INTRODUCTION

Mr. Johnson, a 65-year-old male, presents with chronic heart disease (CHD). He has a

medical history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. His current

medications include lisinopril (ACE inhibitor), atorvastatin (statin), metformin (oral

antidiabetic), and aspirin. He complains of exertional dyspnea, orthopnea, and occasional

palpitations. Vital signs reveal blood pressure 150/90 mmHg, heart rate 88 bpm, respiratory

rate 20 breaths/min, temperature 37°C, and oxygen saturation 95% on room air.

Mr. Johnson's chronic heart disease (CHD) is characterized by the progressive

narrowing of coronary arteries due to atherosclerosis, leading to reduced blood flow to the

heart muscle and subsequent ischemia. This results in symptoms such as exertional dyspnea,

orthopnea, and palpitations (Pathophysiology: Cardiovascular disease, Week 6).

The focused pharmacologic management for Mr. Johnson entails addressing key

aspects of his chronic conditions. Lisinopril, an ACE inhibitor, is prescribed to regulate blood

pressure and mitigate the risk of heart failure exacerbation by inhibiting the renin-

angiotensin-aldosterone system. Atorvastatin, a statin drug, is utilized to manage

dyslipidemia by reducing LDL cholesterol levels, thus lowering the risk of cardiovascular

events such as myocardial infarction and stroke. Metformin is employed to achieve glycemic

control in diabetes, aiding in the prevention of microvascular complications like neuropathy

and retinopathy by improving insulin sensitivity. Furthermore, aspirin serves as antiplatelet

therapy, decreasing the likelihood of thrombotic events and playing a crucial role in the

secondary prevention of myocardial infarction and stroke in high-risk individuals like Mr.

Johnson. These medications collectively target different facets of Mr. Johnson's chronic

conditions, aiming to optimize his cardiovascular health and minimize the risk of associated
complications (Pathophysiology: Cardiovascular disease, Week 6; Capodanno & Angiolillo,

2016)

Moreover, in organizing Mr. Johnson's care plan according to Maslow's Hierarchy of

Needs, various aspects of his well-being are addressed across different levels. Firstly,

physiological needs take precedence, ensuring medication adherence for his chronic

conditions and implementing effective symptom management strategies to alleviate

discomfort and improve overall health status. Safety concerns are meticulously attended to

through continuous monitoring for adverse drug reactions, thus mitigating potential risks

associated with pharmacological interventions, alongside the implementation of fall

prevention strategies to safeguard Mr. Johnson's physical well-being (Adult Teaching and

Learning Principles, Week 1). Love and belonging needs are met through the provision of

supportive counseling, which offers emotional support, and education on lifestyle

modifications, fostering a sense of connection and community while promoting psychological

well-being. Additionally, self-esteem is encouraged by empowering Mr. Johnson to engage in

self-care activities, enabling him to take an active role in managing his health and fostering a

sense of control and autonomy. Finally, self-actualization is promoted by encouraging his

participation in cardiac rehabilitation programs, not only aiding in physical recovery but also

facilitating personal growth, self-improvement, and the realization of his full potential in

managing his chronic heart disease.

During system data collection, various aspects of Mr. Johnson's health are assessed

across different body systems. Cardiovascular evaluation includes monitoring for chest pain,

dyspnea, palpitations, and signs of peripheral edema. Respiratory assessment focuses on

identifying symptoms such as orthopnea and paroxysmal nocturnal dyspnea. Endocrine

scrutiny involves regular monitoring of blood glucose levels and vigilance for signs

indicating hyperglycemia or hypoglycemia (Pathophysiology: Cardiovascular disease, Week

6). Additionally, a thorough head-to-toe physical assessment is conducted, where subjective

symptoms reported by Mr. Johnson, including exertional dyspnea, orthopnea, and occasional

palpitations, are noted. Objective findings reveal elevated blood pressure, with heart rate and

respiratory rate within normal limits, along with normal temperature and oxygen saturation

on room air. Analyzing these cues helps in generating priorities, with the presenting problems

of exertional dyspnea, orthopnea, and occasional palpitations identified as primary concerns.

Furthermore, potential complications such as myocardial infarction, heart failure

exacerbation, and diabetic complications are recognized as at-risk issues, guiding the

formulation of a comprehensive care plan (Clinical Decision Making and Planning Care,

Week 4).

In establishing priorities for Mr. Johnson's care, the foremost concern is addressing

Priority 1, which involves exertional dyspnea and orthopnea due to the potential risk of acute

heart failure exacerbation. Immediate intervention is essential to prevent respiratory distress

and enhance oxygenation, thereby stabilizing his condition and improving his overall well-

being. Following this, Priority 2 focuses on managing hypertension to mitigate the risk of

further cardiovascular complications, such as stroke or myocardial infarction, which could

exacerbate his existing heart condition. Additionally, Priority 3 emphasizes the importance of

glycemic control to prevent diabetic complications, including neuropathy or retinopathy,

which could further compromise his cardiovascular health. Overall, the main priority of care

centers around effectively managing exertional dyspnea and orthopnea to prevent acute

decompensation and enhance Mr. Johnson's quality of life, ensuring a holistic approach to his

health needs (Kuo & Peacock, 2015; Sandeep Sharma et al., 2019).
 Consequently, the primary goal of care is to alleviate Mr. Johnson's exertional

dyspnea and orthopnea, thereby enhancing his quality of life and reducing the risk of acute

heart failure exacerbation. This objective will be achieved through a multifaceted approach,

including optimizing medication therapy to manage his chronic conditions effectively.

Additionally, education on lifestyle modifications, such as dietary changes and regular

exercise, will be provided to empower Mr. Johnson to take an active role in his health

management. Continuous monitoring and follow-up appointments will ensure the

effectiveness of interventions and enable timely adjustments to the care plan as needed,

ultimately promoting Mr. Johnson's overall well-being and cardiovascular health (Idris

Zubairu Sadiq, 2023).

In conclusion, Mr. Johnson's case underscores the complex interplay between chronic

heart disease and its management within the framework of Maslow's Hierarchy of Needs.

Through a comprehensive care plan addressing physiological, safety, love and belonging,

self-esteem, and self-actualization needs, his well-being is prioritized and supported across

various dimensions. By focusing on immediate concerns such as exertional dyspnea and

orthopnea, alongside long-term management of hypertension and glycemic control, the goal

is to enhance Mr. Johnson's quality of life and minimize the risk of acute cardiovascular

events, ultimately promoting his overall health and well-being.

References

Adult Teaching and Learning Principles, Week 1

Capodanno, D., & Angiolillo, D. J. (2016). Aspirin for Primary Cardiovascular Risk

Prevention and Beyond in Diabetes Mellitus. Circulation, 134(20), 1579–1594.

https://doi.org/10.1161/circulationaha.116.023164

Clinical Decision Making and Planning Care, Week 4

Idris Zubairu Sadiq. (2023). Life style medicine as a modality for prevention and

management of chronic diseases. https://doi.org/10.1016/j.jtumed.2023.04.001

Kuo, D. C., & Peacock, W. F. (2015). Diagnosing and managing acute heart failure in the

emergency department. Clinical and Experimental Emergency Medicine, 2(3), 141–149.

https://doi.org/10.15441/ceem.15.007

Pathophysiology: Cardiovascular disease, Week 6

Sandeep Sharma, Hashmi, M. F., & Madhu Badireddy. (2019). Dyspnea on Exertion (DOE).

Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499847/