Table of ContentsClient Narrative and Therapeutic Treatment Plan Activities: ExamplePhysiology of Congestive Heart FailurePharmacological Care Plan and Medication ProfilesConclusionIn Developing a Plan of narrative therapy treatment, an example would be exploring and reframing the client's personal narrative to enable them to overcome challenges and shape a more resilient and positive future. Diseases, chronic conditions, all these sufferings can be contracted or expressed in a variety of people through similar symptoms determined by the individual diagnosis. Although each individual condition may express itself in a similar manner, the steps taken to establish an effective treatment plan can vary greatly depending on several biological, chemical and phycological factors. In order to understand a treatment plan developed in an individual patient, several factors must be analyzed such as: a detailed description of the client to understand their needs and reason for admission, current pathophysiology of the disease and management of the disease. the use of pharmacological reactions. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the Original Essay Client Narrative and Therapeutic Treatment Plan Activities: Example Descriptive data was researched and acquired on a hospitalized patient through a nursing student completing their clinical rotation at their local hospital. The patient studied is an elderly woman, currently married, not affiliated with any religion and coming from her own address. The patient presented to the hospital due to symptoms of fatigue and shortness of breath (SOB) which led to an admitting diagnosis of congestive heart failure (CHF) as well as a code status for complete resuscitation. The selected patient has an extensive history of health problems and diagnoses, the most prevalent being: type 2 diabetes, endometrial cancer, hypertension, metabolic syndrome, renal cell carcinoma, and high cholesterol. Previous treatment attempts on the previously mentioned diagnoses had revealed a long list of allergies that could harm the patient's health, such as allergies to beta blockers, Ativan, calcium channel blockers, gentamicin, clindamycin, nitrofurantoin and several others. This understanding of general patient information can interfere with creating a specialized care plan specifically for the patient that attempts to avoid any adverse reactions or unnecessary stress on the patient's body and mind. Further research was conducted into the patient's current plan of care regarding: their activities of daily living in the hospital involving their nutritional status, hygiene and dressing abilities, eliminatory needs and outpatient necessities that are normally met at home by the patient themselves or with the help of their husband. The patient's nutritional care plan revolves around a low-carbohydrate diet with only minimal assistance required to prepare food for direct consumption, as the patient requires time to eat due to fatigue. The patient's hygiene and dressing abilities vary by day based on their current level of fatigue and SOB, as they may be independent and only installation is required or they may need minimal assistance with the areas that are more difficult to reach. The patient's eliminatory needs are usually managed independently by the patient, with only assistanceoccasional needed in the form of a bedpan or urinal due to its symptoms. The patient's ambulatory needs are minimal, with the patient able to get out of bed and walk to the chair on their own. The patient also has a four-wheel walker that can be used to walk greater distances with only monitoring required for signs of weakness due to fatigue and SOB. The understanding of the patient's plan of care as it relates to their activities of daily living is important for the comfort and health of the patient in order to meet their needs and routines within a semblance of normalcy that avoids any unnecessary risk that the patient attempts to accomplish these tasks. needs for themselves. Pathophysiology of Congestive Heart Failure Upon admission to the hospital, the patient was diagnosed with CHF. The condition known as CHF occurs when damage or weakness begins to affect the heart, inhibiting the strength needed to pump blood around the body. This inhibition of force in the heart allows for the possibility of fluid buildup due to blood returning from the lungs to the heart due to lack of muscle relaxation which can increase during stressful activity or events. Congestion caused by backflow of blood can lead to exhaustion, SOB, and edema accumulating in the patient's ankles, legs, arms, hands, or torso. CHF has several possible underlying factors that may have triggered the disease, with the two main underlying factors being heart damage or weakness caused by: myocardial insult or long periods of hypertension. CHF can manifest itself by multiple symptoms of varying severity such as: SOB, peripheral and sometimes central edema, increased levels of fatigue during activities or at rest, increased urination which occurs mainly at night, accompanied by pain , discomfort. or pressure in the chest or heart. As the heart is considered one of the most vital organs that supports the functioning of several other organs, 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 done to detect CHF before symptoms appear in the final stages, as long as the patient sees a health care provider as soon as symptoms appear. These tests may include an electrocardiogram to assess the size, rate, and strength of the heart as it pumps blood, a chest X-ray to look for any fluid buildup in the lungs, and a complete blood count to assess any bleeding, electrolytes. kidney loss and function. Once CHF is diagnosed, the primary treatment is primarily pharmacological with medications such as diuretics, beta-blockers, and AS inhibitors to decrease fluid volume, increase cardiac output, and decrease systemic resistance. The patient, once admitted and evaluated by the nursing student, presented with several signs and symptoms suggesting the presence of CHF. Symptoms assessed included irregular heart rate where occasional beats could not be heard, swelling accompanied by pitting in the lower peripherals, mainly around the ankles, suggestive of fluid accumulation, increased fatigue with increased rest periods and sobbing with little