Case Study Of The Rachel Suffered From Heart Attack – Discussion And Recommendations

Introduction to the client

Discuss about the Case Study Of The Rachel Suffered From Heart Attack.

This report mainly focuses on the case study of the client named Rachel. Rachel is a 51 years old woman who works as florists. Rachel lives with her husband and actively looks after her three grand children at least four evenings a week. Rachel though maintains an active life but is a smoker. She also has a family history of cardiac complications. At present, Rachel has suffered from heart attack and is hospitalised for the past 3 days.

New Zealand Cardiac Rehabilitation Framework sums up a set of interventions directed towards the physical, social and psychological conditions of the patients with post-acute and chronic cardiovascular disease. The main aim of these interventions is to ensure quality of life and well-being of the cardiac patients so that they can maintain optimal functioning within the society via improved health behaviours along with slow or reverse progression of disease. The principal aim of the NRCRF (2017) can be summed up in three goals and these includes

1. Prevention of further cardiovascular events via empowering patients to work on lifestyle change
2. Improvement of the overall quality of life of the patients via proper identification along with treatment of the psychological distress
3. Facilitation of patients return into active life via helping them to generate and use their own resources.

The main program components of NRCRF (2017) include empowerment of patient towards making lifelong changes; inclusion of proper exercise programs in order to maintain a healthy height: weight ration; proper management of nutrition; proper weight management; cessation of smoking; proper management of the psychosocial aspects of life; proper pharmacotherapy; periodic follow-up and support.

Two main program components that coincide with the physiological need of Rachel as identified form the case study is proper management of pharmacotherapy during hospital stay and smoking cessation after release from the hospital and lifelong nutrition and exercise management.

Importance of pharmacotherapy for Rachel

According to Basaraba and Barry (2015), pharmacotherapy is an important aspect for fast recovery for the patients suffering from cardiac complications. Proper pharmacotherapy management both during the tenure of the hospitals stay and after release are crucial in maintaining the stable heart condition (Basaraba & Barry, 2015). NWCRF (2017) is of the opinion that the usefulness of pharmacotherapy is significantly substantial. The main pharmacotherapy approaches, which are proposed by NWCRF (2017), include use of beta-blockers, aspirin, ACE (angiotensin-converting-enzyme) inhibitor and other lipid lowering agents. Such pharmacological interventions help in lowering of the blood pressure, maintenance of the serum cholesterol levels and other risk factors associated with the cardiovascular disease irrespective of the initial risk level. Bushnell et al. (2014) further opined that proper pharmacological interventions are crucial for reducing both the family risk factors and other physiological risk factors associated with cardiac complication. Since Rachel has family history of heart attack, proper maintenance of the pharmacological intervention is important to reduce the associated cardiac risk.

Relevant details highlighted from the case study

Importance of smoking cessation in relation to Rachel’s case study

From the case study it is clear that Rachel smoker. According to Masethe and Masethe (2014) habit for smoking for a considerable period of time is associated with the risk of heart attack and other cardiac complications. Tada et al. (2015) further stated that smoking increases the overall risk of the heart attack among the people genetically pre-disposed to heart attack in comparison to the population who does not have a family history of heart attack.  NWCRF (2017) advise all patients with cardiovascular disease to quit smoking. According to NWCRF (2017), smoking reduces the risk of coronary heart disease and myocardial infarction (MI). NWCRF (2017) promotes smoking cessation program via individual counselling, group counselling, nicotine replacement therapy and use of anti-depressant medication (if the person’s smokes in order to fight against depression). For Rachel most suitable smoking cessation therapy will be group and individual counselling.

Nutrition and exercise management for Rachel

NWCRF (2017) propose special cardio-protective dietary pattern in order to reduce bad cholesterol (low density lipoprotein or LDL) and blood pressure while improving lipid profile and glycaemic control. However, from the case study, it is not clear that whether Rachel has high blood pressure, cholesterol or lipid. But as per the recommendations sated in the NWCRF (2017), all individuals with cardiovascular disease must adapt to cardio-protective dietary pattern in order to reduce threats of further cardiac complications. The highlight of cardio-protective dietary pattern includes vegetables, fruits, whole grains and no fat products.

Phase 1: Inpatient rehabilitation

This includes early education and mobilisation of patients and their family members in order to develop a proper understanding about the heart disease. In case of Rachel, the early education wills mostly encompass Rachel and her husband. Nordestgaard et al. (2013) is of the opinion the education about the overall disease prognosis among the patient and their family member help to increase the disease awareness and thereby helping them to take proper initiatives to fight with the complex disease condition. NWCRF (2017) also the practise of giving a detailed discharge plan that includes time plan for periodic medical follow-up along with referral to Phase II.

