1.
The patient is diagnosed to have congestive heart failure. This is a heart disorder resulting to pulmonary vascular congestion with a reduced cardiac output. Among the diagnostic symptoms of the disorder include pulmonary complications, such as pulmonary edema, obstructive sleep apneas and pleaural effusions (Figueroa and Peters 2006). It is also characterized by the main symptoms of orthopnea, fatigue, dyspnea, paroxysmal nocturnal dyspnea and peripheral edema (Grimshaw, Khunti and Baker, 2001), which are all present in the clinical symptoms presented by the patient Mabel. During the exacerbation of the congestive heart failure, the patient will benefit from continuous positive airway pressure as well as non-invasive positive pressure ventilation which was given to the patient to provide her some relief. Heart valve disease is also a known risk factor for congestive heart failure and the patient’s past medical history showed having undergone a four-vessel coronary artery bypass surgery.
2.
The appropriate pharmacologic treatment to prescribe for the patient include diuretics, angiotensin converting enzyme inhibitors and beta blockers. These are usually the first line of drug treatment that aim to produce preload reduction using dieuretics, afterload reduction with angiotensin converting enzyme inhibitors, and reducing the catecholamine surges using beta blockers (Figueroa and Peters 2006).
3.
Long term clinical trials show that the potential side effect closely associated with diuretics is dehydration (Freis 1992). Its common symptoms include dry skin, extreme thirst, sry mouth, sleepiness, tiredness, irritability and confusion. Patients taking beta blockers may experience dizziness due to bradycardia and hypotension (Kearney, 2008). Sodium retention is a common side effect of angiotensin converting enzyme inhibitors which necessitates the need of taking it with diuretics to compensate with this side effect. All these symptoms must be observed during the patient’s follow-up visit.
4.
The most common approach in reducing the side effects of drug therapy is to reduce the dose in consideration of the patient’s age. Geriatric patients are most susceptible to the adverse side effects of drugs and Daughton and Ruhoy (2013) indicated in their study that it is possible to reduce the risks to side effects by prescribing a lower dose while still achieving the desired outcome. Dose reduction also helps prevent poisoning and provides the safer technique of drug diversion.
5.
Gibbs, Jackson and Lip (2000) suggest other approaches in congetive heart failure management without resorting to a drug therapy. This includes teaching the patient with the proper low sat diet, restrictions on their fluid intake, and modifying their lifestyle such as avoiding alcoholic drinks and smoking that are known risk factors to the development of cardiomyopathies and other heart diseases. Doing regular exercise for weight reduction is also an effective preventive measure against congestive heart failure. This makes patient education a crucial aspect of congestive heart failure prevention and management. Improving patient compliance to non-pharmacological approach to treatment is just as important according to Ven Der Wal, et al (2010) since non-compliance may result in frequest hospitalization, higher mortality rate and recurrence of symptoms.
References:
Daughton, C.G. and Ruhoy, I.S. (2013). Lower-dose prescribing: Minimizing “side effects” of pharmaceuticals on society and the environment. Science of the total environment, 443: 324-337.
Figueroa, M.S. and Peters, J.I. (2006). Congestive Heart Failure: Diagnosis, Pathophysiology, Therapy, and Implications for Respiratory Care. Respiratory Care, 51(4):403-412.
Freis, E.D. (1992). Adverse Effects of Diuretics. Drug Safety, 7(5):364-373.
Gibbs, C.R., Jackson, G. and Lip, G.Y (2000). Non-drug management. BMJ, 320(7231): 366–369.
Grimshaw, G.M., Khunti, K. and Baker, R. (2001). Diagnosis of heart failure in primary care:an assessment of international guidelines. British Journal of General Practice, 384-386.
Kearney, M. (2008). Chronic Heart Failure. New York: Oxford University Press.
Ven Der Wal, M. et al. (2010). Compliance with non-pharmacological recommendations and outcome in heart failure patients. European Heart Journal, 1486-1493.
