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.

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