Question

M.D. is 69 years old, visits her GP for a repeat prescription of perindopril arginine 2.5 mg. She was diagnosed with heart failure and heart disease 1 year ago (LVEF < 40%) after a myocardial infarction and was started on carvedilol 12.5 mg. M.D. moved into a retirement village 1 year ago after the death of her husband. She is an active member of the walking group, but over the last 3 weeks she has had increased shortness of breath and fatigue after a steady 20 minute walk at the park. Since then she has reduced her level of physical activity and has also noticed swelling in her ankles despite her usual fluid tablets. She tells you that she has been having packaged soups instead of regular meals, because she finds it convenient, and is drinking more water than previously recommended (< 1.5 L/day was recommended after her heart failure diagnosis). Her medical history includes dyslipidemia, osteoarthritis, stable ischemic heart disease, and hypertension. Her current medicines (all once daily) are carvedilol 12.5 mg, aspirin 81 mg, atorvastatin 20 mg, celecoxib 200 mg, controlled-release isosorbide mononitrate 60 mg and furosemide 20 mg. M.D. currently weighs 70 kg (up by 4 kg from last visit 6 months ago) and her blood pressure is 140/82 mmHg. Serum biochemistry (urea, creatinine and electrolytes) was normal when tested 6 weeks ago. LDL was 100 and HDL was 52. Her estimated creatinine clearance was 60 mL/min.

evaluate legal and ethical concerns that should be considered when using this approach (Team -based)

Answer 1

Ethical & legal concern for a Heart failure patient is a big challenges for us. Depending on patient's physical condition they have own right to make their decision depends on their own beliefs & values.

Here Mrs M.D is a chronic heart failure patient.She needed advance care for her further betterment.

***LEGAL & ETHICAL ISSUES :-

1.Informed consent:- consent must be taken to discussed about patient's condition & her further management.

2.prepredness planning:- Here we assess the patient condition,taking her past present history including family history,physical examination&diagnostic tests are done.depending on all we predict her prognosis.

3.inform patient:- atfirst assess patient understanding level related to her diagnosis. Then give her honest information regarding her disease condition & further prognosis. Assess her emotional distress & giving hopeful reinforcement to reduce her distress.Empathize to her emotion.

4.Advance care planning:- Here we informed patient about the further managemet(Therapy & Devices )that can improve quality of life.

5.Clarify patient needs :- clarify patient about the devices & some advanced therapies like Transplantation, ventricular assistive devices,implantable defibrillators etc.we must discussed about the advantages & risks of those devices.

6.Discussion :- Discussed the complexed issues surrounding the uses of implants.& clear them about life expectancy & economical burden. Then reinforce commitment to further management is taken from the patient.

7.Co ordination :- co ordination of care & further management among care giver team.allocation of recipient is taken.then promote & improved quality of life for patient & care giver.

8.cardiovascular training program should be incorporated.