Phase II: Outpatient Rehabilitation

This phase deals ambulatory program, supervised traditionally. According to NWCRF (2017), ambulatory program must initiate soon after the discharge and referral. It mainly includes an healthy exercise plan (both home base and / or professionally supervised physical activity sessions); proper education sessions targeted towards the overall disease process, associated risk factors, treatment procedure and nutritional advice; proper guidance for physical and other living activity and psychosocial support. The areas of the outpatient rehabilitation program that will be useful for Rachel include education session in the domain of smoking and its harmful effects on overall health condition, with a special mention to cardiac health. This will help Rachel to fight against her unhealthy habit of smoking (Kaleta et al., 2012). Case study reveals that Rachel leads a active life so proper education in the domain of physical activity that will be suitable for Rachel will be helpful in reducing her disease risk (Heyward & Gibson, 2014). Rachel has spent time with her grandchildren so psychosocial support may not be an urgent need for Rachel however, proper home activity must be drafted for Rachel so that she remains physically active and healthy.

New Zealand Cardiac Rehabilitation Framework (NZCRF)

Phase III: Long term Maintenance (community level practise)

This phase deals with the maintenance of skills and behavioural changes which are educated in phase and phase II (NWCRF, 2017). In New Zealand, this phase deals with independent community activities like “cardiac clubs” which will act as a support group to fight against cardiac threats. The main community level intervention or activities that will be useful for Rachel include primary health care services; this will help Rachel to maintain a periodic track record of her blood pressure, cholesterol and lipid level. Other community level interventions that will useful for Rachel include mass media coverage to provide correct information along with re-enforcement for the overall change in life-style and behaviour along with development of the reliable monitoring and evaluation system for the outcome of the intervention (Walton-Moss et al., 2014). Since Rachel is a working woman, the community level programs and interventions should be drafted in such a way that is does not coincide with her working hours (Walton-Moss et al., 2014).

The fist rehabilitation goal would be directed at Rachel’s home environment.

S- Promotion of independence in activities of daily living

M- Ability to look after grandchildren four times a week

A-Restoration in self-confidence

R- Improved quality of life

T- Two months

The second rehabilitation goal would be directed at Rachel’s return to her work.

S-Return to work as a full time florist

M-Ability to engage in active work as appropriate 

A-Ability to manage physical stress

R- Improved quality of life

T- Four months

Tobacco cessation- Tobacco cessation would be the most crucial and effective strategies for enabling return of Rachel to normal life. As an inpatient service Rachel is to be subjected to Nicotine replacement therapy (NRT). At the initial stage the therapy is to be given at a low dose. This can be increased in case the patient shows withdrawal symptoms. Smoking cessation might be challenging since dependence on tobacco is noted to be a highly complex phenomena.  A personalized care approach would be needed for consolidating cessation process.

Nutritional counseling- The focus of nutritional counseling in case of cardiac rehabilitation is to provide support to patients to make healthy food choices. In case of Rachel, it is noted that she has poor health conditions as she had been hospitalized due to cardiac concern three days back in addition to having a family history of cardiac concern. A diet is to be outlined for Rachel so that the nutritional needs of the patient are addressed. As an outpatient consultation, a nutritionist would teach Rachel about healthy diet consumption and demonstrate cooking practices.  

Relevance of NRCRF

Physical activity counseling-Physical activity has been linked to reduction in cardiovascular mortality. Physical activity has been found to improve functional capacity of patients and reduce symptoms of angina and shortness of breath. Exercise therapy would be a part of the community rehabilitation services. 40 minutes of moderate intensity activity on 5 days a week would be recommended.

Psychological counseling- Patients suffering from cardiac conditions are often confronted with social problems and different psychological issues affecting morbidity. In the present case, Rachel is at increased chances of suffering from depression due to her condition. Routine screening is needed to understand the level of Rachel’s anxiety, depression and other social issues. Informed positive relationships are significant for emotional adjustments and returning to a full life. Counseling is to be given as a part of outpatient care provision that would address the psychological status of the patient.

Patient education and empowerment- Knowledge is to be backed by empowerment and education for leading to behavior change. Rachel is to be empowered for making a behavior change so that her health outcomes are optimal. Empathetic coaching would be crucial from the healthcare provider’s end for facilitating the process of sustained change. Rachel’s husband is to be involved in the activity. The cornerstone of the services would be mobilization of the patient’s motivation, reflective listening and respecting preferences of the patient (Mampuya, 2012).

Heart foundation New Zealand-The Heart Foundation is the country’s heart charity that aims to fight against the country’s poor condition related to heart disease. The vision of the foundation is to ensure fit hearts for life, for the present generation as well as for the future generation. The mission is to stop individuals from facing premature deaths due to heart diseases and help people living with heart diseases to live a meaningful and productive life. The foundation provides care, support and advice to individuals affected by heart diseases. The education programs address the condition in a direct manner within the community. Education is imparted on one-on-one sessions as well as in groups in order to meet the varied needs of the patients. Services are catered to the needs of the individuals with the focus on person-centered care approach (heartfoundation.org.nz, 2018).

Korowai Aroha health centre- This is a Maori centre that provides primary healthcare services addressing health concerns of patients residing in the Rotorua and surrounding areas. The focus of the service is on Maori health and wellbeing. The setting provides affordable, accessible and high quality services allowing in alignment with the cultural values of the Maori people. The primary services that are provided include advocacy for mothers, general medical practitioner, mobile nursing, an outreach service and home-based support services. Professionals working with the unit look into total patient experience and a holistic care plan is outlined for each individual. Due to this, the whole practice has the primary focus on the journey of the patient throughout care continuum. A culturally sensitive care is provided to the patients that are completely safe and responsive to the beliefs and values of the patients (health.govt.nz 2018).

