Caring for Patients with Chronic Illness
Create an age appropriate, evidence based plan of care for a
client that might present to a primary care setting with a chronic disease or diseases. include in the case study subjective, objective, and assessment data. You will post
this information to the Discussion Board. Please provide a list of differential diagnoses,
diagnostic exams and create an evidenced based management plan for the client. Be sure to
provide a medication list and appropriate dosages.
Caring for a patient with chronic illness
Chief Complaint: Shortness in breath, fatigue, a “racing” heart, and weight gain
HPI: A 55 year old African American presents to the hospital complaining of shortness of breath,
fatigue, a “racing” heart, and weight gain. The patient reports that she has noted breathlessness
over the last three months while walking up stairs and in other activities that are strenuous. Two
weeks ago she was not capable of completing her routine one-mile walk. The patient further
reports that yesterday she became severely breathless while walking from one room to another.
Today, she presents with extreme dyspnea.
Medication: The patient is on anticoagulants (warfrain, INR 2.0-3.0).
Allergies: Denies any having any food or drug allergies
Past Medical History: Patient was diagnosed with peripheral vascular disease with venous
insufficiency at age 25.
Pat surgical History: Denies any surgery
Sexual/Reproductive History: Patient married and has two children
Personal/social history: Moderate alcohol use. She goes for a jog every morning.
Significant Family History: Patient’s father suffering from hypertension and type II diabetes.
General: Moderately obese, in acute distress sitting upright, breathless
HEENT: Normoceohalic. Ears, eyes, and throat normal
Neck: Distended neck veins visible
Chest: Scattered rhonchi with productive frothy cough
Heart: Irregular, S3 gallop, grade III murmur
Gastro intestinal: Denies having acid reflux and GI upset
Extremities: Pitting edema, no clubbing, pulse intact
Hematologic: No history of blood transfusion or dyscrasia
Skin: negative for skin lesion, lumps, bruises, discoloration or itching.
Neurologic: Anxious with an impending doom feeling.
Vital signs: BMI 28, BP 130/91, Pulse ox 94%, temperature 37.4 0 C, heart rate 88bpm
Abdomen: no observable or palpable abnormalities
Growth issues: the patient can say his name, speak clearly, respond to three-part commands, and
bend his back without falling
Alertness: the patient is oriented, not agitated, but slightly less alert than normal
Musculoskeletal: Denies having any disorders
- Chest X-ray: cardiomegally with pulmonary edema
- Echocardiogram: Grade III murmur
- Electrocardiogram: Atrial fibrillation
- Exercise stress test: Exercise intolerance
The most likely diagnosis for this patient is congestive heart failure. This is a condition that is
characterized with tachycardia, breathlessness, and edema in the extremities all of which are
consistent with the patient (McMurray et al., 2012).
Some of the medications that will be recommended for the patient include:
Diuretics: Furosemide 60mg once daily
Beta blockers: Propranolol 100 mg orally twice daily
Angiotensin converting enzyme inhibitors: Enalopril 40mg per day orally (McMurray et al.,
Chromium supplements will also be administered for management of the patient’s weight.
The patient will be advised to monitor her weight and avoid junk foods that may increase her
weight. Therefore, she should maintained a balanced diet and restrict herself from taking excess
salt. Excessive intake of salt may result in increased blood pressure (Scott & Winters, 2015). She
should also regulate drinking of alcohol which may hinder her from achieving positive outcomes.
In addition, the patient should continue doing her morning jog which will aid her in managing
her weight. She should use at least to pillows at night so that she can sleep comfortably. She
should adhere to her medication and report to the physician whenever she is experiencing side
McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., … &
Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic
heart failure 2012. European journal of heart failure, 14(8), 803-869.
McMurray, J. J., Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., … & Zile,
M. R. (2014). Angiotensin–neprilysin inhibition versus enalapril in heart failure. New
England Journal of Medicine, 371(11), 993-1004.
Scott, M. C., & Winters, M. E. (2015). Congestive heart failure. Emergency medicine clinics of
North America, 33(3), 553-562.