nurse Today. (2012, March 11). Retrieved January
13, 2016, from http://www.americannursetoday.com/using-
teach-back-for-patient-education-and-self-management/
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5
CASE STUDY ONE

6. Case Study One
Ishwari Basnet
Grand Canyon University: NRS-410V
January 31, 2016
Iron Deficiency Anemia
There are many types of anemia; anemia is a medical condition
when an individual lacks healthy red blood cells to carry
oxygen in the body. One kind of anemia is iron deficiency
anemia; this is a condition that occurs when the blood lacks
adequate mineral, iron. In order to transport oxygen from the
lungs to different organs and body tissues, iron is essential in
order to make hemoglobin, a protein that is essential for oxygen
transport. The lack of iron in the body depletes necessary
oxygen, which lowers the function of the organs and body
tissues (Cafasso & Nall, 2015). In the case of Ms. A, showing
classic anemia symptoms, the paper studies the rationale
methods of identifying iron deficiency anemia.
Identification of Anemia and Rationale
According to Ms. A’s symptoms, health history, and lab results,

7. she is a iron deficient anemic. Ms. A has experienced multiple
common symptoms that point to anemia like hypotension,
fatigue, dyspnea, tachypnea, tachycardia, and is constantly
light-headed due to the frequent blood loss. In addition to these
symptoms, Ms. A has also experienced problems of extended
continuous menstrual period of extreme bleeding for duration of
10-12 years. This indicates that she is experiencing chronic
blood loss, which can result in becoming iron deficient. Another
factor that contributes to her being iron deficient is her constant
intake of aspirin during her period for joint stiffness. Studies
have shown that continuous usage of an anti-inflammatory drug,
like aspirin, has been shown to cause iron deficiency. Ms. A’s
laboratory results also indicate iron deficiency due to her low
hemoglobin level of 8 grams per deciliter and only 32% of
hematocrit. These results are significantly low compared to the
average results of a woman, whose hemoglobin levels are 12
grams per deciliter and 35 to 45% of hematocrit. Other lab
results that would indicate iron deficiency anemia would be low
Erythrocyte count of 3.1 x 10/mm, compared to normal RBC
count of 4.10-5.10/mm, and more extensive lab reports of
microcytic and hypochromic RBC smear.
Diagnosis
An individual can become iron deficient if there is a lack of
iron in the blood. The lack of iron depletes the level of
hemoglobin, and there is a decrease of oxygen flow from the
lungs to the body. Thus, the symptoms of this condition are
most commonly shortness of breath and constant fatigue due to
the lack of oxygen in the body. The most common treatment of
this condition is a prescription of iron supplement to help the
body in binding with hemoglobin. This treatment is only a
option if the case is simple, if there are further consequences of
iron deficiency like internal bleeding, then there may be a need
for further tests and extensive treatment (Iron deficiency
anemia, n.d.). In this particular case, Ms. A, may need to
undergo further tests analyzing her reproductive organs in order
to decide if her prolonged bleeding is caused by her iron

8. deficiency. Depending on each individual’s body, patients may
not show any or show few symptoms in mild or moderate iron
deficiency anemia, however, for extreme cases, the symptoms
are usually obvious. Some of these symptoms can be paling of
the skin, cold hands and feet, brittle nails, extreme and constant
fatigue, restless leg syndrome, poor appetite, headaches and
dizziness (Mayo Clinic).
It is vital to consider multiple aspects of a individual patients
medical history, physical examinations, and lab results when
diagnosing one with iron deficiency anemia. A patient’s medical
history will allow the health worker to observe the patients
history of iron count, diet, any previous, medical problems and
any medications the patient might be using. Conducting a
physical exam of the patient will allow the health care provider
to examine for brittle nails, paleness of skins, and the
opportunity to check for any unusual heart beating patterns,
shortness of breath, and examination of pelvic and rectal area
for internal bleeding. Lab results are also vital to diagnosing a
patient with iron deficiency anemia because lab procedures can
check the levels of hemoglobin, white blood cells, platelets and
the size of RBC’s. These results then are checked against the
normal numbers and levels, giving the health care provider more
evidence for the diagnosis (Iron Deficiency Anemia, 2014).
In conclusion, the incapability to carry sufficient oxygen to
body tissues and organs via the lack of healthy hemoglobin cells
(binded to iron) is the medical condition, iron deficient anemia.
The lack of oxygen in body tissue and organs can result in
fatigued and weak patients, but can also cause more serious
problems like internal bleeding. It is vital that one should visit
the doctor if experiencing multiple of the common symptoms.
Anemia can be an indicator of another serious illness and thus
should be diagnosed as early as possible. Anemia can be most
efficiently diagnosed via laboratory procedures, physical
examinations and medical history. After positive diagnosis, the
treatment can range depending on severity of the condition, iron
deficiency can be treated with an iron supplement. It is

9. important to include variety of vitamins in our diet in order to
avoid anemia and other illnesses.
References
Anemia. (n.d.). Retrieved January 28, 2016, from
http://www.mayoclinic.org/diseases-
conditions/anemia/basics/definition/CON-20026209?p=1
Cafasso, J., & Nall, R. (2015, October 15). Iron Deficiency
Anemia. Retrieved January
28, 2016, from Healthline.
Iron deficiency anemia. (n.d.). Retrieved January 28, 2016,
from http://www.mayoclinic.org/diseases-conditions/iron-
deficiency-anemia/basics/definition/con-20019327
Mayo Clinic. (n.d.). Iron Deficiency Anemia. Retrieved January
28, 2016, from Mayo
Clinic: http://www.mayoclinic.org/diseases-
conditions/iron-deficiency-
anemia/basics/treatment/con-20019327