Importance of pharmacotherapy for Rachel

Auckland district health board cardiology- Public Service in cardiac rehabilitation is provided to address the needs of the patients. Auckland city hospital is responsible for supporting cardiac rehabilitation for supporting, educating and assisting the patients and family members in relation to acute cardiac event. The motive is to significantly reduce further cardiac events and hospital admission. Improvement in quality of life of patients is the main motto at the setting. The rehabilitation process can be divided into different phases. Educating a patient assists towards psychological, physical recovery and self-care. Topics covered in the education programs include healthy food habits, risk factors for heart diseases, medications, exercises for heart health and cardiologist referral (healthpoint.co.nz 2018).

Conclusion

Rachel is a 51 year old lady who had been working as a full time florist. The patient had suffered a heart attack at present and had been hospitalization upon heart attack three days ago. She is a smoker and has a family history of heart diseases. She has an active lifestyle and lives with her husband. Cardiac rehabilitation for the patient would focus on the New Zealand cardiac rehabilitation framework. The framework could be effectively applied within three modes of service delivery, namely inpatient, outpatient and community based services. The two rehabilitation goals would focus on social life and return to professional life. The 5 activities to be carried out in this regard would be smoking cessation, Patient education and empowerment, psychological counseling, nutritional counseling and physical activity counseling. The national and would be Auckland district health board cardiology, Korowai Aroha health centre and Heart foundation New Zealand.

References

Basaraba, J.E. & Barry, A.R., (2015). Pharmacotherapy of heart failure with preserved ejection fraction. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 35(4), pp.351-360. DOI: https://doi.org/10.1002/phar.1556

Bushnell, C., McCullough, L. D., Awad, I. A., Chireau, M. V., Fedder, W. N., Furie, K. L., … & Reeves, M. J. (2014). Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(5), 1545-1588. DOI:  10.1161/01.str.0000442009.06663.48. 

Healthpoint.co.nz. (2018). Auckland DHB Cardiology : Cardiac Rehabilitation : Healthpoint. [online] Available at: https://www.healthpoint.co.nz/public/cardiology/auckland-dhb-cardiology/cardiac-rehabilitation/ [Accessed 26 May 2018].

Heart Foundation NZ. (2018). Heart Foundation NZ. [online] Available at: https://www.heartfoundation.org.nz [Accessed 26 May 2018].

Heyward, V. H., & Gibson, A. (2014). Advanced fitness assessment and exercise prescription 7th edition. Human kinetics.

Kaleta, D., Korytkowski, P., Makowiec-D?browska, T., Usidame, B., B?k-Romaniszyn, L., & Fronczak, A. (2012). Predictors of long-term smoking cessation: results from the global adult tobacco survey in Poland (2009–2010). BMC public health, 12(1), 1020. DOI: 10.1186/1471-2458-12-1020.

Mampuya, W. M. (2012). Cardiac rehabilitation past, present and future: an overview. Cardiovascular Diagnosis and Therapy, 2(1), 38–49. https://doi.org/10.3978/j.issn.2223-3652.2012.01.02

Masethe, H. D., & Masethe, M. A. (2014, October). Prediction of heart disease using classification algorithms. In Proceedings of the world congress on Engineering and Computer Science (Vol. 2, pp. 22-24).

Ministry of Health NZ. (2018). Korowai Aroha Health Centre. [online] Available at: https://www.health.govt.nz/your-health/services-and-support/health-care-services/maori-health-provider-directory/north-island-maori-health-providers/lakes-maori-health-providers/korowai-aroha-health-centre [Accessed 26 May 2018].

New Zealand Cardiac Rehabilitation Framework. (2017). Best Practise and Evidence based guidelines (2002). Access date: 26^th May. Retrieved from: https://www.moh.govt.nz/notebook/nbbooks.nsf/0/20B3EF98EBDD6D98CC257A5200113C96/$file/summary_resource_kit.pdf

Nordestgaard, B. G., Chapman, M. J., Humphries, S. E., Ginsberg, H. N., Masana, L., Descamps, O. S., … & Wiegman, A. (2013). Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. European heart journal, 34(45), 3478-3490. DOI: 10.1093/eurheartj/eht273

Tada, H., Melander, O., Louie, J. Z., Catanese, J. J., Rowland, C. M., Devlin, J. J., … & Shiffman, D. (2015). Risk prediction by genetic risk scores for coronary heart disease is independent of self-reported family history. European heart journal, 37(6), 561-567. DOI: 10.1093/eurheartj/ehv462

Walton-Moss, B., Samuel, L., Nguyen, T. H., Commodore-Mensah, Y., Hayat, M. J., & Szanton, S. L. (2014). Community based cardiovascular health interventions in vulnerable populations: a systematic review. The Journal of cardiovascular nursing, 29(4), 293. DOI: 10.1097/JCN.0b013e31828e2995

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