Mr Silveria Heart failure 2 Case study
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Mr Silveria is a 47-year-old Brazilian man who was referred to the heart failure clinic by his consultant cardiologist for titration of his heart failure treatment. He has severe biventricular failure (NYHA III-1V) secondary to mitral valve disease. His current presenting symptoms are breathlessness on minimal exertion, paroxysmal nocturnal dyspnoea and poor appetite, and he experiences dizziness with quick movements. His past medical history includes septic arthritis with mitral endocarditis and septic emboli, mitral valve repair in 2012 and out of hospital ventricular fibrillation arrest in 2009. He has an implantable cardioverter defibrillator to manage recurrent ventricular tachycardia. Unfortunately his arrest in 2009 left him with profound short-term memory loss. His partner also stated that he often forgot to drink enough fluids. Sometimes he only drank 12 glasses of fluid per day whilst she was at work. Mr Silveria, however, has normal coronary arteries. His medication on the initial consultation is: lisinopril 2.5mg once daily, aspirin 75mg once daily, furosemide 40mg once daily and bisoprolol 1.25mg once daily.
On clinical examination, his observations were within the normal parameters, including a clear lung field on auscultation and no peripheral oedema. His jugular venous pressure (JVP) was not raised and his renal function and ECG were within normal limits. However, his systolic BP was relatively low, at 100/86mmHg.
In summary, his main problems were hypotension and memory loss and he was low in mood. The plan for Mr Silveria was to:
c) Increase his medication (up-titration of heart failure treatment) in order to reduce the deterioration in his current symptoms. On the first consultation, Mr Silverias lisinopril was increased from 2.5mg to 5mg.
d) Provide support to help him address how he felt about his condition and suggest strategies to help him cope with his memory loss.
On the second consultation, Mr Silveria returned to the clinic with paroxysmal nocturnal dyspnoea. During the assessment it was discovered that he had stopped taking his furosemide but neither he nor his partner knew who had instructed him to stop it. Furosemide was recommenced.
This situation illustrates the need for good communication and clear documentation by all involved in a patients care. The matter was investigated further, and the relevant individual was made aware of the results of their actions.
On his third visit to the clinic, Mr Silveria was generally well and more optimistic about his progress. However, his systolic BP was now 80mmHg, and although the dizziness was still present it had not worsened. No further changes were made to his medication and a follow- up appointment was made to see the consultant cardiologist. The consultant commenced Mr Silveria on spironolactone 25mg od because he was still symptomatic, (hypotension, dizziness) despite almost optimal treatment with an ACE-inhibitor and a beta-blocker.
RUBRIC
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