activity, such as getting out of bed. Other signs suggesting a problem were seen in blood results,with almost triple values ​​of creatine and blood urea nitrogen, suggesting reduced blood flow to the kidneys, as well as low levels of hemoglobin, hematocrit and mean platelet volume, suggesting a decrease in volume percentage . of red blood cells in the blood and a reduction in the transport of oxygen in the blood. Treatment measures selected by their doctor involved the use of beta blockers to decrease heart strength and rate, which would lower the pressure of blood in the arteries as it leaves the heart, immunosuppressants to reduce the body's reaction to beta blockers. to the patient's allergies to the medication, diuretics to decrease fluid volume and accumulation to prevent increased edema and manage blood pressure levels and a combination of bronchodilators and selective beta-adrenergic receptor agonists to help facilitate the flow of oxygen through the airways and into the lungs. This treatment plan proved ineffective for the patient as evidenced by the observations on a weekly basis until a transfer was necessary for further treatment measures. When caring for this patient, the nursing student noted that several considerations and interventions were necessary, for example the patient needed breaks between activities and rest from their normal life activities daily due to his fatigue and SOB. Short, direct activities were needed to decrease the patient's level of fatigue compared to long, slow activities, with moments of independence such as allowing them to perform peri care and eating at a slower pace to avoid fatigue. 'exhaustion. Pharmacologic Care Plan and Medication Profiles The patient over the course of his life, developed multiple conditions requiring multiple pharmacologic treatment methods that carried over to the patient's current treatment plan for CHF. Medications previously ordered by the patient include: apixaban used to prevent serious blood clots due to atrial fibrillation, atorvastatin and ezetimibe used to manage high lipid levels, insulin aspart and insulin glargine used for the management of diabetes, levofloxacin to prevent the growth of bacteria in patient wounds, mometasone for psoriasis, pantoprazole for the management of gastroesophageal reflux disease, and tolterodine for overactive bladder. Understanding and recognizing currently prescribed medications from previous diagnostics the patient is using is critical to creating a pharmacological care plan to prevent any chemical reactions between medications and avoid overdoses. Sometimes when developing a pharmacological care plan, certain medications are needed for benign conditions or as secondary medications that are not related to the patient's diagnosis, such as: allopurinol for kidney stones, acetylcysteine ​​for the management of acetaminophen poisoning and prednisone to suppress the patient's immune system. medications can be considered among the most important, as they can prevent other symptoms from occurring or contribute to the action of the main medications to improve the chances of recovery. Finally, the main medications associated with a pharmacological care plan are those that act to manage or treat the condition for which the patient was admitted, 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. An analysisFurther depth of the patient's pharmacological care plan can be explored through the prevalence of the five most important medications in the patient's care plan. Prednisone, also known as Winpred, is one of the most important medications present in the patient's pharmacological care plan. plan of care, not as the primary medication used to manage the diagnosis, but rather as a secondary medication that allows for the appropriate effects of bisoprolol due to its immunosuppressive effects. Prednisone belongs to the corticosteroid class due to its primary anti-inflammatory effects. The prescribed medication was administered daily in the morning as a 30 mg oral tablet. Prednisone was indicated for the patient to suppress the body's natural immune response, as the patient is allergic 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 rate of white blood cell replication in the body to decrease the immunological and inflammatory response. As no medication is perfect, certain side effects have occurred such as: dry skin that could be found on the feet where the gout appeared, increased bruising as shown by the bruising present during injections and slow healing of wounds as evidenced by scarring. rate of injury to the patient's legs. For nursing reasons, 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, also known as Zebeta, is the most important medication for the treatment of CHF in the patient's pharmacological care plan due to its diminishing effects on rare heart contractions. Bisoprolol belongs to the class of selective beta-adrenergic receptor blocking agents for its effect in the management of high blood pressure. The prescribed medication was administered daily as a 2.5 mg oral tablet. Bisoprolol was indicated in the patient to allow the heart to relax while replenishing the amount of incoming blood. Bisoprolol works by blocking stimulation of adrenergic receptors in the heart muscles to slow conduction of the atrioventricular node. Side effects of bisoprolol included increased fatigue, with the patient needing periods of rest throughout the day, and a slower heart rate, seen when assessing the patient from head to toe. For nursing reasons, it is important to slowly decrease the amount administered rather than simply stopping it as serious adverse effects may occur. Furosemide, also known as Lasix, can be invaluable in managing the diagnosis as the medication can be used to lower blood levels. pressure and eliminate any excess fluid in the body. Furosemide belongs to the class of drugs known as non-potassium training diuretics for its effects in managing hypertension through fluid loss. The prescribed medication was administered twice daily as a 40 mg oral tablet. Furosemide was indicated in the patient to help manage blood pressure and excrete any excess fluid that may accumulate and move to interstitial tissues, causing increased edema. Furosemide works by blocking the absorption of sodium, chlorine, and water in the kidneys. The side effects of furosemide are.